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HEA-01 Workshop Supporting students who are struggling academically: one medical school’s approach. Jo Brown & Dason Evans 12. Plan for the day. Defining the problem. Examples. Student 1: an excellent student academically, fails her first Clinical Skills OSCE. .

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hea 01 workshop supporting students who are struggling academically one medical school s approach

HEA-01 WorkshopSupporting students who are struggling academically:one medical school’s approach

Jo Brown & Dason Evans

12

The Clinical Communication and Learning Skills Unit

plan for the day
Plan for the day

The Clinical Communication and Learning Skills Unit

defining the problem
Defining the problem

The Clinical Communication and Learning Skills Unit

examples
Examples

Student 1: an excellent student academically, fails her first Clinical Skills OSCE.

She has a deep learning style for theoretical knowledge but an inappropriate learning style for clinical skills.

We provided her with sessions on “how to learn clinical skills”.

The Clinical Communication and Learning Skills Unit

examples5
Examples

Student 2: fails his third year theory exams with a very poor score. He had excellent A-levels, good year one exams and reasonable year two exams.

He turns out to have an excellent short term memory and a superficial learning style. The volume of work is finally too much to cram and he fails.

We provided him with sessions encouraging a regular habit of self directed learning.

The Clinical Communication and Learning Skills Unit

examples6
Examples

Student 3: a previously excellent student fails her third year clinical skills OSCE.

She has no insight into the fact that she is clinically depressed. Her attendance has been poor, but she is academically strong as she starts bookwork when she wakes at 3am every morning.

We arranged an urgent GP and psychiatry appointment.

The Clinical Communication and Learning Skills Unit

examples7
Examples

Student 4: an international student fails her clinical skills exam, saying she didn’t know what to expect

More to come!

The Clinical Communication and Learning Skills Unit

examples8
Examples

Student 5: Fails his clinical skills exam scoring poorly on communication skills stations

He finds talking to patients difficult, as he isn’t sure exactly what information he needs to gather and how he might go about this in a time-limited fashion.

We went with him to the wards on two occasions and using video tape review helped him gain structure and confidence in talking to patients.

The Clinical Communication and Learning Skills Unit

your examples
Your examples

The Clinical Communication and Learning Skills Unit

common problems at barts and the london
Common problems at Barts and the London

The Clinical Communication and Learning Skills Unit

why bother
Why Bother?

The Clinical Communication and Learning Skills Unit

why do we bother
Ethical and moral duty to students.

Socio-political culture of accepting and responding to individual differences.

Obligation and responsibility to future patients.

(philosophy of ASP – Not a revision course)

GMC

Producing “Life Long Learners.”

Belief that students who have been supported through difficulty may end up better doctors.

Coping mechanisms

empathy

School philosophy to:

meet the needs of students

produce graduates… who are fit for the nation's present and future health, research and health care needs .

Financial

benefits (widening access)

penalties (attrition rates)

Why do we bother?

The Clinical Communication and Learning Skills Unit

group work 1
Group Work 1

The Clinical Communication and Learning Skills Unit

group work 114
Group work 1

The Clinical Communication and Learning Skills Unit

lunch
Lunch

The Clinical Communication and Learning Skills Unit

12 support for students with academic difficulties

12Support for Students with Academic Difficulties

The Clinical Communication and Learning Skills Unit

overview of presentation
Overview of Presentation
  • Background to the school
  • Background to the A.S.P.
  • Model

Macro

Micro

  • Specific Case History
  • Validation of programme
  • Looking to the future

Macro

The Clinical Communication and Learning Skills Unit

background to barts and the london
Background to Barts and the London
  • An ancient and amalgamated medical school
  • A spiral curriculum
  • Curriculum revised in 1999:
    • Problem Based Learning running throughout the curriculum
    • Early clinical experience in the community
    • Explicit teaching of Communication and Clinical Skills

The Clinical Communication and Learning Skills Unit

assessment
Assessment

Continuous assessment

Year 1

Written Assessment

Year 2

Data interpretation

Year 3

Clinical skills OSCE

Year 4

Year 5

The Clinical Communication and Learning Skills Unit

background and history to asp
Background and History To ASP
  • Began in 1999 when committed teachers began to give detailed feedback to students about their exam results and offer clinical skills workshops.
  • Previously informal and variable support from senior tutors, concerned and interested faculty
  • Formalised and funded in 2002, the ASP has grown to provide student centred support for learning.
  • Now represented on all major educational committees and produces an annual report.

The Clinical Communication and Learning Skills Unit

formalised embedded in curriculum
Formalised & embedded in curriculum

Dean for Student Affairs and senior tutor system

Teaching

CCLSU

Dean for Education

ASP

Assess

Medical School

Education Directorate

The Clinical Communication and Learning Skills Unit

the system

Short Courses: Learning style

  • Aimed at encouraging a change in learning style,
  • how to learn clinical skills
  • Reflective communication skills
  • exam (eg MCQ) technique
  • anxiety management
  • others
The system

Referral

Assessment

Intervention

Poor Performance in Summative Assessment

Principally JOSCE & 3rd year EMQ

No action

E.g. precipitating problem resolved or obtaining academic support elsewhere

  • Educational Assessment interview
  • Free discussion
  • Semi-structured interview
  • Fine-tooth analysis of assessment results
  • Problem List
  • Action Plan
  • Learning Contract

Specific Suggestions

To Students, Senior tutors, tutors or firms

Direct

Poor performance in continuous assessment

Ongoing Individual Tuition

Aimed at supporting self-directed Learning either in clinical skills or theoretical background to medicine. Always student led.

Indirect

Senior Tutor Referral

  • Referral Elsewhere
  • Medical referral
  • Educational psychologist
  • Learning support unit

Student request

Other

The Clinical Communication and Learning Skills Unit

educational assessment interview
Free discussion about reasons for poor performance

How he/she learns

Knowledge

Skills

Self directed learning

Collaborative learning

Fine tooth-comb analysis of assessment results

Screening questions

Motivation

Scale of 1-10

What sort of doctor?

Enjoy the course?

Attribution

Have you received enough teaching?

Was the exam a fair exam?

Is mark representative of performance?

Pastoral

Medics in the family?

Received enough support?

Working with patients

Problems attending

Educational Assessment Interview

The Clinical Communication and Learning Skills Unit

the system24

Short Courses: Learning style

  • Aimed at encouraging a change in learning style,
  • how to learn clinical skills
  • Reflective communication skills
  • exam (eg MCQ) technique
  • anxiety management
  • others
The system

Referral

Assessment

Intervention

Poor Performance in Summative Assessment

Principally JOSCE & 3rd year EMQ

No action

E.g. precipitating problem resolved or obtaining academic support elsewhere

  • Educational Assessment interview
  • Free discussion
  • Semi-structured interview
  • Fine-tooth analysis of assessment results
  • Problem List
  • Action Plan
  • Learning Contract

Specific Suggestions

To Students, Senior tutors, tutors or firms

Direct

Poor performance in continuous assessment

Ongoing Individual Tuition

Aimed at supporting self-directed Learning either in clinical skills or theoretical background to medicine. Always student led.

Indirect

Senior Tutor Referral

  • Referral Elsewhere
  • Medical referral
  • Educational psychologist
  • Learning support unit

Student request

Other

The Clinical Communication and Learning Skills Unit

questions on process
Questions on process

The Clinical Communication and Learning Skills Unit

case study

Case study

Referral

The Clinical Communication and Learning Skills Unit

case study referral i
Case Study: Referral I

An international student fails her clinical skills exam, saying she didn’t know what to expect.

  • Came in the lowest 5% of cohort
  • Failed 12 out of 19 stations
  • Previously received A and B grades for her written exams

The Clinical Communication and Learning Skills Unit

score
Score

The Clinical Communication and Learning Skills Unit

number of stations passed
Number of stations passed

The Clinical Communication and Learning Skills Unit

case study31

Case study

Educational Assessment Interview

The Clinical Communication and Learning Skills Unit

case study diagnostic i
Case Study: Diagnostic I
  • Fine tooth analysis

The Clinical Communication and Learning Skills Unit

semi structured interview
Semi-structured interview
  • General questions
    • Lives in international halls
    • Rarely mixes with students of other nationalities
    • Rarely uses conversational English
    • Home sick, isolated and unsure if she really wants to study medicine in the UK

The Clinical Communication and Learning Skills Unit

semi structured interview36
Semi-structured interview
  • Learning Methods – declarative knowledge
    • Works 3-4 hours a week SDL
    • Relies on memory of reading from text books
    • Reads with TV or radio on
  • Learning Methods - skills
    • Has used clinical skills lab (alone)
    • Uses one skills book and handouts
    • Clerks 2 patients a week “if I am pushed”
    • Found third year unstructured

The Clinical Communication and Learning Skills Unit

semi structured interview37
Semi-structured interview
  • Specific questions
    • Is motivated to be a Dr
    • No medics in the family, much pressure to succeed from her government
    • Doesn’t feel there has been enough teaching
    • “sometimes” finds difficulty approaching patients

The Clinical Communication and Learning Skills Unit

case study38

Case study

Problem List

The Clinical Communication and Learning Skills Unit

problem list
Problem List
  • Not fully committed to course, not working
  • Social isolation
    • Language
    • Collaborative learning
    • Loneliness
  • Study skills
    • Limited for theory to simply reading
    • Poor model for learning clinical skills
      • Never seeks feedback
      • Limited amounts of practice

The Clinical Communication and Learning Skills Unit

common problems at barts and the london40
Common problems at Barts and the London

The Clinical Communication and Learning Skills Unit

case study41

Case study

Negotiated learning contract

The Clinical Communication and Learning Skills Unit

learning contract
Learning Contract
    • Consider if she wants to be a doctor
    • Consider if she wants to continue training in the UK
  • If she wishes to remain
    • Clerk a minimum of 5 patients a week
    • Study a minimum of 2 hours a night
    • Commit to work collaboratively with retake group
    • Move into college halls
    • Integrate with other students from the medical school

The Clinical Communication and Learning Skills Unit

case study43

Case study

Intervention

The Clinical Communication and Learning Skills Unit

case study interventions
Case Study: Interventions
  • Clinical Skills
    • Extra clinical skills tuition
    • Clinical skills study skills
    • Supportive ward placement
  • Communication Skills
  • Collaborative learning
  • Pastoral

The Clinical Communication and Learning Skills Unit

case study45

Case study

Outcomes

The Clinical Communication and Learning Skills Unit

case study outcomes i
Case Study: Outcomes I
  • Exam Success/Competency
  • Ongoing success
  • Pastoral
  • Smiling!

The Clinical Communication and Learning Skills Unit

score47
Score

The Clinical Communication and Learning Skills Unit

number of stations passed48
Number of stations passed

The Clinical Communication and Learning Skills Unit

case study outcomes iii

64%

60%

64%

62%

Case Study: Outcomes III

Knowledge test

Data Interpretation test

Continuous assessment

Skills test

The Clinical Communication and Learning Skills Unit

finals 2005

65%

Finals 2005

The Clinical Communication and Learning Skills Unit

questions on case study
Questions on Case Study

The Clinical Communication and Learning Skills Unit

validation
Validation
  • Student evaluation
  • Independent evaluation
  • Exam results
  • Links to curriculum & institution
  • Publications & presentations

The Clinical Communication and Learning Skills Unit

validation student evaluation
Validation: student evaluation

The Clinical Communication and Learning Skills Unit

qualitative comments
Qualitative comments

“They (ASP staff) are very friendly, very approachable and very easy to talk to”

“I felt that it (assessment interview) didn’t put me down, didn’t make me feel thick”

“They (ASP staff) went through all the exams we had done and really allowed us to explore how we do them”

“(In the assessment interview) They are kind and listening and paying attention…I could take the first positive step after that…the interview itself is part of the intervention”

“I did go to my senior tutor but no-one was asking the right questions… not getting to the root of the problem”

The Clinical Communication and Learning Skills Unit

validation formal independent evaluation
Validation: Formal independent evaluation
  • Educational psychologist evaluation
    • Video review
    • Document review
    • Focus group and individual student interviews
    • Faculty interviews
    • Educational literature review
  • “The outcomes and processes of the educational assessment and subsequent support are highly effective”

The Clinical Communication and Learning Skills Unit

exam results
Exam results
  • Are exam results an appropriate surrogate marker for outcomes of an Academic Support Programme?
  • Students failing OSCEs do well, and continue to do well after passing through ASP (from bottom 5% to “average”).

The Clinical Communication and Learning Skills Unit

validation exam results
Validation: exam results

62.9

49.1

The Clinical Communication and Learning Skills Unit

validation exam results58
Validation: exam results

10.4

16.2

The Clinical Communication and Learning Skills Unit

continuing success
Continuing success
  • Of the 16 students who failed their third year OSCE in 2002, all passed through a modified academic support programme,
  • 9 took finals in 2004. Their mean OSCE score at finals was no different from the rest of the cohort(p=0.52, Scheffe post hoc analysis),
  • Compare with the lowest 17 students passing the third year OSCE,
  • 9 took finals in 2004 and performed significantly worse than the rest of their cohort (*p=0.029 Scheffe post hoc analysis from ANOVA).

The Clinical Communication and Learning Skills Unit

validation reporting and liaison
Validation: Reporting and Liaison
  • Medical Education Committee
  • Student Affairs Board
  • Senior Tutor system
  • Queen Mary’s Learning Support Unit

The Clinical Communication and Learning Skills Unit

validation publications presentations
Validation: Publications & presentations
  • ASME conference: Identifying and supporting medical students with communication difficulties; June 2005, London
  • First International Clinical Skills Conference – 2005 Prato, Italy.
  • Educational psychologist input - 2005
  • CETL - 2005
  • Presentation at 11th Ottawa international conference on medical education, 2004
  • Draper’s award for excellence in teaching & learning 2004
  • Example of good practice at the LTSN-01 National Meeting of Medical Curriculum Co-ordinators 2002
  • Sayer M. Chaput de Saintonge M. Evans D. Wood D. Support for students with academic difficulty. Medical Education. 2002 July;36(7):643 – 650.
  • ASME: Association for the Study of Medical Education Annual Scientific Meeting 2000, Dublin.

The Clinical Communication and Learning Skills Unit

the future
The future
  • Publications
  • Focus on faculty development
  • Focus on dissemination

The Clinical Communication and Learning Skills Unit

summary
Students always have, do and always will struggle

They struggle for a wide variety of reasons

Remedial programmes should be personalised to meet individual learning needs

Successful remedial programmes are resource-intensive and require institutional support for success

There are exciting opportunities for further development and dissemination of this programme.

Summary

The Clinical Communication and Learning Skills Unit

questions
Questions

The Clinical Communication and Learning Skills Unit

group work 2
Group Work 2

The Clinical Communication and Learning Skills Unit

group work 267
Group Work 2

The Clinical Communication and Learning Skills Unit

close
Close
  • Academic Support Network
  • Goodbye and safe journey home!

The Clinical Communication and Learning Skills Unit

ltsn 01 workshop supporting students who are struggling academically one medical school s approach

LTSN-01 WorkshopSupporting students who are struggling academically:one medical school’s approach

Jo Brown

Dason Evans

12

The Clinical Communication and Learning Skills Unit