ePoster
Abstract Title | Teaching Respiratory Medicine in the ambulatory setting

Authors

  1. Isabel M. Leiva
  2. Macela Bitran
  3. Fernando Saldías

Theme

Simulators and Simulation

Category

Simulation

INSTITUTION

Facultad de Medicina. Pontificia Universidad Católica de Chile.

Background

As most of doctor-patient encounters occur in the ambulatory care, undergraduate clinical teaching in this setting is important, thus increasing attention must be given to the evaluation of this teaching activity.

 

Traditionally, teaching quality is evaluated by students using questionnaires. This information is valuable, but, because of its   natural bias, it must be complemented with students’ and teachers’ opinions. 

 

Aim: To assess students’ and teachers’ views about the strengths and weaknesses of interacting with real and simulated patients to teach clinical skills related to respiratory diseases in the undergraduated medical curriculum in the ambulatory setting.  As most of doctor-patient encounters occur in the ambulatory care, undergraduate clinical teaching in this setting is important, thus increasing attention must be given to the evaluation of this teaching activity.
Traditionally, teaching quality of teaching is evaluated by students using questionnaires. This information is valuable, but, because of its natural bias, it must be complemented with students’ and teachers’ opinions.
Aim: To assess students’ and teachers’ views about the strengths and weaknesses of interacting with real and simulated patients to teach clinical skills related to respiratory medicine in the undergraduated medical curriculum in the ambulatory setting.

 

Conclusion

Teaching Respiratory Medicine in the ambulatory setting with real and simulated patients was well evaluated by both students and clinical tutors.

 

Clinical tutors were able to identified teaching facilitators and factors that hinder teaching.

Summary of Work

Fourth-year medical students (120 per year) were exposed during two weeks to real and simulated patients with common respiratory problems (COPD, asthma, tobacco, and sleep apnea syndrome) in an outpatient clinic. Each patient encounter was followed by tutor and peer feedback.


Quantitative methodology: At the end of the rotation students evaluated the program and the quality of teaching using questionnaires from 2004 to 2010. t-student analysis was applied; p value <0.05 was considered significant.

Qualitative methodology: Six medical tutors were interviewed in 2011 to evaluate their perception on the strengths and weaknesses of the ambulatory rotation. Interviews were analyzed using qualitative methods.

Take-home Messages

Qualitative methodology allowed us to contrast the information obtained from the students to the perspective of clinical tutors. This methodology also allowed to identify teaching facilitators and weaknesses. These teaching facilitators can be reinforced and the weaknesses remediated in order to potentially improve teaching and/or the degree of satisfaction of students and clinical tutors.

Acknowledgement

We are very grateful to Denisse Zúñiga and Gricelda Gómez for their support and assistance with the interviews. We thank Rodrigo Moreno, Julio Pertuzé, María Teresa Beroíza and Jorge Jorquera, members of the Respiratory Diseases Department.

Summary of Results

I. Students’ perspective 

Evaluation of contents 
Students declare both to dedicate 6-9 hours per week of personal study and achieve more than 85% of the learning objectives.
All domains were evaluated with a score above 6.1 (1.0 to 7.0 point scale).

Evaluation of teaching quality
All domains were evaluated with a score above 3.3 (1 to 4 point scale).
In each dimension and in the global evaluation, no statistically significant differences were observed among clinical tutors or among the compared years.

 

II. Teachers’ perspective
Tutors identified teaching facilitators (some depending on learning module, others on students and on clinical tutors) and factors that hinder teaching (related to resources of the module, to students, and to clinical tutors).

References

Bitran M, Mena B, Riquelme A, Padilla O, Sánchez I, Moreno R. Desarrollo y validación de un instrumento en Español para evaluar el desempeño de docentes clínicos a través de las percepciones de sus estudiantes. Rev Med Chile 2010; 138:685-93.

Dent J. AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med Teach 2005;27: 302-15.

Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med 1995;70:898–31.

Sánchez I, Riquelme A, Moreno R, Mena B, Dagnino J, Grebe G. Revitalizing medical education: the school of medicine at the Pontificia Universidad Católica de Chile. Clin Teach 2008;5:57-61.

Sprake C, Cantillon P, Metcalf J, Spencer J. Teaching in an ambulatory care setting. BMJ 2008;337:690-2.

Background

Undergraduated medical school in Chile lasts seven years: three years of basic science courses, two years of preclinical courses and supervised clinical practice and two years of internship, a supervised full clinical practice. Fifty percent of the programmed clinical practice is carried out in the ambulatory setting.

  

Ambulatory services at the San Joaquín Campus houses a special unit with mirrored rooms for unidirectional vision and video, which help both teaching the basics of clinical medicine and learning evaluation.

 

Respiratory Medicine Rotation: Groups of 5-7 students under the supervision of one tutor from the Respiratory Diseases Department. This rotation last two weeks and is repeated 18 times for a total of 110–120 students per year.


Objectives:
 
1. To learn basic clinical skills and laboratory test related to four common respiratory problems: COPD, asthma, tobacco, and sleep apnea syndrome.
                    2. To build integrated skills for history taking, physical examination, clinical reasoning, and communication.

 

Activities:  Interviews of real and simulated patients.
                  Evaluation and feedback by tutor and peers after each encounter.
                  Pulmonary function test session.
                  Seminars and discussions of clinical cases.
                  Personal readings, self-instruction and multimedia tools.

 

Conclusion
Summary of Work

Questionnaire to evaluate contents          

 

Questionnaire to evaluate clinical tutors

 

Thematic script of interviews:  

1. Strengths and weaknesses of teaching respiratory diseases in the ambulatory setting.
2. Aspects of tutorial teaching and group dynamics.
3. Differences in teaching theoretical and practical aspects of clinical activity, and development of communicational skills.
4. Use of educational resources.

  

Take-home Messages
Acknowledgement
Summary of Results

I . Evaluation from students’ perspective

Table N° 1. Content evaluation of the Respiratory Diseases Module in the Ambulatory Unit conducted by the students. (596 surveys, 74% of return) 

Year of the evaluation                                       

                       2004      2005      2006      2007      2008      2009      2010

of surveys                                                       93           105         87           71           86           76           78

Dedicated time (hours)                                     9.0          6.8          7.8          7.1          8.2          6.6          5.9

Objectives (% of achievement)                       86.8        89.1        89.5        90.9        87.8        89.8        87.7

Dimensions (1.0 to 7.0 point scale)

Methods                                               6.6          6.6          6.6          6.7          6.5          6.6          6.5

Professors                                            6.8          6.8          6.8          6.8          6.6          6.6          6.8

Sources of information                      6.6          6.7          6.5          6.8          6.6          6.7          6.7

Feedback                                              6.1          6.4          6.4          6.7          6.6          6.6          6.6

Evaluation                                            6.6          6.7          6.4          6.7          6.6          6.5          6.6

Organization                                        6.8          6.8          6.8          6.7          6.6          6.6          6.7

Infrastructure and materials             6.8          6.9          6.9          6.9          6.8          6.8          6.8

Global score                                         6.5          6.7          6.6          6.8          6.5          6.6          6.6

Average                                                 6.6          6.7          6.7          6.8          6.6          6.7          6.7

Values expressed are average values. No statistically significant differences were observed.

 

 Table N 2. Quality of teaching evaluation of 10 clinical tutors conducted by the students. (588 surveys, 73% of  return).

Year of the evaluation                               2004      2005      2006      2007      2008      2009      2010

of surveys                                                       109         101         82           66           77           68           85

Dimensions (1 to 4 point scale)

Teaching based on patients              3.6          3.7          3.6          3.7          3.6          3.7          3.8

Communication of the objectives    3.7          3.8          3.8          3.9          3.8          3.8          3.8

Evaluation                                            3.3          3.6          3.6          3.6          3.5          3.7          3.7

Promoting understanding                 3.8          3.9          3.9          3.9          3.8          3.8          3.8

Promoting self-directed learning     3.5          3.7          3.6          3.7          3.5          3.6          3.7

Control of the session                        3.6          3.8          3.6          3.8          3.7          3.6          3.7

Feedback                                              3.3          3.7          3.7          3.7          3.6          3.7          3.7

Learning environment                       3.8          3.9          3.9          3.9          3.8          3.8          3.9

Global evaluation                               3.8          3.9          3.9          3.9          3.8          3.7          3.9

Values expressed are average values. No statistically significant differences were observed.

 

 II. Evaluation from clinical tutors’ perspective

Factors identified as teaching facilitators: 
Factors depending on learning module:
Resources:
“Patients are the most important resource; they are the reason of ambulatory teaching.”
Design:
“...everybody tries to teach in a similar way, to reinforce the same aspects. Students are going to be evaluated in a similar way”.
Teaching based on patient care: “...to be a model of how patient-doctor relationship should be.” “To teach based on the patient… to reinforce theory based on the patient… showing how theory is applied.”

 

Factors depending on students:
Student characteristics:
 “...they are eager to be doctors.” “It is a big affection that the students have to patients, and that is very good.”  
Teacher-student interaction:
“The main purpose of this University is to form good students.” “There are groups with which you feel comfortable, stimulated.”

 

Factors depending on clinical tutors:
Skills and teaching styles:
“...if you stimulates them with questions, with the patients, they will study more and you can see happy faces and this makes that the learning begins and increase as a snow ball.” “...you tell them: if you know something, you must express it. Nobody is going to guess if you know or you don’t know if you don´t tell.” “We have a common interest in teaching, a culture of teaching, we all want to improve…” “All the clinical tutors are more or less similar; all of them show concerns to achieve the objectives.”

 

Factors identified that hinder teaching:
Factors depending on resources of the module:
“Sometimes it gets complicated, because the patient didn’t show up, so the module is not longer as structured as you wanted, and you must improvise by adapting the activities, but to good ones.” “The television has a very small screen in black and white…”“The computer is very old…”

Factors depending on students:   “There are students who don’t attend the activities; they are not interested in learning.” “They like feedback very much, they like to receive feedback, but they are not very good at giving feedback.”  

Factors depending on clinical tutors: “You don’t have time in the morning for your regular tasks, so they pile up… and you have to solve them in the afternoon or night because they cannot be postponed.” “Teaching in the ambulatory setting, I would say, is the first, second, and third most time-consuming activity.”
  

 


 

References
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