Integrating elements of undergraduate curriculum learning

Integrating elements of undergraduate curriculum learning Rapidly advancing practice and recognition of nursing, midwifery and medicine as a vital interrelated workforce, implies a need for a variety of curricula opportunities. This project addresses the challenge for healthcare educators to widen student engagement and participation through inter-professional education by creating learning environments whereby student interactions foster the desire to develop situational awareness, independent learning and contribution to patient advocacy. Overall aim of this ‘Feeding and Nutrition in Infants and Children’ project is to provide opportunities for integrated learning to enable students to advance their knowledge and understanding of current best practice. This Inter-professional (IPE) student-lead workshop was initially implemented in 2006-07 in collaboration with the Centre for Excellence in IPE, within the curricula of medical and nursing programmes¹. Supported by the development of a student resource pack, this project is now being offered to Learning Disability nursing and Midwifery students since September 2014. Methods: Fourth year medical students, undertaking a ‘Child Healthcare module’, alongside nursing and /or midwifery students are divided into groups with three or four students from each profession. Each group focuses on a specific feeding problem that is scenario-based on a common real-life issue prior to the workshop and then present their findings / possible solutions to feeding problem. They are observed by both facilitators and peers, who provide constructive feedback on aspects of performance including patient safety, cultural awareness, communication, decision making skills, teamwork and an appreciation of the role of various professionals in managing feeding problems in infants and children. Results: Participants complete a Likert-scale questionnaire to ascertain their reactions to this integrated learning experience. Ongoing findings suggest that students evaluate this learning activity very positively and have stated that they value the opportunity to exercise their clinical judgement and decision making skills. Most recent comments: ‘appreciate working alongside other student’s / multidisciplinary team approach’ As a group students engage in this team problem-solving exercise, drawing upon their strengths and abilities to learn from each other. This project provides a crucial opportunity for learning and knowledge exchange for all those medical, midwifery and nursing students involved. Reference: 1. Purdy, J. & Stewart, M (2009) ‘Feeding and Nutrition in Infants and Children: An Interprofessional Approach’. The Clinical Teacher, vol 6, no.3. Authors: Dr. Angela Bell, Centre for Medical Education, Queen’s University Belfast. Doris Corkin, Senior Lecturer (education), Children’s Nursing, School of Nursing & Midwifery, Queen’s University Belfast. Carolyn Moorhead, Midwifery Lecturer, School of Nursing & Midwifery, Queen’s University Belfast. Ann Devlin, Lecturer (education), Learning Disability Nursing, School of Nursing & Midwifery, Queen’s University Belfast.

A strategy towards professionalism in the dissecting room

The teaching and cultivation of professionalism is an integral part of medical education as professionalism is central to maintaining the public’s trust in the medical profession. Traditionally professional values would have been acquired through an informal process of socialisation and observation of role models. Recently, however, medical educators have accepted the responsibility to explicitly teach and effectively evaluate professionalism. A comprehensive working definition of the term professionalism and a universally agreed list of the constituent elements of professionalism are currently debated. The School of Medicine and Dentistry of The Queen’s University of Belfast uses an approach of self-directed learning for teaching anatomy, and students are given the opportunity to learn anatomy from human dissection. Self-directed learning teams have been found to be underutilised as educational strategies and presented an opportunity to utilise the first year dissection room teaching environment to nurture the development of the attributes of professionalism. An educational strategy based on role-playing was developed to engage all students around the dissection table. Students received comprehensive background reviews on professionalism, its attributes and the identification of such attributes in the context of the dissection room. Roles, with specific duties attached, were allocated to each team member. Circulating academic staff members directly observed student participation and gave formative feedback. Students were given the opportunity to reflect on their ability to identify the attributes and reflect on their own and their peer’s ability to develop and practise these attributes. This strategy indicated that small group learning teams in the dissection room utilise widely accepted principles of adult learning and offer an opportunity to create learning activities that will instil in students the knowledge, values, attitudes and behaviours that characterise medical professionalism. Anatomy faculty have a responsibility to nurture and exemplify professionalism and play a significant role in the early promotion and inculcation of professionalism. It remains imperative not only to assess this strategy but also to create opportunities for critical reflection and evaluation within the strategy. Key words: Medical Education – Professionalism – Anatomy - Reflective Practise – Role-play

A survey of perceived training differences between ophthalmology residents in Hong Kong and China.

Background: To study the differences in ophthalmology resident training between China and the Hong Kong Special Administrative Region (HKSAR).Methods: Training programs were selected from among the largest and best-known teaching hospitals. Ophthalmology residents were sent an anonymous 48-item questionnaire by mail. Work satisfaction, time allocation between training activities and volume of surgery performed were determined.Results: 50/75 residents (66.7 %) from China and 20/26 (76.9 %) from HKSAR completed the survey. Age (28.9 ± 2.5 vs. 30.2 ± 2.9 years, p = 0.15) and number of years in training (3.4 ± 1.6 vs. 2.8 ± 1.5, p = 0.19) were comparable between groups. The number of cataract procedures performed by HKSAR trainees (extra-capsular, median 80.0, quartile range: 30.0, 100.0; phacoemulsification, median: 20.0, quartile range: 0.0, 100.0) exceeded that for Chinese residents (extra-capsular: median = 0, p < 0.0001; phacoemulsification: median = 0, p < 0.0001). Chinese trainees spent more time completing medical charts (>50 % of time on charts: 62.5 % versus 5.3 %, p < 0.0001) and received less supervision (≥90 % of training supervised: 4.4 % versus 65 %, p < 0.0001). Chinese residents were more likely to feel underpaid (96.0 % vs. 31.6 %, p < 0.0001) and hoped their children would not practice medicine (69.4 % vs. 5.0 %, p = 0.0001) compared HKSAR residents.Conclusions: In this study, ophthalmology residents in China report strikingly less surgical experience and supervision, and lower satisfaction than HKSAR residents. The HKSAR model of hands-on resident training might be useful in improving the low cataract surgical rate in China.

Beyond work-hour restrictions: a qualitative study of residents' subjective workload

INTRODUCTION: Following the introduction of work-hour restrictions, residents' workload has become an important theme in postgraduate training. The efficacy of restrictions on workload, however, remains controversial, as most research has only examined objective workload. The purpose of this study was to explore the less clearly understood component of subjective workload and, in particular, the factors that influenced residents' subjective workload.

METHOD: This study was conducted in Japan at three community teaching hospitals. We recruited a convenience sample of 31 junior residents in seven focus groups at the three sites. Audio-recorded and transcribed data were read iteratively and analyzed thematically, identifying, analyzing and reporting themes within the data and developing an interpretive synthesis of the topic.

RESULTS: Seven factors influenced residents' subjective workload: (1) interaction within the professional community, (2) feedback from patients, (3) being in control, (4) professional development, (5) private life, (6) interest and (7) protected free time.

DISCUSSION AND CONCLUSION: Our findings indicate that residents who have good interaction with colleagues and patients, are competent enough to control their work, experience personal development through working, have greater interest in their work, and have fulfilling private lives will have the least subjective workload.

Emotions and identity in the figured world of becoming a doctor

CONTEXT: There is little room in clerkship curricula for students to express emotions, particularly those associated with the development of a caring identity. Yet it is recognised that competence, alone, does not make a good doctor. We therefore set out to explore the relationship between emotions and identity in clerkship education. Our exploration was conceptually oriented towards Figured Worlds theory, which is linked to Bakhtin's theory of dialogism.

METHODS: Nine female and one male member of a mixed student cohort kept audio-diaries and participated in both semi-structured and cognitive individual interviews. The researchers identified 43 emotionally salient utterances in the dataset and subjected them to critical discourse analysis. They applied Figured Worlds constructs to within-case and cross-case analyses, supporting one another's reflexivity and openness to different interpretations, and constantly comparing their evolving interpretation against the complete set of transcripts.

RESULTS: Students' emotions were closely related to their identity development in the world of medicine. Patients were disempowered by their illnesses. Doctors were powerful because they could treat those illnesses. Students expressed positive emotions when they were granted positions in the world of medicine and were able to identify with the figures of doctors or other health professionals. They identified with doctors who behaved in caring and professionally appropriate ways towards patients and supportively towards students. Students expressed negative emotions when they were unable to develop their identities.

CONCLUSIONS: Critical discourse analysis has uncovered a link between students' emotions and their identity development in the powerful world of becoming and being a doctor. At present, identity development, emotions and power are mostly tacit in undergraduate clinical curricula. We speculate that helping students to express emotions and exercise power in the most effective ways might help them to develop caring identities.

Comunidades de prática online e a construção de competências para o ensino ativo

O presente estudo foi realizado no âmbito da formação continuada de professores através das interações numa Comunidade de Prática online (CoP online). Nas CoPs ocorrem a partiha de dúvidas e problemas comuns ao trabalho dos docentes. Quando as interações são mediadas por computadores, sejam estas síncronas ou assíncronas, ultrapassam as barreiras de espaço e tempo, se adequando ao cotidiano dos professores, invariavelmente tomado por múltiplas atividades. Nesta investigação delineamos os seguintes objetivos: i) Construir uma CoP online ancorada no software social Facebook, como espaço virtual de interação entre os participantes; ii) Comprender as interações através duma CoP online como etapa na construção de competências; iii) Criar e desenvolver um programa de formações presenciais e online com vistas à desenvover as competências de Questionamento e Argumentação; e, iv) Avaliar os impactos da formação através da CoP online no desenvolvimento das competências do Questionamento e da Argumentação enquanto estratégia de promoção do ensino ativo. Como estratégia, optamos em promover as interações através do Facebook por não ocasionar custos aos participantes e por atender ao modelo de presença virtual já existente. Participaram das interações professores em exercício da Autarquia do Ensino Superior de Garanhuns (AESGA), situada no interior de Pernambuco, Brasil. As interações decorreram no período de Abril de 2012 até Março de 2013, numa comunidade fechada, de livre adesão através de convite. Para solidificar a aprendizagem através da CoP online promovemos dois ciclos de formação, um presencial e um online. Em ambas as intervenções visamos o desenvolvimento das competências do Questionamento e da Argumentação por entendermos que estas são competências instrumentais para o desenvolvimento do Pensamento Crítico e da reflexão essenciais ao docente na revisão constante de suas práticas. Nas sessões online, realizadas com o apoio do Skype e concretizadas no software ArguQuest para dinamizar atividades práticas no desenvolvimento das competências do Questionamento e da Argumentação do professor, oportunizando a este a construção coletiva de estratégias alternativas de ensino e de aprendizagem, fundamentadas no ensino ativo. O estudo foi realizado através dum estudo de caso único, alicerçado no paradigma naturalista e de abordagem qualitativa. Os dados de cariz numérico fundamentaram as análises qualitativas, promovendo também a triangulação dos dados. As interações entre os professores foram analisadas através do modelo IAM (Interaction Analysis Model) proposto por Gunawardena, Lowe e Anderson (1997), que tem como objetivo determinar se o conhecimento foi cosntruído através das interações e qual o grau de mudança do entendimento decorrente das interações. Para verificar esta construção do conhecimento analisamos os excertos de episódios interativos com apoio do software de análise qualitativa WebQDA (Neri de Souza, Costa & Neri de Souza, 2012). A análise das situações de aprendizagem planejadas e desenvolvidas demonstraram que as TIC, nomeadamente os softwares sociais, podem ser aplicados com eficiência no desenvolvimento de competências dos professores em exercício, apresentando-se como alternativa para a promoção da formação continuada de docentes. Em relação ao desenvolvimento das competências do Questionamento e da Argumentação, percebemos que os docentes foram sensibilizados para trabalhar com uma metodologia interativa, promovendo um ambiente favorável à aprendizagem ativa. Através da aplicação adaptada do modelo de construção de conhecimento preconizado no ArguQuest, foi possível acompanhar a prática do docente junto aos seus alunos, ampliando o seu repertório didático, e, sobretudo, implantando uma forma de aprender fundamentada na construção compartilhada de Questionamentos e Argumentos.

Using genomics for drug discovery in medulloblastoma

Tese de doutoramento, Medicina (Neurocirurgia), Universidade de Lisboa, Faculdade de Medicina, 2014

Projecto de formação contínua de professores de educação visual em regime b-learning

Tese de mestrado, Educação (Área de especialização em Educação e Tecnologias Digitais), Universidade de Lisboa, Instituto de Educação, 2014

Synaptic dysfunction in early encephalopathies : from genes to function

Tese de doutoramento, Medicina (Neurologia), Universidade de Lisboa, Faculdade de Medicina, 2015