Monash Medicine Curriculum Conference 2017
Improving Monash medical graduates’ preparedness for practice
Charlotte Rees, Laura Eades, Lewis Fry, Kate Johnson & Tom Kovitwanichkanont
The primary purpose of medical school is to prepare its graduates for safe and effective clinical practice as PGY1 doctors. While medical students and graduates navigate plentiful transitions across their medical education continuum, increased research over the last ten years has focused on the important medical student-PGY1 doctor transition and new doctors’ preparedness for practice (P4P). While this transition offers new graduates huge opportunities for intense learning, ultimately benefiting graduate well-being and patient care, we know that transitions can be challenging for junior doctors. Many of these challenges relate to new doctors feeling unprepared for various aspects of clinical practice (e.g. safe prescribing, clinical reasoning, ward-craft etc.), alongside interpersonal (e.g. unsupportive or disrespectful colleagues) and systemic factors (e.g. understaffing) acting as barriers to their transition experiences. In this keynote, Charlotte will first present a brief overview of the P4P literature in terms of two research questions: (1) How prepared are medical graduates for practice? (2) How effective are common P4P transitional interventions? Then, Charlotte will facilitate a panel discussion with four medical learners at different stages of training (one Monash year 5 student medical student and three Monash Medicine Graduates: PGY1-PGY4) to talk about their Monash experience of P4P. Laura, Lewis, Kate and Tom will answer questions on their understandings of preparedness, memorable preparedness (and unpreparedness) experiences, their thoughts on the facilitators and barriers to P4P, alongside their suggestions on effective P4P educational interventions. We hope that this interactive plenary will stimulate discussion about future curriculum enhancement at Monash to improve future medical graduates’ P4P.
Improving feedback in medical education
Feedback is a challenging but important business in medical education. Despite compelling evidence that it is important for learning, feedback is seen as one of the most problematic aspects of the student experience. Learners report that they do not receive enough feedback, and when they do, it is difficult to use. This finding is consistent across both classroom and workplace settings. Educators in the classroom struggle with turn-around time for comments on work, as well as the pressure to provide personalised and individualised comments on students’ work. Educators in both settings also anticipate the emotional impact of their feedback on students, and can approach these encounters with a tentative (and often back peddling) stance that reinforces to learners that feedback is a practice to be feared.
This session argues for an alternative way of looking at feedback practices in medical education. Recent frameworks proposed by Boud and Molloy (2013) called Feedback Mark 1 and Mark 2 will be explored. Here, feedback is re-conceptualised as an activity driven by learners, rather than an act of ‘telling’ imposed on learners. Learners are encouraged to self-evaluate, and to help devise plans that will help them achieve the set learning goals. This approach challenges learning cultures with established feedback rituals resembling experts telling learners what is going right and what is going wrong, with very little planning for what comes next (Feedback Mark 0). Principles for how to enact Feedback Mark 1 and 2 in pre-clinical and clinical curricula will be discussed, along with the results of recent innovations that have attempted to do so. These innovations include design of assessment where there are nested tasks to allow for clear transference of feedback into subsequent work, use of technology to promote peer engagement in feedback, tools to hone educators’ reflections about their own feedback practice, and explicit training for students, early in their courses, on how to use feedback for learning.
Parallel Session 2: Workshop I
Transition to an MD Degree – Assessment Challenges
Megan Wallace, Julia Harrison, Michelle Leech & Geoff Solarsh
Monash University’s first cohort in its new MD program was enrolled in 2017 and will reach the final year of the MED course (Year 5D) in 2020. Summative assessment in this final year of an Extended Master’s degree needs to generate sufficient assessment workload points at an AQF 9 standard to meet the 48 credit point requirements for a full year of study. Twenty-four credit points have provisionally been allocated to four existing core rotations in Medicine, Surgery, Acute Care and Chronic/Aged Care (6 credit points each) and the remaining 24 credit points to two new units, viz. ‘Scholarly Intensive’ and ‘Patient Safety and Preparedness for Practice’ (12 credit points each).
In this session we wish to cover some of the assessment challenges associated with this restructure. Following a short overview of the proposed changes that will accompany the introduction of an MD degree, we will run two mini-workshops serially covering assessment issues for: a) The Scholarly Intensive and b) The core rotations in Medicine, Surgery, Acute Care and Chronic Care.
The main challenge for the Scholarly Intensive is the development of an assessment strategy that provides meaningful assessment of short-term scholarly activity, is equally applicable across a wide range of research and professional practice projects, and does not make unsustainable demands on project supervisors.
The main challenge for the Year 5D core rotations is supplementing the existing Pre-Intern Assessment (PIA) at the end of each rotation with more robust instruments to measure performance-based clinical competence of our students without overwhelming the capacity of busy clinical teams to complete these assessments.
Parallel Session 3: Workshop II
Losing the ‘A’: What is the impact of bringing ‘tech’ into ‘teach’?
Jennifer Lindley & Michelle Lazarus
The use of technology and e-learning has increased dramatically in healthcare education. Monash, due to a variety of factors, is also increasing use of technology in the classroom; this is reflected in teaching spaces and the suite of e-learning tools now available to educators. The transition from didactic teaching to student-centered educational approaches is highlighted by the Better Teaching Better Learning agenda. This shift can create a number of challenges for stakeholders in the field of teaching and learning. The purpose of this workshop is to highlight some current educational technologies available at Monash and to explore some of the key issues, challenges, and benefits of stakeholders engaged in using technology in the classroom through roundtable discussions. The purpose of this roundtable discussion will be to ask: What is the role of technology in teaching and learning? How does the use of technology impact upon the learner, the educator and the student-teacher interaction? How can we harness technology effectively for teaching and learning?
Parallel Session 5: Workshop III
“Developing a curriculum to promote collaborative care”
Fiona Kent, Arunaz Kumar & Kerry Hood
Collaborative, rather than profession specific practice is required to deliver safe, efficient and integrated healthcare. Our health systems, while attempting to deliver patient-centred care are becoming increasingly complex. It is important that graduates recognise and acquire the skills for confident collaboration with both their professional colleagues and patients. The new Collaborative Care Curriculum at Monash University details the learning targets for collaborative practice for medicine, nursing, pharmacy and allied health students. Curriculum development has been informed by academics, students, accreditation requirements and experienced patient advocates. We will present a brief overview of the process of development and final framework of the Collaborative Care Curriculum and introduce the formal and informal approaches to learning currently in place and under development. We will workshop some of the education activities currently in place: a medical and midwifery student skills workshop, a combined medical and nursing student placement in the emergency department and some of the informal learning activities under investigation, followed by a facilitated debrief. Finally, the importance of the facilitator in promoting learning opportunities across the professions will be discussed.
Parallel Session 6: Workshop IV
Enhancing student involvement in medical curriculum design and research: techniques and challenges
Kevin Shi, Dinesh Giritharan, Patrick Tang & Jennifer Wang
Medical students are a major stakeholder in the content and delivery of medical school curricula but have traditionally not been involved in their planning and design. This session, presented by current senior student representatives of the Monash MBBS cohort, will demonstrate how student input can be used to supplement the expertise of educators to improve the appeal and relevance of learning activities.
Both formal and informal methods for collecting student input will be discussed, with particular reference to recent changes to the Monash MBBS program. We will also review the most significant concerns received from students across the medical course as well as the common difficulties faced by educators seeking feedback, such as sampling bias, poor survey response (survey fatigue) and unrealistic student expectations.
Many Monash students are also involved in formal and informal peer teaching, such as the VESPA program, and this is a valuable supplement to students’ formal education. However, student collaboration may also inadvertently obstruct curriculum changes or decrease assessment reliability, and strong communication is essential in helping students teach in parallel to the medical course.
The evolving role of students in medical education research, both as participants and investigators, will be considered briefly, with an aim to encourage translation of ongoing curriculum review into high quality data for analysis.
Student representatives will then facilitate a small group discussion and provide a student perspective to any academic staff seeking feedback on current or planned future curriculum components. We hope this session provides an opportunity to develop strong partnerships between students and educators to help maximise the learning and teaching experience.