#7jj - posters - curriculum: community and rural based ...€¦ · self-rating was done by...

#7JJ - Posters - Curriculum: Community and Rural Based Education

7JJ01 (2523)

Date of Presentation: Tuesday, 27 August 2019

Time of Session: 1015-1200

Location of Presentation: Hall/Foyer F, Level 0

Applying community-based learning (CBL) activity for Otorhinolaryngology curriculum

AUTHOR(S):

Chonthicha Chit-ueaophat, Chaiyaphum Medical Education Center, Thailand (Presenter)

Prangtip Kongsatree, Chaiyaphum Medical Education Center, Thailand

Natthawan Suangtho, Chaiyaphum Medical Education Center, Thailand

ABSTRACT

Background: Integration of CBL to otorhinolaryngology curriculum by introducing hearing screening in the community could be beneficial. The aim of this study was to evaluate the impact of CBL on the learning skills of medical students during the otorhinolaryngology rotation.

Summary of Work: Twenty students were divided into two groups. One group participated in the hearing screening activity in a selected community (CBL group). Another group did not participate in the screening activity (non-CBL group). Clinical skills including ear examination and spot diagnosis were assessed during the objective structured clinical examination (OSCE) at the end of the rotation. Self-rating was done by selection on a 5-point Likert-type scale in the CBL group. Descriptive statistics and t-test were used as appropriate.

Summary of Results: Mean scores of the ear examination and the spot diagnosis in CBL group and non-CBL group were 6.70 ± 0.54 and 6.60 ± 0.52, respectively (P-value=0.676) and 2.80 ± 1.67 and 1.60 ± 1.84, respectively (P-value=0.146). The overall satisfaction mean score on the CBL activity was 4.4 out of 5. The mean score on the usefulness of CBL activity was 4.7 out of 5. The students believed that this activity improve their ear examination skills (mean score 4.5 out of 5) and provide them opportunities for community engagement (mean score 4.6 out of 5).

Discussion and Conclusions: There was no difference in the OSCE score between the CBL group and the non-CBL group, however the medical students in the CBL group self-reported that this teaching method was beneficial and enjoyable. They would prefer participating in this activity rather than only having a clinical experience in a hospital setting. The CBL activity could be a useful teaching strategy to improve the learning outcomes of medical students on otorhinolaryngology by fostering them to be an active learner, integrate the academic theory to real-world practice and to improve the teamwork skills.

Take-home Messages: The CBL strategy could be successfully incorporated into various subjects in medical schools. However, this teaching method need to be adjusted and modified as needed to provide the most valuable community learning experience to the students.


7JJ02 (1422)




Building academic partnerships with community agencies in medical education: community agencies perspectives

AUTHOR(S):

Nayereh Kaviani, School of Medicine, Griffith University, Australia (Presenter)

Professor Mieke van Driel, Faculty of Medicine, University of Queensland, Australia

ABSTRACT

Background: The Griffith University MD curriculum provides opportunity for first year students to spend time in the community and develop skills in community health. The program is a partnership with community agencies involved in health promotion, Aboriginal and Torres Strait Islander health services/cross cultural experience, allied health services, and community care/social support. Through these partnerships students learn about the social determinants of health-an increasingly important topic in medical education. Social conditions such as employment, housing, and education, have a large influence on health and disease and students cannot obtain such knowledge through textbooks and lectures alone. The experience helps students identify social perspectives of health and disease, and social factors that impact health. They also learn about resources in the community and non-medical pathways to health, emphasising a more holistic approach to medicine. In addition, they might view community as a teaching resource and partner for future practice rather than just a placement site. The purpose of this study is to explore community agencies’ perspectives of hosting medical students.

Summary of Work: We used quantitative and qualitative evaluation methods. A survey instrument for agency staff was administered online after completion of the placements. Data was de-identified for analysis and reported in aggregate form. For the quantitative evaluation component, all analyses will be reported in a descriptive way. For the qualitative evaluation component, thematic analysis method will be used to analyse responses.

Summary of Results: Preliminary analyses highlights that community agencies greatly appreciate continued partnership. They also report the types of contributions that students can provide through participation in small-scale support and education activities.

Discussion and Conclusions: The final analysis will provide ideas and suggestions that could offer opportunities for further development of this component of the MD curriculum and build stronger partnership with our community organisations. The findings illustrate how community-academic partnerships in medical education can be mutually beneficial.

Take-home Messages: Community agencies highly value their involvement in medical education through academic partnerships.


7JJ03 (3119)




A study of correlation between grades and learning outcome achievement in Home Health Care (HHC), Family Medicine, Prapokklao Hospital, Thailand

AUTHOR(S):

Kullawan Chaicharoenpong, Faculty of Family Medicine,Prapokklao Hospital, Thailand (Presenter)

ABSTRACT

Background: To accomplish optimal patient care, home visits after hospital discharge play an important role in the continuity of care, especially in long-term follow up cases and chronically ill patients. Medical Education Center, Prapokklao hospital (MED PPK) believed that Home Health Care (HHC) program help medical students to attain preferable physician characteristics which were defined by Faculty of Medicine, Chulalongkorn University as 12 medical learning outcomes. This study aimed to compare the learning outcome achievement among medical students with different grades.

Summary of Work: 31 fourth-year medical students taking a family medicine course at Prapokklao Hospital, Thailand, were classified into 2 groups using their accumulated grade point average (GPAX) of < 3.0 and >= 3.0 and were assigned to perform post-hospitalized home visits every 2 months for 8 months. Self-assessment questionnaires were given after finishing this HHC program to assess whether the students achieved 12 medical learning outcomes. The questionnaires were based on 1-5 scale, rating from least to most applicable of the course to the learning outcomes, respectively, and analyzed with SPSS statistics, version 19.

Summary of Results: There was not a statistically significant difference in the achievement of each medical learning outcome between groups of medical students with GPAX <3.0 and >=3.0 at p-value less than .01 in this longitudinal HHC study.

Discussion and Conclusions: Home visits helped students to achieve medical learning outcomes unrelated to their grades. This might be explained by that home care required thorough consideration rather than intelligence. In addition, home visits could enhance discovery of further health care needs, leading to better patient understanding.The accumulated grade point average (GPAX) did not affect medical students’ learning outcome acknowledgement in HHC.

Take-home Messages: Continuing of home health care can help medical students gain desirable physician characteristics and better patient understanding.


7JJ04 (1226)




Do the medical skill and performance outcomes of medical students differ by type of training?

AUTHOR(S):

Anchalee Buangoen, Songkhla hospital, Thailand (Presenter)

ABSTRACT

Background: Songkhla hospital medical education center (SK-MEC) has trained medical student called CPIRD (Collaborative project to increase production of rural doctor) that based on COME(community oriented medical education). Extern is the last year training medical student before transitioning to practice. Extern in SK-MEC has trained in general and community hospital that differ from university based medical school program. Previous studies had reported training experiences of training in university based were higher than community based. COME in practice of extern is real life experience trend to increase medical skill and performance. OSCE and MEQ examination by the center of medical school in Thailand is the assessment tool to evaluate medical skill. Performance outcome were evaluated by medical staff.

Summary of Work: Objective : To examine the differences of medical skill and performance outcomes between extern CPIRD and Non-CPIRD (university based medical school program). Method: This observational cohort study of 38 externs in SK-MEC, Thailand, between 1 January to 31 December 2017. 21 Externs CPIRD and 17 externs non-CPIRD performed OSCE and MEQ examination. Performance outcome was evaluated by medical staff at SK-MEC. Medical skill and performance outcomes were analyzed by Chi-square tests SPSS 17.0.

Summary of Results: No significant difference was observed between CPIRD and non-CPIRD trained extern in age (mean, 23.5 years vs 23.7 years), sex (female, 88.2 % vs 66.7%), clinical GPA (mean, 3.35 vs 3.35). Overall, a positive association between clinical GPA and OSCE, MEQ examination were found (P<0.001), but no statistic significant correlation between clinical GPA and performance outcome were found for externs CPIRD and NON-CPIRD (P = 0.345). After matching, no significant difference in results of OSCE, MEQ examination, and performance outcome were found between CPIRD and non-CPIRD trained externs.

Discussion and Conclusions: Extern trained in CPIRD and non-CPIRD programs have distinct practice patterns. When compared within the same assessment tool by OSCE, MEQ examination and performance outcome, extern from both training backgrounds achieve similar medical skill and performance.

Take-home Messages: CPIRD (Collaborative project to increase production of rural doctor) of SK-MEC is one of COME program for training rural doctor that can achieve medical skill and performance outcome of medical student.


7JJ05 (644)




Benefits of Homestay in Community Engaged Medical Education for Undergraduate Medical Students in Thailand

AUTHOR(S):

Ananya Chutimarat, MNST Medical Education Center, Thailand (Presenter)

Sompong Karuna, MNST Medical Education Center, Thailand

ABSTRACT

Background: An increasing trend in clinical training is to send medical students to sites away from the tertiary academic medical centers. Immersion of the students within the community is one strategy to serve this trend. A training program of fourth-year medical students in community medicine rotation of MNST Medical Education Center with a homestay of 2 weeks with host families was implemented to place them at decentralized learning sites. So, this study was done to evaluate the benefits of homestay to provide a database towards improving a model for a training program.

Summary of Work: The participants in this study included 43 undergraduate fourth- through sixth-year medical students who had completed their homestay training. A self-administered questionnaire regarding the engagement between the students and host families, benefits of the homestay, and the curriculum was used as a data collection instrument. Focus group interviews with 30 host families were also done.

Summary of Results: The majority (95.4%) of the participants had moderate to high level engagement with their host families. More than half (66.7%) still keep in touch at least once a month within the past year. Out of 43 participants, almost half (48.8%) were personal health consultants for the host families. More than half reported that homestay with host families influenced their cultural learning, professional skill improvement, and motivation to practice in rural areas following graduation. They also recommended continuing the homestay program as a learning platform of community-engaged medical education (CEME). The host families were pleased to host the students and treated them as their own child. Moreover, the students shared many life events with the host families such as medical admission, religious ordination, wedding ceremonies, and funeral ceremonies.

Discussion and Conclusions: A homestay program provides an exclusive experience with the potential to engage medical students in the community to serve a significant role in a CEME program.

Take-home Messages: Homestay with local host families is useful for CEME.


7JJ06 (901)




Improving Teaching and Learning with Student Participation Scheme at the Maharaj Hospital Medical Education Center, Nakhon Si Thammarat, Thailand

AUTHOR(S):

Patcharaporn Khajornwattanakul, Maharaj Nakhon Si Thammarat Hospital, Thailand (Presenter)

Ananya Chutimarat, Maharaj Nakhon Si Thammarat Hospital, Thailand

ABSTRACT

Background: The Community and Family Medicine program for senior medical students at the Maharaj Hospital Medical Education Center was organized over a 4-week period.In the first week, lectures on community and family health were given, including practice sessions at the Chronic Diseases Clinic. Students also visited families with the Home Health Care unit and learned about primary care services at the Primary Care Cluster. During the last three weeks, students continued studies Primary Health Care Service system and practiced at community hospitals.The purpose of this research was to improve teaching and learning through a student-centered and student-directed design.

Summary of Work: Questionnaires and focus group interviews were conducted before the course for 23 senior medical students during the 2018 academic year. After completing the course, focus group interviews were used again and students’ log books were analysed.

Summary of Results: Before the course 86.9% of students concluded that the duration of the course was appropriate. 95.8% suggested that the method of teaching in the first week could be improved, particularly with regards to field study and the primary care service system. Regular follow-up group discussions were recommended. Additionally, practice with the Chronic Diseases Unit should be increased in order to better integrate knowledge and practice.Students suggested that medium-sized community hospitals with good accommodation, information technology and senior clerkships should be provided for the final three weeks. Knowledge-sharing between students and staff before the course was also suggested. After completing the course, the study found that students were pleased with the program and were able to better comprehend the Primary Care Service System and provide medical care, including to chronic disease patients,using a family medicine approach.

Discussion and Conclusions: The study found that students could gain more and meet more course objectives if they designed their own course.

Take-home Messages: Results from this study can apply to other subjects.


7JJ07 (1413)




Community Research of Undergraduate Medical Students: Sharing Experiences from Mae Fah Luang University (MFU), Chiangrai Province, Thailand

AUTHOR(S):

Chitrlada Utaipiboon, School of Medicine, Mae Fah Luang University, Thailand (Presenter)

Paween Tangchitpisut, School of Medicine, Mae Fah Luang University, Thailand

Arnon Jumlongkul, School of Medicine, Mae Fah Luang University, Thailand

Patcharin Pingmuangkaew, School of Medicine, Mae Fah Luang University, Thailand

Waraporn Eoaskoon, School of Medicine, Mae Fah Luang University, Thailand

Chaiyos Kunanusont, Bangkok Dusit Medical Service, Thailand

ABSTRACT

Background: School of Medicine, MFU aims to build excellent community physician of the Greater Mekong Sub-region. One aspect is the research capacity building among medical students. The 1st class enrolled 32 students since 2013 who will graduate in 2019. With good exposure to community hospitals, the majority of students (59/64, 92%) conducted community research studies.

Summary of Work: Four factors contributing to these education outcomes are: (i) Medical program with research courses during year 2-5 of the 6 year program; (ii) Multi-disciplinary experiences sharing by epidemiologists, biostatisticians, and medical staff; (iii) Funding support from the medical school including donation at the early phase; (iv) Collaboration with community, sub-district hospitals and health volunteers. Processes of Teaching and Learning are both in classroom and on-site at community level with tailored-made mentoring. Students learned and practiced through formulation of research questions, literature review, defining study objectives as well as study design, selecting study tools, implementing data collection, data analysis, and manuscript writing.

Summary of Results: As of 2018, 20 group work manuscripts and 64 individual research projects have been conducted. The preclinical (Year 3) projects were mostly conducted in the university and employed survey design. Almost all individual researches (Year 4-5) were conducted in the communities. Wide range of research questions regarding health topics and research design had been done. In addition to research, students also created 5 medical innovation, four were selected to be presented at the national level contest.

Discussion and Conclusions: Skills of critical thinking, creativity, communication, collaboration can be strengthened by participating in research. Furthermore, awareness on health system and health problems, health information system, public health policy, and human research ethics are essential for improving the quality of medical education and training.

Take-home Messages: Community research in medical education is crucial for promoting the skills of lifelong learning and preparing for the complexities of future working across different challenges as community physicians.


7JJ08 (1817)




Task-based assignment in community curriculum as a educational tool for achieving real life professional doctor

AUTHOR(S):

Narut Wongsakorn, Sawanpracharak Hospital, Thailand (Presenter)

Chaowaphon Ittiphanitphong, Sawanpracharak Hospital, Thailand

ABSTRACT

Background: In Thailand, rational use of drugs still remain major health problem. Therefore, in teaching at a community hospital, medical students were assigned to increase public knowledge and teach rational use of drugs to solve the problems of drug abuse in the country. Purpose of this study were 1. Students can truly understand the problems of the countrys health system and 2. Students can practice using problem solving skills and team working in the their group.

Summary of Work: 32 medical students during their rotation at the community hospital will be responsible for providing knowledge on reasonably drug use in order to solve the major problems of the country.Medical students designed their own technique, presentations based on available information either online or offline. Pre and Post test using questionnaire was used to evaluate efficacy of educating people.

Summary of Results: 45 people, 16 male, 29 female, average age 44 years were included in this study.It was found that after giving educate to the public, there was a statistical significant increase in all three important aspects of rational drug use with paired t-test. (p<0.001) Mean of indication for antibiotic use has increased from 4.8 ± 0.485 to 7.9 ± 0.463. Mean of side effect and contraindication was increased from 4.1 ± 0.39 to 7.9 ± 0.29. Mean of behavioral and life style modification was also increased from 3.0 ± 0.379 to 6.7 ± 0.284.

Discussion and Conclusions: From the assignment medical students use cognitive, affective and psychomotor domains of learning to work together as a team. Solving problems by thinking, analyzing, brainstorming and using various techniques to educate people. Students build their own creating level of Bloom Taxonomy

Take-home Messages: Community based approach by solving real life problems can stimulate medical student to achieve top level of Bloom’s taxonomy.


7JJ09 (2097)




Home Visits as Interprofessional Learning Activity for Students in Primary Care

AUTHOR(S):

Christina Olsson, Academic Primary Healthcare Centre, Sweden (Presenter)

Stefano Torres Asenjo, Karolinska Institutet, Sweden

Eva Toth-Pal, Karolinska Institutet, Sweden

Cecilia Fridén, Karolinska Institutet, Sweden

ABSTRACT

Background: Interprofessional collaboration is known to improve patient safety, increase job satisfaction, and reduce stress among healthcare professionals. Students should already during their initial training experience interprofessional collaboration. The purpose of this project was to evaluate person-centered home visits as an interprofessional learning (IPL) activity for undergraduate students during clinical placements in primary healthcare.

Summary of Work: Students from different educational programs and supervisors from different professions participated in the learning activity. The students read a brief description of the patient history before the visit together with a supervisor. During the home visit, the students were responsible for history taking and for performing relevant assessments. Afterwards, the students made a joint care plan for the patient. Thereafter, a seminar took place where students and supervisors from the participating professions discussed the outcome and reflected on each other’s professional roles. The students and the patients answered a questionnaire about the activity and the supervisors were interviewed in nine focus groups.

Summary of Results: Thirty interprofessional home visits were conducted, involving 109 students from six different healthcare professions. The students reported that they had gained insight into how different professions could collaborate. An increased understanding of teamwork as well as an understanding of the other professions’ areas of competence was gained. All patients were satisfied with the visits and felt that they had been listened to, and treated with respect by the students. The interview analysis showed one overarching theme: Major organizational barriers to implement home visits as IPL method in primary care and three main categories: Perceptions of interprofessional collaboration in the clinic, Choosing the right patient for IP home visits and Prerequisites for IPL.

Discussion and Conclusions: The students and the patients were generally positive to the activity. However, there were barriers for implementing home visits in the context of reimbursement system and the high clinical workload on the supervisors. Interprofessional collaboration was not a routine in the supervisors’ everyday clinical work.

Take-home Messages: The results of the study indicate that home visits could be used in primary healthcare settings to promote students IPL.


7JJ10 (1094)




Breaking community and healthcare team engagement in eastern culture

AUTHOR(S):

Amandha Boy Timor Randita, Faculty of Medicine, Universitas Sebelas Maret, Indonesia (Presenter)

Fitriana Fitriana, Faculty of Medicine, Universitas Gadjah Mada, Indonesia

Daniel Richard Kambey, The University of Tokyo, Japan

Ayuningtyas Satya Lestari, Depati Hamzah Hospital, Indonesia

ABSTRACT

Background: Implementation of Interprofessional Education (IPE) mostly done in community based setting in South-East Asia based country especially in Indonesia. Although IPE shows many benefits, the implementation of IPE is challenging mainly in community acceptance related to health care service by undergraduate health students. Learning environment that support community engagement for health care students is needed.

Summary of Work: Focused group discussions were explored the barriers of community acceptance related to healthcare students performance, role of community stakeholder, community expectation to healthcare students, and flow of community approach. The participants of this study were fourthy stakeholders from two cities (Yogyakarta and Surakarta) that have implemented IPE with community based learning.

Summary of Results: This study covers three themes: 1) Communication in community, 2) Collaboration model, and 3) Set the outcome. There were differences between communication among health provider and patient as individual. Structural approach with local cultural consideration was needed. The specific model consist of socialization to all of the elements who involved in IPE learning (communities, local health provider, primary health center, and students), identification and health stakeholder approach, assessment of needs, family approach, gather the plan, action, monitoring and evaluation. The community need to be involved in set learning outcome for healthcare students to synchronize between community expectation and student activity.

Discussion and Conclusions: Community involvement in IPE learning with community based was important. Community not only as learning facility but also as learning foundation. Engagement between healthcare students and communities was more difficult than patient as individual. Healthcare service in individual patient context start on patient come to healthcare provider. However, in community context, healthcare provider should be more comprehensively to assess health problem. Based on cultural in Indonesia, community was ressistance to change without local cultural consideration. Health students and community should be collaborate in a model learning, good field assessment, effective communication, and monitoring evaluation.

Take-home Messages: Based on cultural consideration in Eastern culture, IPE learning with community based should involve community before field learning was started by set the outcome. Learning method of IPE in community needs specific model approach that should be trained for health care students.


7JJ11 (1214)




Community based medical camp as one of the best methodologies of community based educational learning to approach patient as educator

AUTHOR(S):

Tuangprot Porapaktham, Sawanpracharuk Medical Educational Center, Thailand (Presenter)

Chaowaphon Ittiphanitphong, Sawanpracharuk Hospital, Thailand

ABSTRACT

Background: Community based education is the important to improve medical student to be community oriented doctors and be professional physician. In Thailand has many methodology of community medical learning, one of its facility is Community based medical camp to get virtual medical experience.

Summary of Work: Purpose of this study is to demonstrate one of the best strategy of community based education to approach patient as educator. We enroll medical student, internist and medical specialist in Sawanpracharuk medical education center, Nakhonsawan, Thailand. This study took place in primary medical care. The community based medical camp has 4 stations consisting of history taking and physical examination until basic medical treatment station, basic cancer screening station, patient education station and patient doctor relationship enhancement station. For the last session of camp, we perform public benefit for example cleaning public rest room, cleaning primary medical care center. Then we use questionnaires from google form to integrate and evaluate data and impressive experience.

Summary of Results: Total enrolled case was medical student (65%), internist (25%), medical specialist (10%). They receive many advantages of community based medical camp consist of improving professional responsibility(77.3%), improving professional competent(72.7%), maintaining appropriate relation with patient(63.6%), improving patient confidentiality(59.1%), improving scientific knowledge(54.4 %), improving accessibility to health care(50%), improving quality of health care(40.9%), maintaining trust by managing conflict of interest(40.9%), distribution of finite resource(31.8%), honesty with patient(31.8%). The summarize, this study report that community based medical camp can improve medical professionalism(82.5%) by learning to approach patient as educator.

Discussion and Conclusions: We have many strategy to improving medical professionalism. Community based medical camp is one of the best methodology by receiving virtual medical experience and approach patient as educator in Medical educational center.

Take-home Messages: The more we access advance technology, the more we should approach to patient with empathy and humunity to be a professional physician which is part of global health care developing.


7JJ12 (3142)




Early Exposition to General Practice for Second-Year Medical Students: An Opportunity to Discover Clinical Examination, Professionalism and the Roles of General Practitioners?

AUTHOR(S):

Sophie Pelloux, Collège Universitaire de Médecine Générale, Université de Lyon, France (Presenter)

Sophie Sun, Collège Universitaire de Médecine Générale, Université de Lyon, France

Christine Maynié-François, Collège Universitaire de Médecine Générale, Université de Lyon, France

Xavier Lainé, Collège Universitaire de Médecine Générale, Université de Lyon, France

Caroline Tilikete, Collège Universitaire de Médecine Générale, Université de Lyon, France

Gilles Rode, Collège Universitaire de Médecine Générale, Université de Lyon, France

ABSTRACT

Background: First internship with General Practitioners (GP) occurs between the fourth and sixth years in the curriculum of medical students in France. In 2018, the Faculty of Medicine of Lyon Est was the first to set up an internship with GPs for second-year students. Its objectives were to discover clinical examination, professionalism, and the roles of GPs. Our research question was: were the educational objectives of this internship achieved?

Summary of Work: Half of the second-year students of the Faculty of Medicine of Lyon Est completed an internship of 5 half-days with GPs during September 2018. The evaluation was built on Kirkpatrick’s model. Satisfaction of students and of GPs was measured using Lickert scales (0 not at all satisfied to 5 very satisfied). A questionnaire assessed learning achievement: we asked students which parts of the clinical examination they could carry out themselves under supervision, and which topics related to professionalism and the roles of GPs they discussed with GPs.

Summary of Results: At the end of January 2019, of the 217 students who completed their internship with GPs, 47 responded and their median satisfaction score was 4. 43 students (91%) declared that this internship should continue to be offered. Of the 204 GPs who hosted second-year students, 120 responded and their median satisfaction score was 4. 88 physicians (73%) wished to continue to receive a second-year student. Students could perform part of the physical examination themselves for 44 of them (94%), and part of the clinical interview for 46 (98%). They had the opportunity to address at least one notion of professionalism (medical secrecy, responsibility, independence) for 46 of them (98%) and the roles of GPs for 45 of them (96%).

Discussion and Conclusions: Students and physicians were satisfied by this innovative internship. This on-going evaluation reveals that second-year students can discover clinical and professional skills during an early internship with GPs and encourages its perpetuation.

Take-home Messages: An early internship with GPs for second-year medical students is possible and well accepted by GPs and students. Students can discover clinical examination, professionalism and the roles of GPs.


7JJ13 (338)




What do medical students learn from Pediatrics family home visit? Mixed method

AUTHOR(S):

Nawarat Aroonyadech, Sunprasitthiprasong Hospital, Thailand (Presenter)

ABSTRACT

Background: Family home visit is a didactic strategy allowing medical students to comprehend the health illness process in a biopsychosocial way. Our goal was to assess what they learned from family home visit in a part of social pediatrics.

Summary of Work: During a 12-week clinical rotation in Pediatrics, 5th year medical student at Sanprasitthiprasong Hospital are require to visit children with chronic illness which need continuing care at home. Data collection from 5 simple questions likert scale questionnaires and group interview. Content analysis was perform for data obtained from group interview. Student perception on difference aspects they learned from home visit were describe as percentage.

Summary of Results: Most of student rated the home visit worthwhile (97%). 85% reported home visit increase their capacity to apply medical knowledge with reality situation and also help them develop communication skill(83%). 88% felt home visit sensitized them to social commitment and more empathy. From analysis of students’ interviews, they reported that home visit enhanced them clearly understand in reality situation and biopsychosocial aspect of patient , collaborate with multidisciplinary team and community, more emphasize in quality of family care-giving and increase motivation to do holistic care approach.

Discussion and Conclusions: Family home visit enhanced students learning in professionalism , community and holistic care and humanist and social profile as future healthcare professionals.

Take-home Messages: The home visit is essential for providing a learning experience in biopychosocial way and enhanced students learning in professionalism and humanist.


7JJ14 (1897)




Medical student’s perspective on home visiting program

AUTHOR(S):

Bor-Yuan Tseng, School of Medicine, Buddhist Tzu Chi University, Taiwan (Presenter)

Shao-Yin Chu, Department of Medical Education, Buddhist General Hospital, Taiwan

ABSTRACT

Background: A comprehensive medical education should include medical science and medical humanities. There are different ways cultivating medical student’s humanitarian accomplishment all over the world. Home visiting program (HVP) was conducted to year one medical students (MS) at School of Medicine, Buddhist Tzu Chi University as part of humanity courses. This study present MS’s perspectives on HVP.

Summary of Work: 56 first-year MS, age ranged from 18-33 years old, was divided into 10 groups. 5-6 MS of each group were supervised by three volunteer mentors who had constructed chronic relationship with socially vulnerable consented families to be visit. Three times of home visits were conducting in one semester. A 5-point Likert scale questionnaire including three dimensions of knowledge/skills/attitudes with 21 items was designed and completed by MS after the home visit. Cronbach's alpha (α) for the 21‐items scale was 0.87 and content validity was tested based on expert views.

Summary of Results: The response rate was 59%. 75.8% of MS aware the minority population existing in the society after HVP. 51.5% and 44.5% of MS agree HVP can improve skills of communication and conduct holistic care respectively. 42.4% learned how to support and comforted others through volunteer mentoring. 57.5% consider HVP nurture good doctor-patient relationship in the future, and 42.4% felt the sense of accomplishment after helping others. 72.7% and 60.7% agree HVP promote empathy and respect for life respectively. Overall, only 63.7% MS satisfied HVP. Unsatisfactory rate was higher at MS aged less than 20 and those who comes from big city area (41.7% vs 25%, 45.8% vs 14.3%). For the 36.3% (12/33) unsatisfied students, 7 suggested HVP after senior.

Discussion and Conclusions: HVP not only lead medical students to a fuller understanding population of low social economic status and their suffering patients, but can also learn empathy, implementing holistic care and respect to every unique living style. Reasons for younger medical students not appreciating the humanity course need further clarification.

Take-home Messages: Home visit is still a good method to teach medical humanity. The optimal timing to implement may do more with less.


7JJ15 (955)




Learning by Doing in Cataract Lesson - The CBME study

AUTHOR(S):

Anant Bhornmata, Chumphon Khet Udomsakdi Hospital Medical Education Center, Thailand (Presenter)

ABSTRACT

Background: Teaching others is the highest average retention rates in the learning pyramid. To gain the knowledge and service mind in the community, cataract lesson was created in the community based medical education (CBME) study. The aim of cataract lesson is to compare pre and post education of cataract knowledge in nursing home.

Summary of Work: Fifth year medical students were brain stormed to design the cataract lesson. Total 28 elders participated in the study. A research utilized the questionnaire administered as pre-test (step 1), cataract education by using the poster and acting of the cataract story (step 2). And last post-test (step 3) was done and analyzed by dependent t-test.

Summary of Results: Hundred percent of elders are more than 60 years old. The result showed 89.29% (25 elders) have improved their knowledge ( ͞Xpre, S.D.pre = 6.85, 1.84 and ͞Xpost, S.D.post = 8.89, 1.40) with p< 0.001 and 7.14% (2 elders) have no difference in pre and post-test. Only 3.57% (1 elder) had failed in post-test.

Discussion and Conclusions: Almost allelders gained cataract knowledge. This reflects to the CBME study that has high potential to teach medical students. Medical students have to learn the process to search and analyze know-how of cataract disease before teaching others. The CBME model is the powerful technique to use as the tool for medical learning. All medical students agreed with the CBME study. Therefore, this model is proposed for use in any block of medical learning and improves their service mind.

Take-home Messages: Learning with patients is not restricted only in the hospital. Community based learning is the one technique to initiate a good relationship between medical students and people in the community. Finally, medical students have more learning experience with CBME study.


7JJ16 (1353)




Influencing nursing students’ perceptions of community care with curriculum-redesign

AUTHOR(S):

Margriet Iersel van, Amsterdam University of Applied Sciences, Netherlands (Presenter)

Corine Latour, Amsterdam University of Applied Sciences, Netherlands

Rien de Vos, Academic Medical Center, Netherlands

Paul Kirschner, Open University of the Netherlands, Netherlands

Wilma Scholte op Reimer, Academic Medical Center, Netherlands

ABSTRACT

Background: In many Western countries, healthcare is changing from intramural care to caring for patients in their own homes. However, it is problematic that most nursing students orientate on a career in the hospital, which leads to increasing labour market shortages in community nursing. Providing students with a more community-orientated curriculum may help build more positive perceptions that lead to other career choices.

Summary of Work: The curriculum-redesign is based on research about first-year students’ perceptions and placement preferences. First, a cross-sectional multicentre survey study with first-year students (n = 1058) was conducted using the SCOPE-scale (Scale on COmmunity care PErceptions). Second, a focus group study with students (n = 16) was performed to better understand the factors underlying students perceptions.

Summary of Results: The findings of the survey confirm the hospital’s popularity, as 71.2% prefer the hospital and only 5.4% choose community care, which is perceived as a ‘low-status-field’ with little care complexity and few challenges. The focus group study led to formulation of eight themes, namely (1) variety and diversity, (2) challenges, (3) improving peoples health, (4) collaboration, (5) role models, (6) patient- or environment-based perceptions, (7) self-efficacy, and (8) immediate vicinity. Students’ perceptions of community care are at odds with what they consider important in professional practice.

Discussion and Conclusions: Students have clear ideas about what they think is attractive but their perceptions do not always appear to be realistic. They expect the hospital to possess all desired characteristics while community nursing is perceived as primarily elderly care and guidance in daily life. Many students have a limited view of what complex caregiving entails as they attribute this only to acute care involving technical skills.

Take-home Messages: Curriculum designers can more prominently highlight the complexity of community nursing in the theory, and patient cases can be presented that do not fit the stereotypical views commonly held. Also, it is important that students collaborate with mentors in the field with an appropriate level of education, who can act as a source of inspiration. This can potentially increase awareness of the fields opportunities and contribute to well-informed career decisions.


7JJ17 (1624)




Visiting rural hospital as an inspiration tool during selection for rural doctors

AUTHOR(S):

Araya Khaimook, Hatyai Hospital, Thailand (Presenter)

ABSTRACT

Background: Thailand still has a problem of shortage of rural doctors in some rural areas. One strategy to maintain rural doctors is to recruit medical students from local areas but not all students are familiar with rural hospitals.

Summary of Work: In 2019 student selection for medical students of Hatyai CPIRD and faculty of medicine, Prince of Songkla University. Forty students need to select from 64 high-school students that applied for medical students in TCAS1 (Thai University Center Admission System step 1, Portfolio). During two-day of selection process, all of students have opportunity to visit rural hospital and observe home health care system in the village for half day.

Summary of Results: At the reflection period after visiting rural hospital, students showed their understanding for need of rural health care system and clarify their future roles and moreover inspire them to be a rural doctor. In other hand some of them have decided not to be rural doctors

Discussion and Conclusions: Visiting rural hospital as a part of student selection can inspire students for their future roles and also help them make decision according to their preferences. Conclusion This innovative way of student selection makes it more vivid and more relevant to their near future contexts

Take-home Messages: Visiting rural hospital can inspire and help students understand more in their future roles.


7JJ18 (775)




Students’ rural background and training in well-equipped rural teaching hospitals enhance intention to return to work in rural hometown

AUTHOR(S):

Wasana Hongkan, Collaborative Project to Increase Production of Rural Doctors, Thailand (Presenter)

Roungtiva Muenpa, Collaborative Project to Increase Production of Rural Doctors, Thailand

Parinya Chamnan, Collaborative Project to Increase Production of Rural Doctors, Thailand

ABSTRACT

Background: Thailand’s Collaborative Project to Increase Production of Rural Doctor (CPIRD) recruits students with the rural background and provides training in rural teaching hospitals. We studied students’ main reasons for attending this rural recruitment project and their intention to work in rural areas. We also examined factors associated with the intention to work in rural areas.

Summary of Work: During the academic year 2017-2018, 1,349 fourth-sixth year students from 34 rural teaching hospitals under CPIRD responded to a questionnaire about their gender, year of medical study, size of teaching hospitals, a domicile of origin, parental occupation, family income and main reasons for choosing to attend the CPIRD rural medical schools as well as their attitudes towards rural job placement. Factors associated with student intention to work in rural areas were examined using exact probability teat, t-test, and one-way ANOVA.

Summary of Results: Of 1,349 medical students, 809 (60%) were female, 914 (68%) had adequate family income, 519 (38%) had a domicile of origin in rural areas, 247 (18%) had either a mother or father being health professionals. The top three main reasons for choosing to attend the rural medical schools were intention to return to work in their hometown (32%), student recruitment being less competitive (18.5%) and pre-specified job placement in their home districts (15%). Medical students who had a domicile of origin in rural areas and trained in large-sized teaching hospitals had higher intention to work in rural hometown (p=0.037, and p=0.010 respectively). 1,283 (95%) medical students had favorable attitude towards rural placement after their graduation.

Discussion and Conclusions: Discussion: CPIRD’s student recruitment strategy may help increase the number of rural doctors possibly through its students’ positive attitude towards working in rural health services. Training in real-world rural health service systems might foster students’ community-oriented competencies, which in terns enhance rural doctor retention. Conclusion: Recruitment of medical students with rural background and being trained in rural medical schools may enhance the likelihood that they would intend to start and remain working in rural health services.

Take-home Messages: Student rural background and early exposure to rural healthcare services essentially determine intention to work in rural underserved areas.


7JJ19 (150)




Opinions of Community Hospital Directors in the Northern Thailand (2nd Regional Health) toward the Medical Curriculum, Faculty of Medicine, Naresuan University

AUTHOR(S):

Pantitra Singkheaw, Faculty of Medicine, Naresuan University, Thailand (Presenter)

Sirikasem Sirilak, Faculty of Medicine, Naresuan University, Thailand

Krit Pongpirul, Faculty of Medicine, Chulalongkorn University, Thailand

Supawadee Makanut, Faculty of Medicine, Naresuan University, Thailand

Inthiporn Kositanurit, Faculty of Medicine, Naresuan University, Thailand

Yuthapong Buddharaksa, Faculty of Medicine, Naresuan University, Thailand

ABSTRACT

Background: The core mission of the Faculty of Medicine, Naresuan University is providing graduates of medical curriculum for the Collaborative Project to Increase Production of Rural Doctor (CPIRD). The project recruits 145 students per year from 5 provinces under the 2nd Regional health. The graduates from this project are deployed to work in rural areas of the 5 provinces for at least 3 years after graduation in accordance with the contract executed with the project. Based on the research, 52% of the doctors from CPIRD continue working in the rural area after the completion of 3-year contract. As aforementioned, the Faculty of Medicine, Naresuan University focuses on apply outcome-based curriculum to make attributes of graduates compliant with needs and anticipations of relevant stakeholders such as community hospital directors. Therefore, a study on the opinions of community hospital directors in the 2nd Regional Health toward the medical curriculum should be carried out.

Summary of Work: A questionnaire survey was conducted to community hospital directors within the 5 provinces and asked about expectation and opinions toward benefits of learning topics and methods for the practice in a community hospital. Descriptive statistics were used for data analysis.

Summary of Results: The participants regard that there are 28 learning topics benefiting to the community practice. Of 28 learning topics, 9 topics are considered the most benefit. The top five scores are leadership skill and teamwork, inter-professional education, community collaboration, referral system and patient safety, respectively. Meanwhile, the most useful learning method is problem-based learning by using evidence-based medicine.

Discussion and Conclusions: According to the research, the results prove that coordination skills in multidisciplinary community working are necessary. The graduates should be experts in these skills to advance their future work and to resolve problems by using evidence-based medicine as the 21st century skills are communication and collaboration, critical thinking, and problem solving.

Take-home Messages: The necessary skills of the medical graduates for practicing in community hospitals are communication and collaboration, critical thinking, and problem solving.


7JJ20 (597)




Rural community site visit: the essential step of student selection for rural medical program

AUTHOR(S):

Supat Hasuwannakit, Hatyai Medical Education Center, Ministry of Public Health, Thailand (Presenter)

ABSTRACT

Background: Student recruitment for rural medical program is the essential step of prolonged retention in rural hospital. However, the students who apply for rural medical program in Thailand usually come from middle class families and live in urban area. So how can we set student selection process as a self-recognition activity and reassurance them to be the rural doctors? Rural community site visit is the essential intervention for rural medical program student selection.

Summary of Work: In 2019, rural medical tract student selection of Hatyai Medical Education Center has the significant change from examination-based to portfolio-based admission. 63 students from 3 provinces applied in this admission process. 40 students were admitted. Only 30.2% of students have rural background. Half day rural site visit was set first day of three day selection process. After a short presentation of expected rural doctor role-model, students had 1/2 hour for the community hospital quick round and 2 hours visiting rural community and talking with poor families, then came back for reflection and writing self-reflection essay. The essay was also the tool for interviewer to select the students.

Summary of Results: The essay content analysis found that 30.2% were student first time visiting rural community, 42.1% of rural background students also get more understanding of rural context. For the essay first three key contents, 60.3% acknowledge the scarcity of doctor and inequity in rural area, 50.8% have inspiration to be a good rural doctor, and 38.1% have more understanding the expected role of rural doctor. However, one student decided to leave this program to be the dentist after visited rural community.

Discussion and Conclusions: Rural community site visit on student selection process is essential especially in setting of portfolio-based admission to acknowledge the students before decision to be the rural doctor.

Take-home Messages: Rural community visiting for rural medical program student selection can both reassure and inspire the students decision to be the rural doctor.


7JJ21 (47)




How to improve medical students’ interest in rural area: Lessons from TAK

AUTHOR(S):

Chaiyakit Udnan, Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Thailand (Presenter)

Worasit Charoensin, Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Thailand

Manoch Ouwuttipong, Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Thailand

ABSTRACT

Background: Somdejphrajaotaksin Maharaj Hospital Medical Education Center (TAK) is the small medical school in TAK province, under the administration of “Collaborative Project to Increase Production of Rural Doctor” (CPIRD) with “Naresuan University”. TAK establish in 2004, start teaching on 2005 to present and can produced 120 doctors. Moreover, from the human resource data of CPIRD found medical students who graduate from TAK has retention in rural hospital 92% (110 doctors). It was the one in medical schools of Thailand that producing doctor to most stay in rural hospital. So, this research has objective to showed TAK model for improve medical student’s interest in rural area.

Summary of Work: This study was qualitative research. Data collected by focus group discussion with 20 doctors, 5 nurses and 5 support staffs from TAK and in-depth interview from 5 alumni. Then presented results through description analysis.

Summary of Results: TAK has 7 strategies for improved medical student’s interest in rural area includes: (1) Set vision, for support everyone understanding on school’s goals. (2) Admission, selected only medical students from postgraduate system. (3) Role model, instructors will improve yourself to be the best role model. (4) Promote CPIRD identity, Instructors will support identity in subject as appropriate. (5) Using the rule for control, medical students will pay for a fine when don’t working in rural hospital. (6) Support the training in community hospital, we will sent medical students to training in border hospital for learning rural context and (7) Sharing experience from alumni, for making inspiration to medical students.

Discussion and Conclusions: TAK model is 14 years’ experience learning that reflected to be lessons and best choice. However, TAK should searching new strategies for maintenance standard and motivate to medical student’s interest in rural area always.

Take-home Messages: TAK model is the best choice for small medical schools. So, Small medical school should apply some strategies for organizational development and improve medical student’s interest in rural area.


7JJ22 (2786)




Factors related to drop out rate of clinical medical students in a CPIRD, Collaborative Project to Increase Production of Rural Doctors, Suratthani Hospital, Rural Medical School

AUTHOR(S):

Kiattisak Wongvorachart, Suratthani Hospital, Thailand (Presenter)

Juntima Euathrongchit, Chiangmai Hospital, Thailand

Termsak Napattalung, Suratthani Hospital, Thailand

ABSTRACT

Background: One interesting medical education problem is MEDICAL STUDENT DROP OUT, there are different causes between each country. Many schools attempt to eliminate this problem with many activities to closing the gap. Many Thai publications showed the reasons of this drop out, but (MAY) not in deep or match with every institute. This is the first study in a regional medical education hub to find out the causes and prepare the way to protect and encourage the success of our medical students.

Surat thani hospital is a RURAL provincial hospital and one of medical studying hubs, taking care of approximately 25 students per class of three clinical years. In 2018, there were 8 potential drop out students. Moreover, some had suicidal thinking and major depressive disorders which was higher than any of the major institutes. This study was stressed on the route causes of failure and hope to create a SURAT MODEL to protect drop out and transform our students to be new 21st century professional physician.

Summary of Work: After research processing, this descriptive study covered 72 Surat Thani students in the 2018 academic-year. Systematic sampling was applied. The 2007 Thai Happiness Indicators were used to obtain levels of happiness. Self-administered questionnaires were used to collect their personal basic data and summarized with a statistic program. All databases were sent to the committee to create SURAT MODEL in next step.

Summary of Results: Although student burn-out is a multi-factorial problem we found new different major causes which included failure to make parents and applicants realize “TRUE THAI PHYSICIAN” life and THE REAL situation of the Thai health care system. While, unrecognized themselves, low socioeconomic status, psychiatric problem, etc were similar to the prior works.

Discussion and Conclusions: The differed major causes of burn-out syndrome were shown and analyzed to find the next steps of new SURAT Model for changing mis-conception of medical life, promote self-esteem, apply new learning and working in the real world. Changing of the tutorial program and encouraging the way to balance doctor life and workload may be two keys prevention factors of drop-out.

Take-home Messages: To stop this we need CHANGE !!!

#7jj - posters - curriculum: community and rural based ...€¦ · self-rating was done by...

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