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EDU/WED/01 EVALUATION OF ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH E-PORTFOLIO PILOT LAUNCH IN YORKSHIRE

1S Frazer, 1A Morris, 1L Highett, 2K Beggs, 2A Haigh. 1Yorkshire School of Paediatrics, Yorkshire, UK; 2NHS Education Scotland, Edinburgh, UK

Context: The Royal College of Paediatrics and Child Health (RCPCH) e-portfolio provides an innovative support platform that includes an interactive curriculum, space and structure for focussed reflection, education supervision and personal development planning.

Objectives: To present the evaluation of the RCPCH e-portfolio pilot launch from Yorkshire.

Key Message: The e-portfolio contains several sections including an alert board and messaging system. A planning section allows trainees to work through the interactive curriculum recording their level of competence and experience within different areas of practice. There are structured sections for education supervision meetings. The personal development plan allows trainees to set SMART objectives and periodically review progress towards obtaining these. There are two reflective components of the learning portfolio. The first is the developmental log; in this section trainees record and reflect on critical incidents, education meetings, their own teachings and many other similar areas. The skills log allows trainees to record and reflect upon a range of practical procedures. The work-based assessments are uploaded regularly into the e-portfolio. Education supervisors and programme directors can maintain a database of trainees and access their portfolios remotely in order to assess progress in obtaining the required level of competencies through the trainee’s record of assessments, self-directed learning, reflection and education supervision.

Conclusion: The e-portfolio, although not an assessment instrument itself will underpin the review process of trainees in order to inform an annual review panel on the fitness to progress from one level of training to the next.

EDU/WED/02 THE ROLE OF TELEMEDICINE EDUCATION IN THE DEVELOPMENT OF MANAGED CLINICAL NETWORKS FOR SPECIALIST PAEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION SERVICES: THE SCOTTISH PAEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION GROUP EXPERIENCE

2A Barclay, 5R Hansen, 3P Gillett, 4M Bisset, 1P McGrogan. 1Department of Paediatric Gastoenterology and Nutrition, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK; 2Division of Developmental Medicine, University of Glasgow, Glasgow, UK; 3Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK; 4Department of Paediatric Gastroenterology and Nutrition, Royal Aberdeen Childrens Hospital, Aberdeen, UK; 5Child Health, University of Aberdeen, Aberdeen, UK

Aims: Emphasis has been placed on the development of regional and national managed clinical network (MCN) working models for the Paediatric Gastroenterology, Hepatology and Nutrition Group (PGHANG) in Scotland. The Scottish PGHANG is a multidisciplinary society whose primary goals involve the development of close working relationships between health professionals with the aim of improving paediatric gastroenterology services. Regular multi-agency continuing professional development (CPD) and the development of management guidelines are integral to these aims. The geographical distribution of paediatric services within Scotland limits the ability of such groups to develop effective working relationships for MCN development. The Scottish PGHANG in 2005 piloted the introduction of bimonthly telemedicine education sessions to help address these issues.

Methods: The development of the Scottish PGHANG telemedicine sessions over the first 2 years is described, with reference to increasing numbers in the group, formalising educational value and expanding the remit of sessions.

Results: Initial contact between Glasgow, Edinburgh and Aberdeen involved the exchange of case presentations between tertiary specialists. With the expansion of the network a total of eight paediatric centres now participate and over 50 multidisciplinary professionals are involved. Local registration with central storage of attendance, session details and feedback allows formal CPD accreditation of meetings. In addition to case discussion, telemedicine has promoted real-time discussion of protocols for the management of bleeding oesophageal varices, fulminant colitis and intestinal failure, improved understanding of disease management and clarified the roles of and responsibilities for shared-care patients. The planning of national meetings and responses to national service development directives during sessions has harmonised the group’s priorities for future service development. Multi-agency presentation has cultivated relationships between allied health professionals and has forged a group identity for the Scottish PGHANG.

Conclusions: The use of telemedicine has developed a high quality regular accreditable CPD for professionals who would otherwise have to travel excessive distances to receive this. Additional benefits to service development include the evolution of MCN practice. Such processes may serve to enhance the political influence of groups when responding to national planning documentation and applying for national service funding.

EDU/WED/03 DEVELOPMENT OF INTERACTIVE EDUCATION WEBSITES FOR NEONATAL TRAINEES

T Austin. Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

Background: Competency-based training requires that trainees have access to high quality educational resources; changes in doctors working practice require novel approaches to delivering training programmes. The author has developed unique interactive education websites for neonatal trainees at two tertiary level neonatal units.

Objective: The aim of this project is to evaluate the effectiveness of an interactive website at delivering a range of teaching and educational resources relevant to subspecialty training in neonatology.

The Site: Two sites have been developed on the “wikispaces” platform.1 Wiki software allows users to create their own material, upload files and post comments on page content. Content can be shared between the two sites. Each site provides: (1) a range of teaching and educational resources complementing the teaching programme within the departments; (2) the opportunity for “interactive” learning, through users creating content; (3) access to unit guidelines and protocols with a unique search facility; (4) links to various neonatal, paediatric and health-related sites; (5) a forum for discussion.

Feedback: Questionnaires were sent out 6 months after the launch of the first site. Feedback was obtained from 70% of users. All respondents found the site easy to navigate. 55% found the site “extremely useful” in addressing their educational needs and 45% found it “quite useful”.

Discussion: The “wiki” site provides a novel approach to learning, allowing trainees to complement traditional teaching with a range of self-directed and interactive components. Developing virtual learning environments on the wikispaces platform is simple, intuitive and secure. The feedback has been positive and the site continues to be developed to maximise the learning potential of this educational resource.

EDU/WED/04 FROM PAPER-BASED TO PAPERLESS: THE IMPACT OF THE VIRTUAL LEARNING ENVIRONMENT ON STUDENT SATISFACTION WITH PAEDIATRIC LIFE SUPPORT TRAINING

1S Jyothi, 2S Canaway, 2C Cocking, 2D Jones, 1W Carroll. 1Department of Paediatrics, Derbyshire Childrens’ Hospital, Derby, UK; 2Clinical Skills Department, Derbyshire Royal Infirmary, Derby, UK

Background: In May 2007, the advanced life support group moved from a paper-based preparation for their one-day paediatric life support (PLS) courses (APLS manual) to an internet-based preparation (the virtual learning environment; VLE). Formal PLS training is included in the undergraduate curriculum and this opportunity was used to determine whether internet-based preparation altered student satisfaction with the PLS course.

Methods: Medical students at Derbyshire Children’s Hospital undertaking PLS training were asked for feedback on all aspects of the course. Students were asked to give a score out of 10 for each component of the teaching programme, including the PLS course. Data were anonymised and entered into STATA version 8.0 (STATA Corp, College Station, Texas, USA) for analysis. Scores for PLS training were compared before and after the introduction of the VLE using the Mann–Whitney U test.

Results: 203 medical students undertook a full-day PLS course between July 2005 and November 2007. 190/203 students provided feedback scores for the course. Student satisfaction with the PLS course was extremely high (mean score 9.35/10, median score 10/10). There was a non-significant increase in student satisfaction after introduction of the VLE (p = 0.069). The pre-VLE mean score was 9.29/10, median 9.5/10 (n  =  129) and the post-VLE mean score was 9.49/10, median 10/10 (n  =  61). Student satisfaction with emergency teaching during the course improved when comparing pre and post-introduction of the VLE (p = 0.011).

Conclusions: Medical students report high satisfaction scores for PLS training. Replacement of the paper-based pre-course material with internet-based resources has not reduced student satisfaction.

EDU/WED/05 MEMBERSHIP OF THE ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH CLINICAL EXAMINATION MADE SIMPLE: A UNIQUE MULTIMEDIA TOOL

S Zengeya, T Serane, N Archer, P Okeeffe, H Price, R Chinthapalli, J King. University of Bristol, Bristol, UK

Background: The Membership of the Royal College of Paediatrics and Child Health (MRCPCH) clinical examination can be both easy and difficult. Unfortunately, very little of the currently available teaching material shows a clear way to examine a child thoroughly within the allotted time.

Aim: A multimedia teaching tool aimed at preparing candidates for the MRCPCH clinical examination using audiovisual technology.

Method: Various examiners and experienced paediatricians have offered to demonstrate a structured approach to various systems in this unique multimedia tool, which allows prospective candidates an opportunity to watch and learn. It combines multimedia video clips (on DVD), written comments and PowerPoint presentations. In this computer-based tool, experienced paediatricians and examiners have stepped into the role of the candidate and have demonstrated the clinical skills required to pass, as in an examination setting. This tool covers all clinical stations except the video station. It contains clinical demonstrations to the required standard and live candidate sessions.

Results: This tool is interactive, entertaining and conducive to learning.

Conclusion: This will be a very useful tool for candidates preparing to sit the MRCPCH clinical examination.

EDU/WED/06 A CHANGING CURRICULUM

D Ferdinand, G Body, L Wells, W Carroll. University of Nottingham, Nottingham, UK

Background: The structure of medical education is an important issue, both for undergraduates and postgraduates. There has been recent debate about creating a national curriculum to standardise all medical graduates. This has the disadvantage of moulding all medical schools to uniformity, thus removing the facets of differing courses that attract a variety of learners. The child health written examination format for undergraduates had to change to conform to university requirements. This necessitated the writing of a new question bank. A previous study showed that the curriculum and learning objectives were not aligned to the existing question bank.

Aims: To establish a new curriculum and set of key learning objectives to direct student learning and guide the writing of new questions.

Methods: Paediatric leads from 24 universities across the United Kingdom were contacted to determine their paediatric syllabus. From the 10 syllabuses received a list of paediatric topics included by these universities was compiled. A questionnaire was devised asking whether each topic was “essential to know”, “important to know”, “nice to know” or “should not be included”. This was delivered in electronic and paper format to 82 doctors in the deanery, ranging from foundation year 1 doctors to consultants, including those in paediatric subspecialities.

Results: The 54 replies were compiled and the results divided into four areas: key diagnoses; presenting complaint/symptom; understanding/attitudes and practical skills. For 82% of key diagnoses, 75% of presenting complaints and understanding/attitudes and 73% of practical skills there was clear agreement on the first round. The remaining items were categorised according to the second round voting when the results were sent to nine doctors who held appointments in medical education or were the lead for teaching in their trust.

Conclusion: From the results a new set of learning objectives have been established that are aimed to be introduced as a pilot scheme for the next academic year. Despite the lack of a national syllabus for undergraduate medical education in paediatrics, there is widespread agreement on areas of importance. Negotiation of an agreed syllabus for undergraduate medical students in child health may help to maintain equivalent standards in paediatric teaching in UK medical schools.

EDU/WED/07 IMPLEMENTATION OF CLEVELAND CLINIC’S “CLINICAL TEACHING EFFECTIVENESS INSTRUMENT” INTO UNDERGRADUATE CHILD HEALTH TEACHING IN A UK SETTING: ANALYSIS OF PILOT DATA

A Barclay, S Allan, J Paton. Division of Developmental Medicine, University of Glasgow, Glasgow, UK

Aims: Clinical teaching in child health occurs across a range of settings and a diverse set of “teachers”. Effective student feedback can help formulate future programme development and improve teaching effectiveness. Limited evidenced-based tools exist to evaluate the quality of clinical teaching in child health. The Cleveland clinic’s clinical teaching effectiveness instrument (CCTEI) is a previously validated 15-point clinical teaching evaluation tool that has primarily been used in north American adult practice.1 The implementation of the CCTEI into child health undergraduate teaching in a UK university hospital is described here.

Methods: After prospective approval, the CCTEI was used as the end of session feedback for clinical teaching “skills stations” sessions (video sessions, simulated patients, bedside teaching). Additional qualitative feedback of student’s opinions of the CCTEI was also gathered. Quantitative results were expressed as a percentage of the maximum possible score.

Results: 224/237 (95%) of distributed forms were completed from 72 teaching hours given by eight clinical tutors. The overall rating of teaching sessions was high (94%). Rating from individual points varied from 88% (Q1, good learning environment) to 56% (Q15, teaches cost-effective practice). Overall, 86% of individual question points were answered. Proportions of question points answered varied from 47% (Q15) to 100% (Q2, stimulates independent learning; Q8, questioning that promotes learning). 55% of forms yielded subjective comments that could inform on future teaching sessions (44% positive, 24% negative). Most negative comments related to reducing the size of teaching groups. Only 44% of forms yielded qualitative information on student’s opinion of the CCTEI. 74% of students who expressed an opinion preferred the CCTEI to other previously used feedback tools. The majority of negative comments related to the need to save resources with an on-line form.

Conclusions: The CCTEI offers standardised and valid feedback for child health teaching using a format that is detailed yet acceptable to students. However, its ability to yield valuable qualitative negative feedback is limited. Cultural (transatlantic) differences in healthcare services and the unique requirements of child health teaching may limit the effectiveness of imported evaluation tools.

EDU/WED/08 THE PARTICIPATION OF CHILDREN AND YOUNG PEOPLE IN CLINICAL TEACHING: UNDERSTANDING PERCEPTIONS, MOTIVES AND CONCERNS

1R Klaber, 2I Pollock. 1Division of Medical Education, University College London, London, UK; 2Barnet and Chase Farm NHS Trust, London, UK

Background: Children and young people are used as cases and standardised patients in clinical exams and teaching across the world. Consultation on the participation of children and young people in Royal College of Paediatrics and Child Health (RCPCH) activity suggests future involvement in education, training and exams as a key area for development.

Aims: To examine the perceptions, motives and concerns of children and young people participating in clinical teaching and to compare these views with those of their parents, trainees and tutors involved in the teaching.

Methods: Consultation and pilot study were used to design a single-page anonymised questionnaire with five-point Likert scales and free-text answers. This was sent to 112 children and young people and parents attending either a Diploma in Child Health or membership of the RCPCH clinical teaching course. Tutors and trainees attending the courses were also asked to complete the same questionnaire. Differences in the results between questions and the four groups were analysed using the Mann–Whitney U test.

Results: 71% (80) of the questionnaires sent to children and young people (26) and parents (54) were completed and returned. For children and young people the major reasons for taking part were the enjoyment of helping people to learn (92% agreement) and wanting to “give something back” (85% agreement). Parents put significantly more emphasis on wanting to “give something back” than anything else (p<0.005), whereas both tutors and trainees felt that the chance to earn pocket money was a more important motivation than anything else (p<0.001). 85% of children and young people disagreed with the statement that they participated because their parents had told them to. The major problem, highlighted by all groups, was that it is tiring being repeatedly examined, although tutors (96% agreement) and trainees (90% agreement) were more concerned about this than children and young people (43% agreement) and parents (35% agreement). All groups strongly agreed on the educational value for the trainees of children and young people participating. Of all of the 167 respondents, only one tutor stated that they would not recommend other children and young people to participate. All children and young people and parents said that they would participate in clinical teaching in the future.

Conclusions: This study demonstrates that in the context of well-planned, structured clinical teaching, most children and young people are primarily motivated to participate in order to help educate doctors. Further exploration of the potential involvement of children and young people in the future education and training of paediatricians is needed.

EDU/WED/09 TOO BUSY TO TEACH? SPECIALIST REGISTRARS’ PERCEPTIONS OF THEIR ROLE AS CLINICAL EDUCATORS

1T Bindal, 2D Wall, 2H Goodyear. 1University Hospital of North Staffordshire NHS Trust, West Midlands, UK; 2West Midlands Deanery, West Midlands, UK

Background: The General Medical Council gives guidance on doctors’ educational obligations. All doctors should be prepared to oversee the work of less experienced colleagues and ensure that students and junior doctors are properly supervised. Implementation of the European Working Time Directive and Modernising Medical Careers could hinder this process.

Aims: To explore paediatric specialist registrars’ views in the West Midlands region on their teaching activities and training in medical education.

Method: Questionnaires were distributed to all 133 specialist registrars at regional training days and via e-mail to those who did not attend over a 3-month period.

Results: The response rate was 92% (122/133) with 54% being female and 80% working full time. A majority teach junior trainees (97%, 118) and students (92%, 112). Informal and formal teaching is done by 73% (89). Most teaching is done at the bedside (96%, 117), through lectures (90%, 110) and on ward rounds (81%, 99). Approximately half of the trainees are doing 1 h teaching in the day and half this time at night. Factors that inhibit teaching include being too busy (68%, 83), shift pattern (48%, 58) and inexperience (16%, 20). Over half (55%, 67) the specialist registrars had done some formal training in teaching, most commonly a “teach the teacher” course followed by generic resuscitation instructor courses. Three-quarters of specialist registrars felt that teaching should be recognised formally. Developing specialist registrars as educators was felt to be best achieved through mandatory training (61%, 74), themed regional specialist registrar training days on education (61%, 74) and deanery funding for education conferences (51%, 62).

Conclusions: It is encouraging that specialist registrars are still able to make a contribution to education within the current working climate. However, factors that inhibit teaching will have a greater impact as the number of contracted hours per week reduces to 48 by 2009. Deaneries should equip specialist registrars to teach in a stressful and busy environment by providing formal teaching. At a local level specialist registrars need support and motivation in their role as clinical educators.

EDU/WED/10 DEVELOPING A TOOLKIT FOR THE EQUITY PROJECT: CHALLENGES AND SOLUTIONS FOR TEACHING CHILDREN’S RIGHTS

S Haroon. Advocacy Committee, RCPCH, London, UK

Background: The development of curricular competencies and the Equity Project have been major steps in integrating children’s rights into paediatric training. Education and training are fundamental to facilitating the operationalisation of this field. To this end, several paediatricians, medical educators, children’s rights specialists and non-governmental organisations held a workshop.

Aim: To develop a toolkit for paediatricians effectively to teach and assess children’s rights, advocacy, social justice and equity.

Challenges: These included: the paucity of evidence to inform effective child rights’ teaching and its assessment; a pedagogical responsibility to transform the learning environments trainees navigated; needing to cultivate approaches that tackled the wider determinants of health; ensuring children’s rights were not ghettoised into community paediatrics but seen as relevant to all subspecialities; facilitating attitudinal change as well as enhancing knowledge; appreciating different levels of trainees’ understanding and their sociocultural preconceptions of the field; harnessing work developed by non-governmental organisations; developing a cadre of trainers for the toolkit’s national implementation and ensuring children remained central to the project’s purpose.

Solutions: Following intense debate, the toolkit’s fundamental constructs were agreed for further development by several working groups. Central to moving this initiative forward was the use of the workshop to draw upon the diverse experience of the participants, utilise social, experiential and collaborative learning theory and assessment theory, share examples of current teaching initiatives and models about children’s rights and the embedment of the true meaning of children’s participation as pivotal to the objectives.

Conclusion: Developing this toolkit was an exciting yet complex challenge. The concepts considered and approaches taken provide valuable lessons for others developing similar training packages that require not only the transmission of knowledge and impartation of skills but also the inculcation of the values of professionals.

EDU/WED/11 CAN JUNIOR DOCTORS PRESCRIBE?

1C Brown, 2A Hart, 2S Clark. 1University of Sheffield, Sheffield, UK; 2Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK

Background: Prescribing errors are common, despite the General Medical Council identifying prescribing skills as a component of good medical practice. Many errors are minor but occasionally serious errors are made that can harm or kill a patient. The true prevalence of major and minor prescribing errors is unknown, as many are corrected by staff or go unnoticed/unreported.

Aims: To assess the prescribing skills of junior doctors.

Methods: 230 doctors applying for paediatric ST1–4 training posts in the deanery were asked to complete a hospital drug chart using paediatric clinical scenarios of a suitable difficulty for their postgraduate level. The prescribing skills of candidates were evaluated using published standards. General prescribing skills and the frequency of serious errors were also assessed. ST1 applicants, who had completed foundation training and attained the core competency in prescribing skills, were compared with applicants for more senior posts who had received traditional training.

Findings: Prescribing skills were generally poor. Only one applicant (0.4% of all doctors) completed the entire drug chart correctly. Two scenarios (n  =  101, ST1 and 3) involved a child with a clearly documented previous adverse drug reaction. 40 (36.9%) of ST1 and 3 applicants prescribed or did not discontinue a medication that could seriously harm the patient. ST1 applicants were not significantly better at prescribing than those applying for more senior positions.

Interpretation: Junior doctors’ prescribing skills are poor. Although not examined in a clinical setting, these findings have implications for patient safety and the training of undergraduates and postgraduates. Foundation year training, which lists prescribing skills as a core competency, does not appear to train doctors in prescribing better than traditional methods. Further descriptive work is needed to assess doctors’ prescribing ability across all specialities and grades to allow for targeted training. In the meantime, we should not assume that training of good prescribing techniques occurs “on the job”, as many of the more experienced juniors, who are expected to act as educators, have poor prescribing skills themselves.

EDU/WED/12 IMMEDIATE FEEDBACK AND SOAPP FORMAT IMPROVES MEDICAL RECORD KEEPING

K Catford, S O’Sullivan, R Lakshman. West Suffolk Hospital, Suffolk, UK

Aims: To assess whether a period of rapid feedback to paediatric junior doctors improves the quality of their documentation at the morning ward round.

Methods: Notes were examined for accuracy and content of documentation (date, signature, record of the state of the child, the completeness of objective information, diagnosis, plan for tests and treatment and record of explanation and education provided to the child and family) after morning ward rounds. A score was calculated for each set of notes by giving one unit value to each piece of missing information. This was done at baseline with no intervention, during a period in which the junior doctors were given immediate feedback on their note-keeping and again approximately a month after the feedback period was over.

Results: Baseline information (pre-intervention, n  =  63) showed 5.49 missing units of data per case note. Notes using a problem-orientated format (SOAPP) had fewer missing data units (n  =  31, missing data 119) than those not using that format (n  =  32, missing data 227). Twenty-eight notes were examined during the feedback phase and there were 3.71 missing data units per case note. In the third phase (post-intervention, n  =  56), there were 2.26 missing data units per case note. The use of a problem-orientated format had increased from 49% at baseline to 70% at the end of the third phase.

Conclusion: The use of a SOAPP format and immediate feedback on performance leads to a sustained improvement in the quality of information recorded in medical records.

EDU/WED/13 CHILD PROTECTION TRAINING AND EXPERIENCE: A REGIONAL AUDIT OF PAEDIATRIC INTERNATIONAL GRADUATES

S Hosdurga, F Finlay. Community Child Health Department, Bath, UK

Introduction: The recognition of child protection training is not new but the need for the timely training of overseas professionals is unrecognised.

Aim: To study the overseas doctor’s training and experience in child protection while abroad and within the United Kingdom.

Method: A pre-piloted questionnaire was given to 50 paediatric junior doctors who qualified overseas and were working in the southwest region. The local audit committee approved this study. The first and second sections of the questionnaire asked about their training and experience overseas and in the United Kingdom, respectively.

Results: There was a good response rate: 82% (41/50). Responders were from 15 nations working in various grades. Foundation doctors, senior house officers and specialist trainees (42%), specialist registrars (44%) and staff grades, clinical fellows (14%). 63% qualified in India, the other 37% in Australia, Burma, Egypt, Estonia, Ethiopia, Germany, Italy, Jordan, Latvia, Libya, Nigeria, Poland, Russia and Sudan. Training and experience overseas: 73% had no child protection training as undergraduates. 61% had worked overseas and of these 68% had no child protection training included in their postgraduate curriculum and only 15% had an induction covering child protection during their first hospital placement. 80% said there was no named agency taking the lead in child protection where they worked overseas—“we witnessed child abuse but didn’t know how to help as it is a widespread problem with poor resources”. 72% had no experience of dealing with child abuse outside the United Kingdom. Training and experience in the United Kingdom: 95% had child protection training in the United Kingdom. The timing of training was variable—1st year 49%, 2nd year 25% and 3rd–5th year of their paediatric posts 26%. The duration of training varied: 1–2 h 29%, 1 day 38%, 2 or more days training 33%. 72% had multi-agency training. 71% had child protection included in the induction in their first hospital placement.

Conclusion: This study found that only a small proportion of the doctors trained overseas learn about child protection while overseas. Training in the United Kingdom for 51% did not occur until they had been in the post for 2–5 years. It is recommended that trainees from abroad should be prioritised to get child protection training in the first year of their training in the United Kingdom. Education and information about safeguarding children should be widespread to benefit all children across the globe where child abuse exists but is underestimated.

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