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Setting up a teaching programme for surgical core trainees. Experience from the Oxford School of Surgery.

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Lieske B & Soin B

  Department of General Surgery, Royal Berkshire Hospital NHS Foundation Trust,
  Department of General Surgery, Heatherwood and Wexham Park Hospitals NHS Foundation Trust

We report our experience of a Deanery wide monthly teaching programme for all surgical Core Trainees.
Needs analysis by questionnaire to all surgical SHOs in the Oxford Deanery in 2007. Teaching blueprint
mapped on the ISCP Curriculum with one themed teaching session per month. Booklist – a compilation of
recommended reading material and basis of “homework” prior to teaching sessions. Session outline: Each
teaching session consists of three parts, utilising different teaching modalities: 1. “donut round”, a question
and answer session on a set text, enabling trainees to engage with reading material and practise thought
formulation and articulation. 2. Assessment, a brief written test of recall and comprehension of their
“homework”. 3. Small group teaching, discussion of topics with Senior Trainees and Consultants. Feedback
after every session, enabling continuous improvement of the programme, which is now in its third year.

Quality, Not Quantity: A Collaboration of Training Opportunities to Ensure High-quality Surgical Training
Despite EWTD.

Hamdan MF, Vaughan-Shaw PG & Pearson KL

Introduction: Following Calman reforms and ‘New Deal’, implementation of the EWTD is another threat to
surgical training. Our institution has implemented multi-faceted collaborative training opportunities to ensure
Surgical Core Trainees receive the highest quality training.
Method: A 4-pronged approach was developed: Monthly consultant-led dissection-room clinical anatomy
sessions and clinical tutorials were run to improve theoretical knowledge; weekly laparoscopic-simulator
training and daily bleep/registrar-free training lists at the day-surgery unit were available to increase operative
experience. All sessions were advertised and bookable online.
Results: Trainees have logged on average 27 procedures over the past month at the day-surgery unit, of which
25% were trainee performed. Over 18 months, 28 laparoscopic-simulator classes were run while over 8
months, 19 tutorials and anatomy sessions were delivered with average attendance of 10 trainees. Feedback
on all sessions was extremely positive.
Conclusions: Quality training is achievable despite EWTD. Meticulous organisation, coordination and
consultant support are essential to success.
Abbreviations: EWTD          European Working Time Directive
Medical Education in Sub-Saharan Africa

Young L & Shankar S

UK medical training programmes encourage continuing professional development. For anaesthetic
practitioners in sub-Saharan Africa, formal learning opportunities are rare after completion of undergraduate

We participated in an anaesthetic conference in Togo, West Africa, delivering lectures and running practical
workshops. Our delegates comprised 99 enthusiastic nurse anaesthetists from 23 Togolese hospitals. They
were desperate to enhance knowledge of their profession, and to perfect practical skills.

This experience challenged all aspects of lecture delivery and content and “one-to-one” teaching became
“two-to-one” interaction with delegates via an interpreter. Teaching in one’s first language is itself a
demanding task, requiring thorough preparation, without our additional challenge of French translation.

Subsequent to our experience in Togo, we have undergone a period of intensive deliberation and reflection – it
has forced us to scrutinise the way we think about delivering education, and how lucky we are to have the
educational opportunities and resources that we do.

Introduction to theatre and basic surgical and anaesthetic skills. A theatre induction course for third year
medical students.

Knight W & Glaysher M

Institution & contact details
Queen Alexandra Hospital

Traditionally, operating theatres are a sub-optimal educational setting for medical students. Learning
objectives are not clearly defined and many students are intimidated by unfamiliar rituals and procedures. A
poor induction into theatre has a negative impact on learning behaviour and patient safety.
In 2009/10 a theatre induction course was provided for 24 3 year medical students rotating through a DGH. It
was designed to give a grounding in safe theatre practise, an understanding of the surgical care pathway and
to teach basic surgical and anaesthetic skills.
This presentation argues that a formal one day theatre induction course nurtures confidence and adult active
learning behaviour in students, therefore maximising learning opportunities. A good understanding of theatre
practise lends itself to the development of more effective and safe surgical house officers. Furthermore, the
early development and practise of basic surgical skills will help lessen the impact of the EWTD on surgical

This enquiry set out to explore how one component of WPBA, the Consultation Observation Tool (COT), is
currently integrated into teaching and learning about consultations.
Gibbons E

Research Question: In what way does the use of the Consultation Observation Tool meet a trainee’s needs for
learning from a consultation?
Methodology: The findings of this enquiry are derived from interpretation of a case study of educational
practice in action (action research), and are based on my own values, beliefs and experiences of education,
and the use of Workplace based assessment in particular. It therefore operates in a non-positivist paradigm.
Methods: I observed and made an audio recording of a tutorial between the ST1 GP trainee in our practice and
her clinical supervisor (GP trainer). During the tutorial the trainer reviewed two consultations undertaken by
the trainee. A COT assessment was completed for both consultations. The observations and transcript of the
tutorial were analysed to identify themes relevant to the enquiry
Results: Six themes were identified;
Theme 1: Barriers: These were apparent in a number of forms, particularly when the COT assessment was
being undertaken, but were reduced once it was completed.
Theme2: Reconstruction: The skill of the trainer in reconstructing what he saw and heard during the
consultations and interpreting it for the benefit of the development of the trainee was particularly apparent
during the discussions after the COT form had been completed.
Theme 3: The Apprentice: There were a number of situations where the trainer drew on aspects of the
consultation outside the tasks of the COT assessment specifically to promote the trainees development and
Theme 4: Consultation style: There was a particular focus on ‘Understanding the doctor/trainee’
Theme5: Trainee Confidence: Feedback was tailored to specifically address issues of trainee confidence
Theme6: The approach to the COT: The trainer in this case study saw a much greater significance in his role as
a teacher as opposed to that of an assessor.
Conclusions: The COT was designed in its original form to be a task orientated, objective summative
assessment used by RCGP external examiners. In reality teaching GP trainees about consultations within
practice requires a more significant emphasis on the development of an apprentice rather than signing off a
trainee. There is a significant amount of tacit knowledge about understanding patients, doctors and their
consultations which risks being overlooked by the bureaucratic burden of workplace based assessment, and
the use of an assessment tool which was originally designed for a different purpose.

Saving lives with SimMan: Our experience with FY1 Doctors.
Vaughan-Shaw PG & Pearson KL
Thousands of preventable in-hospital deaths occur annually in the UK. Improving simple aspects of acute-care
through simulation-training could save countless lives. We have implemented protected simulation-training
for FY1s.
FY1 doctors attended sessions chaired by experienced faculty and took turns leading simulated scenarios using
Laerdal SimMan®. Scenarios included chest-pain, seizure, acute asthma, sepsis and anaphylaxis. Each scenario
was followed by feedback and teaching.
To date 40 FY1s have participated. Feedback indicates these sessions are worthwhile and relevant. Participants
felt more confident managing clinical emergencies and felt that simulation should become compulsory within
Foundation training.
Simulation involves integration of knowledge, skills, problem-solving ability and communication . The benefits
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of medical simulation have been widely reported and we believe this programme will better prepare FY1s
for treating acutely-ill patients. We aim to incorporate validated assessments of simulated scenarios into our
Foundation curriculum while in accordance with GMC recommendations , undergraduates will also experience
Human Simulators in PALS teaching – The education of all.
Aggarwal D & Jakeman N

This project aimed to bring together the age-old concept of Peer-assisted learning (PAL) with innovative
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Human Patient Simulators (HPS) by having a 5 year medical student teach 3 year peers daunting Emergency
Medicine topics using HPS in a non-threatening, conducive environment.
Objective analysis used 7 unvalidated MCQs, comparing the 6 HPS students to 12 similar tutorial-only students.
Mean scores were 77.1% (Range 71.4-82.9%) for HPS versus 73.7% (Range 60-94.2%) for “non-HPS” students,
indicating this type of teaching may standardise and improve the range of clinical experience, and therefore
test scores as well as acute patient management. Subjective feedback from the HPS session were excellent,
and better than a similar tutorial by the same PAL teacher.
This method of teaching appears to be beneficial to both levels of students involved, and may also provide a
cost benefit to Universities and Hospital academies wishing to participate in such teaching.

The Royal Bournemouth Buddy Scheme for New Foundation Doctors
S Rees S, Honney R, Drake T, Tang E, Raza T & Vassallo M

Junior doctors can no longer rely upon the traditional team structure and the cohesion, unity and support it
provided. A move from free accommodation and a change to a shift based pattern of work, in order to comply
with the EWTD, has meant alternative systems are required to help with the difficult transition from medical
student to doctor. Two years ago a buddying system was introduced for FY1’s starting their career as a doctor
at the Royal Bournemouth Hospital (RBH), it was an informal scheme similar to the ‘Superfamily’ concept
common in many medical schools. In our evaluation of the existing programme we identified a number of
organisational issues and implemented a range of improvements. These changes in turn were then evaluated.
It is hoped that the buddy scheme could be used as a template for other hospitals both within Wessex and
further a field.

An African experience of nursing education
Ribbons T, Faurie M & Oosthuizen G

South Africa is renowned for being a divided country in the wake of apartheid. This is evident in the healthcare
system. In the private sector nursing staff receive postgraduate training and go on to become specialists in
their branch of nursing, much as in the UK. In the old township state hospital there is little or no postgraduate
training available to nursing staff. This has led to a downward spiral of poor ward care in many state
institutions, with poor working relationships between doctors and nursing staff.
I set up a weekly “in-service” training program for the surgical ward nursing staff at Edendale Hospital, Kwa-
Zulu Natal – an ex-“black” township hospital. There was resistance to the program from several of the senior
nursing staff. My key results were (a) improved understanding of the importance of vital signs and the need to
report them, and (b)enthusiasm and participation at the teaching sessions.

Designing a ‘hernia study guide’ for medical students attached to general surgery at Southampton General
Hospital using the help of the ‘TRACKER’ mnemonic.
Tzouliadis L

Title: Designing a ‘hernia study guide’ for medical students attached to general surgery at Southampton
General Hospital using the help of the ‘TRACKER’ mnemonic.
Aims: Medical students often have a poor understanding of different types of abdominal wall hernias and their
diagnosis and management. A study guide to aid learning was developed.
Results: By using the ‘TRACKER’ mnemonic – (targets, route of study, assessment activities, core information,
key tips, educational opportunities, readable material) a study guide was developed to aid learning and
Conclusion: The ‘TRACKER’ mnemonic facilitates the design of a comprehensive study guide in a chosen area
of the medical curriculum.
The impact of feedback on medical education
Najran P & Matharu G

Aims: To determine whether feedback given by medical students does improve the standard of education.
Methods: Students were given three lectures based teaching sessions on neck of femur fracture, ankle
fracture and basic trauma management. They were then given a basic test and questionnaire. The feedback
was noted and teaching was changed accordingly. The same test was given and the results had improved from
the previous group.
Results: After the teaching sessions were delivered they were given a test comprising of ten questions in which
the average result was 50%. The students suggested replacing lecture-based teaching with bedside teaching.
The test results improved to 80%.
Discussion: This demonstrates the importance of feedback. Being dynamic in teaching and introducing
different methods, this audit demonstrates how this can significantly improve teaching.
Conclusions: Introducing a variety of teaching methods is essential, especially when teaching surgical topics.
Acting on feedback is essential, there are far too many occasions where feedback questionnaires are
introduced but not acted on, this demonstrates how education can improve significantly by simply acting on

A Learner Directed Approach to Teaching Medical Students
Dulay GS

Introduction: When medical students are given control over the content of teaching sessions the educational
format changes to a more learner directed approach (LDA). This approach aims to facilitate effective learning.
Aims & Objectives: To discover whether a LDA to teaching would be more effective than a traditional pre-
formed lecture.
Methods: Groups of medical students were taught on topics using both a pre-formed lecture and a LDA. The
latter entailed conducting a session based upon specific questions the students had about the topic from the
outset. Formal feedback was subsequently sought and amendments made to the teaching.
Results: Students felt they gained more from the LDA. Furthermore, the undertaking of further independent
learning was greater after LDA teaching sessions.
Conclusion: Students stated they gained greater educational value from teaching sessions that they were able
to direct compared to delivery of a traditional pre-formed lecture.

Fluid balance knowledge in medical students can be improved using a multi-dimensional teaching
Wilson J & Taylor MG

Background: Undergraduate experience in practical fluid prescribing is frequently reported to be sub-optimal.
The aim of this project was to improve intravenous fluid prescribing by designing a final year medical student
teaching programme which would: a) improve knowledge of fluid physiology, b) provide practical experience
of fluid prescribing.
Methods: Students were assessed at the start and end of the programme using a portfolio of case summaries
(i.e. fluid overload, septic shock, etc) together with extended-matching questions. They were taught about
aspects of evidence-based fluid balance using interactive lectures, course materials and small group teaching
sessions. Results: Students demonstrated a 21% improvement in mean assessment scores between start and
end, from 60.5% (95% CI: 57.5 to 64) to 81.5% (77-86).
Key Messages: A targeted teaching module incorporating practical experience can improve peri-operative fluid
balance knowledge. The programme could be developed into a universal tool for students and foundation

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