Anna Vnuk¹
Aileen Traves¹, Lauren Finlay¹ and Lachlan McIntosh¹
1 James Cook University

Background:
James Cook University is a six-year undergraduate medical degree focussed on developing rural and remote practitioners. While assessment drives learning, educators can benefit from understanding students’ learning strategies and motivations, to develop an engaging curriculum and activities to assist students becoming Self-Regulated Learners(1). Therefore, semi-structured interviews of year 6 students were undertaken to determine how students' learning strategies and motivations change from pre-clinical to clinical years. 

Summary of work:
After de-identification, the research team determined that saturation was reached by 12 interviews. The team validated the coding undertaken by one of the team members and determined emerging themes. 

Results:
Main identified themes were: 

Motivation in pre-clinical years was mostly fear of failure but this changed in clinical years to learning to benefit patients. This coincided with an increased sense of control over their learning. 

Pre-clinical students’ learning strategies did not prepare them for clinical years where they adopted different strategies in response to increase in content. Despite students’ well developed learning strategies, there was minimal discussion about application of knowledge or clinical reasoning. 

Educators should ensure that application of knowledge and clinical reasoning are emphasised over recall of memorised facts in assessment. 

References (maximum three) 

1. Sandars J, Cleary, TJ, (2011) Self-regulation theory: Applications to medical education: AMEE Guide No. 58, Medical Teacher, 33:11, 875-886 

Johanna Klutmann1
 Constanze Dietzsch1, Ute Schlasius-Ratter2, Alexander Oksche2, Sara Volz-Willems1, Johannes Jäger1 and Fabian Dupont1
 1 Department of Family Medicine, Saarland University
2 German Institute for State Examinations in Medicine, Pharmacy, Dentistry and Psychotherapy (IMPP), Mainz, Germany

As digitized assessments become increasingly prevalent, understanding their impact on educational practices is crucial [1,2]. While educators' perspectives have been extensively discussed, little is known about how students perceive this shift [3]. Prior evaluations of tablet- based assessments have revealed students' desire for prompt feedback. This study explores and compares student perspectives on receiving just-in-time formative and summative feedback during tablet-based multiple-choice-question(MCQ) assessments. 

This mixed-methods study comprises two consecutive qualitative (inductive-content-analysis) and quantitative data collection points during the Family Medicine MCQ-tablet-based-exam (year5). Cohort-1 (n=97) received preliminary summative results at the end of the exam, while cohort-2 (n=116) received formative feedback during key feature MCQs. Both cohorts were asked to reflect on their choice and their perceptions and feelings about this new feedback opportunity. 

Distinct categories were generated for each research question. The most common motivation for seeking summative feedback was "Mental closure," while the most prevalent emotion was "Very positive," reflecting enthusiasm in reducing fear or seeking positive reinforcement. Formative feedback was perceived primarily as "Confirmation/Reinforcement" of previously learned content. (To be completed) 

German students seem to appreciate the concept of mental closure and reduction of post-exam anxiety with summative feedback, as well as the confirmation of correct thought processes with formative feedback during digital exams. While in line with our hypothesis, it remains unclear if students consciously recognize the formative effect of assessment for learning as a valuable learning opportunity. 

This study highlights the differences and similarities in students' perception of summative and formative feedback during digital MCQ assessments. It represents an initial step in transitioning towards "digital assessment for learning" in the German medical curriculum. 

Germany's behavioristic approach to education and the influence of culture and social expectations may necessitate further evaluation in future research efforts concerning summative and formative assessments. 

References (maximum three) 

1. Egarter S, Mutschler A, Tekian A, Norcini J, Brass K. Medical assessment in the age of digitalisation. BMC Medical Education. 2020;20(1). 

2. Al-Wardy NM. Assessment methods in undergraduate medical education. Sultan Qaboos Univ Med J. 2010;10(2):203-9. 

3. Sehy V, Struzena J, März M. Wie wünschst du dir dein Feedback? Das neue Wissensprofil des Progress Test Medizin. In: Jahrestagung 

der Gesellschaft für Medizinische Ausbildung (GMA). Zürich, 09.-12.09.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. 

DOI: 10.3205/20gma090, URN: urn:nbn:de:0183-20gma0902 

Yaw-Wen Chang¹
Kwan Yeh², Chih-Chia Wang¹, Fang-Yih Liaw_¹ and Chin-Sheng Lin¹
1 Tri-Service General Hospital, National Defense Medical Center
2 Graduate Institute of Life Sciences, National Defense Medical Center

The Patient-Physician Alliance for Learning (Patient-PAL) program for penultimate year (5th year) medical students focuses on the continuity of patient care. A medical student has to follow up with four to six patients for about three to six months. In this study, we aimed to explore what and how medical students learned beyond medical knowledge. 

This was a mixed-methods study. We used a questionnaire and in-depth interviews to explore Patient-PAL students’ self-evaluations and learning processes. Twelve students participated in this program in 2021. We invited these students to complete the questionnaire and the interviews after finishing the Patient-PAL program in 2022. We used the social constructivist approach to collect and analyze data. 

In quantitative results, we found that the Patient-PAL students had higher self-rated scores on empathy and effective communication. In qualitative analysis, we found three major elements in this program: the student-patient relationship, patient-centered care, and a supportive learning environment. The longitudinal patient follow-up facilitated the development of the student-patient relationship. The students felt trusted by patients and connected with the patient, like a friend of theirs. The students learned empathy and the social determinants of health in this context. The students could provide patient-centered care. In addition to the instructions of preceptors, the students learned to establish effective communication by observing the preceptor’s behaviors or from experiences shared by peers. 

This study found that the student(doctor)-patient relationship is the core element. Continuity of care, the principle of the Patient-PAL program, encourages medical students to develop meaningful relationships with patients and their families. Based on this relationship, the students could have more effective communication and connection and earn patients’ trust, reinforcing their behaviors of demonstrating empathy, knowing patients’ socioeconomic backgrounds, and applying patient-centered care. The continuity with preceptors and peers also provided a supportive learning environment. 

References (maximum three) 

Bowen, J. L., Ilgen, J. S., Irby, D. M., Ten Cate, O., & O’Brien, B. C.(2017). “You have to know the end of the story”: Motivations to follow up after transitions of clinical responsibility. Academic Medicine, 92(11S), S48-S54. 

Chang, Y. W., Hirsh, D. A., Fang, W. H., Li, H., Tzeng, W. C., & Kao, S.(2021). Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study. BMC Medical Education, 21(1), 1-9. 

Grau Canét-Wittkampf, C., Eijkelboom, C., Mol, S., Zwart, D., Hendriks, I., & de Groot, E.(2020). Fostering patient-centrednessby following patients outside the clinical setting: an interview study. BMC Medical Education, 20, 1-8. 

Grace keegan¹
Akash Dharni¹
1 Mid-Yorkshire Teaching Trust

There is evidence suggesting escape rooms can be utilised as a tool for team building and communication1. Few studies evaluate escape rooms as an assessment tool. 

Medical students at the University of Leeds are introduced to ENT, ophthalmology and dermatology in their 3rd year of study. We wanted to create an interactive form of assessment of these specialities. 

The ‘Special Senses’ Escape Room, delivered to 3rd year medical students, utilised logic puzzles created around core topics from these specialities. Students were observed by the doctors who delivered their speciality teaching. A post session debrief was then held. 

Students participated in groups of 2-6. 100% of students found the escape room to be a useful revision tool and would recommend to other students; with 94% of students agreed it was a useful way to consolidate knowledge, and 82% agreed it helped identify knowledge gaps. 100% agreed it encouraged the use of collaboration and communication and would like to see game- based learning included in the curriculum. 

Pre-session, students rated their confidence in ENT, dermatology, and ophthalmology domains. Pre-session 61.6%, 69.2% and 69.3% of students agreed or strongly agreed they were confident in these domains, respectively. Post session 100% agreed or strongly agreed they were confident in ophthalmology domains and 93.7% in dermatology and ENT domains. 

The activity encourages assessment for learning, as it enables students to identify knowledge gaps and receive timely constructive feedback on performance. Student's confidence levels increased after the escape room, highlighting its educational value. 

The escape room is a useful tool to assess medical students and is an enjoyable way of consolidating knowledge and encouraging teamwork and collaboration. 

With increasing demand and interest in gamification as a learning tool, escape rooms highlight a way to incorporate gamification into assessment. 

References (maximum three) 

Guckian J, Eveson L, May H. The great escape? The rise of the escape room in medical education. Future Healthc J. 2020 Jun;7(2):112-115. doi: 10.7861/fhj.2020-0032. PMID: 32550277; PMCID: PMC7296573. 

Pundaree Benjarattanaporn
Nawasiri Siriprasert¹ and Sira Vachatimanont^2,3
1 Chulalongkorn University International Doctor of Medicine Program (CU-MEDi), Faculty of Medicine, Chulalongkorn University
2 Chulalongkorn University
3 King Chulalongkorn Memorial Hospital, Thai Red Cross Society 

PowerPoint and Prezi are popular multimedia tools in medical education. With limited comparative evidence on these software's effectiveness and perception, we conducted a study to assess and compare the impact on knowledge acquisition, retention, and perception among medical students following the utilization of PowerPoint and Prezi in teaching bone mineral density. We aim to understand how these tools enhance assessment-driven learning for medical students. 

The students took a quiz and were divided into two groups. Each group watched recorded lectures with PowerPoint and Prezi, respectively. They took the same test immediately after watching (acquisition test) and 2 weeks afterwards (retention test). The students’ perceptions were obtained from anonymous questionnaires. 

From the class of 35 students, 31 took the pre-test, 35 took the acquisition, 25 took the retention tests. The acquisition test scores (M = 10.0, SD = 1.91) were higher than the pre-test test scores (M = 6.52, SD = 2.58; p <.001). The retention test scores (M = 11.5, SD = 2.28) were higher than the acquisition test (p = .009), and the pre-test (p < .0.001) scores. Between groups, the score increases from the pre-test to the acquisition test (p = .057), the pre-test to the retention test (p = .089), and the retention test to the acquisition test (p = .079) were not different. From the 22 respondents, there were no significant differences between Prezi and PowerPoint in terms of engagingness (p = 0.115), helpfulness for understanding the overview (p = .212), and the problems encountered using the media (p = .121). They found that Prezi was more confusing (p = .034), more distracting (p < .001), and less helpful (p < .001). 

Both PowerPoint and Prezi could lead to similar knowledge acquisition and retention. However, there was a significant preference towards PowerPoint as a teaching medium. 

References (maximum three) 

1. Duffy, R. M., Guerandel, A., Casey, P., Malone, K., & Kelly, B. D. (2015). Experiences of Using Prezi in Psychiatry Teaching. Academic Psychiatry: the journal of the American Association of Directors of Psychiatric Residency Training and the 

Association for Academic Psychiatry, 39(6), 615–619. https://doi.org/10.1007/s40596- 014-0204-x 

Issarawan Keadkraichaiwat¹
Chantacha Sitticharoon¹, Punyapat Maprapho², Nisa Jangboon³, Nadda Wannarat³ and Varanya Srisomsak¹
1 Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University
2 Siriraj Health science Education Excellence center, Faculty of Medicine Siriraj Hospital, Mahidol University
3 Education department, Faculty of Medicine Siriraj Hospital, Mahidol University

Background:
The 2021 Doctor of Medicine curriculum underwent extensive revisions, including specific Course Learning Outcomes (CLOs) design, a shift from compensatory to non-compensatory evaluation, and grading to non-grading evaluation as Outstanding-"O", Satisfactory-"S", and Unsatisfactory-"U". Each CLO assessment allowed unlimited attempts. 

Summary of Work:
This study analyzed data on CLO behaviors and academic performance of first-year medical students, academic year 2021 (n=320), to define the appropriate attempt number for each CLO. 

Results:
For each CLO, mean and median attempts were 2.6-14.9 and 2-8 for total attempts, 2.1-7.6 and 2-7 for intentional attempts, 1.44-4.61 and 1-3 for the first-pass attempt, and 0.85- 2.95 and 0-1 for additional attempts after passing. Highest-scoring attempts ranged from 1.98- 6.84 (mean) and 2-5 (median). "O" students excelled with fewer total CLO attempts than "S"/"U", and "S" students attempted fewer than "U". Summative scores positively correlated with CLO scores, intentional attempts, attempts passing each CLO, and additional attempts but negatively correlated with total attempts and the first-pass attempt. 

Discussion:
Students attempted CLOs multiple times, reflecting their commitment to mastery. "O" students achieved higher scores with fewer total attempts compared to "S" and/or "U" students and also "S" compared to "U" students. Summative scores correlated positively with CLO performance and attempts passing each CLO, suggesting that high formative performance predicted good summative outcomes. However, negative correlations with total attempts and first-pass attempts call for optimizing learning strategies. 

Conclusions:
The non-grading evaluation and unlimited attempts fostered a growth mindset, encouraging students to focus on learning rather than grades. Top performers demonstrated efficient learning. Persistence and performance in individual CLOs influenced academic outcomes. 

Take home messages:
1) Non-grading evaluation with unlimited CLO attempts enhances engagement and learning. 
2) Tailored interventions and support can improve students' learning outcomes. 
3) Factors influencing learning behaviors should be further investigated to optimize curriculum and support systems. 

Saranya Prathaithep¹
1 Sunpasitthiprasong hospital

Evidence-based Medicine (EBM) has been integrated into medical curricular worldwide. There are some evidences support about the appropriate time to early introduction EBM to medical student. The aim of this study was to determine the competency of first-year medical students to perform the skills related to EBM and explore their perceptions after learning. 

54 First-year medical students were invited to join the extracurricular workshop to practice English skills and introduction some skills such as EBM. The workshop consisted of short lecture and followed by practice session. The students were separated into 6 groups and start by developed group’s focused question which relevance to their interest, searched and reviewed articles critically by using PICO model, apply the information to the question followed by group presentations. The student’s performance was observed by their colleagues and 2 staffs. After class they were invited to feedback by using opened end questions about What they have learned? How they feel? And What they expect to the next session? The students’ perceptions were analyzed using thematic analysis. 

All of students were responded. The majority of them reported positive perspective. They perceived that introduction about EBM and literature review by using PICO model was easy and useful to understand research process. All participants noticed that they also have the ability to appraise the information and apply evidence to answer their question effectively and they believed that skills is necessary to develop good clinical skills in the future. Moreover, most of them mentioned about fun and happiness learning atmosphere, they satisfied with team-based learning, practice English and intend to learn more practical skills. 

Discussion And Conclusion 

Early introduction of EBM related skills in the first-year medical students proved favorable and better equipped them with the competency to critical thinking and apprise the research for optimal learning experience. 

References (maximum three) 

YOGESH ACHARYA,M.V. RAGHAVENDRA RAO, and SATEESH ARJA. Evidence-based medicine in pre-clinical years: a study of early introduction and usefulness.
J Adv Med Educ Prof. 2017 Jul; 5(3): 95–100. 

PMCID: PMC5522909 

PMID: 28761882 

Janna Lutze¹
Meredith Kennedy¹
1 Discipline of Nutrition & Dietetics, University of Wollongong 

 

At the University of Wollongong, Nutrition and Dietetics students complete an integrated penultimate year subject (Dietetics Care) that incorporates learning on medical nutrition therapy alongside behavioural counselling and communication. The subject also embeds professional practice skills and behaviours that reflect the National Competency Standards for Dietitians in Australia. 

To prepare students for their final year of professional placement, the following assessment innovations, which showcase current authentic work tasks of dietitians in practice, were implemented. 

The first task was a telehealth consultation to carers of a simulated client. The carer actors were provided with a scripted case and the student dietitian was responsible for coordinating the appointment, preparing relevant prioritised education information and delivering an interactive session in a 15-minute zoom appointment. The appointment was recorded and assessed by two dietitian subject coordinators. This authentic task reflected the increased experiences of dietitians and placement students participating in telehealth consultations following the COVID19 pandemic. The carers were role played by current placement students providing them with opportunity to provide peer mentoring and feedback to students in the year below. 

The second task was interprofessional counselling consultations with exercise science students. Interprofessional pairs conducted telehealth consultations with an authentic community client to support healthy lifestyle interventions. Prior to and after each of the counselling sessions, students engaged with each other and a supervising dietitian or exercise physiologist to discuss their planned strategies and learnings from the experience. Reflective practice was also embedded into this assessment task. 

The final task was the addition of student-led feedback to the dietary counselling exam utilising the Pendleton feedback model. This reflects the most common feedback model reported from dietitian supervisors and aimed to enhance students real time feedback. 

These authentic WIL assessment tasks have enhanced the development of professional skills and behaviours essential for consultations in practice. 

References (maximum three) 

Centre for Advancement of Interprofessional Education (CAIPE). Interprofessional Education Guidelines. 2017. Accessed August 9, 2023. https://www.caipe.org/resources/publications/caipe-publications/caipe-2017- interprofessional-education-guidelines-barr-h-ford-j-gray-r-helme-m-hutchings-m-low-h- machin-reeves-s 

Dietitians Australia (DA). National Competency Standards for Dietitians in Australia. 2021. Accessed August 9, 2023. https://dietitiansaustralia.org.au/working-dietetics/standards-and- scope/national-competency-standards-dietitians 

Pendleton D, Schofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press; 1984.