Phua Hwee TANG¹
1 KK Women's & Children's Hospital 

Orientation lecture series covering common on call conditions encountered was implemented for trainees rotating into the department during the first month of posting with quiz at the end. 

Trainees consisting of medical officers with minimal radiology experience and radiology residents from 2019 to 2023 completed the orientation lecture series and took the quiz (consisting of 10 cases with correct answers scored 1 point with maximum score being 10). 

87 trainees (7 medical officers, 80 residents- 21 in 2nd year of residency, 45 in 3rd year of residency, 13 in 4th year of residency, 1 in 5th year of residency) completed the quiz. 71 out of the residents scored at least 5 points giving a pass rate of 82% and overall average score was 6.3. 

The pass rate showed positive correlation with the years of residency with 5/7 (71%) of medical officers, 16/21 (76%) of 2nd year residents, 37/45 (82%) of 3rd year residents, 12/13 (92%) of 4th year residents and the sole 5th year resident scoring at least 5 points. 

Average scores were 5.1 (range from 1 to 8) for medical officers, 6.4 (range from 3 to 9) for 2nd year residents, 6.2 (range from 3 to 9) for 3rd year residents, 7.1 (range from 3 to 10) for 4th year residents and 8 for the 5th year resident. 

Better performance is seen with those with increased years of radiology training and this is in keeping literature showing relationship between studies interpreted in the first three years of residency and performance on the American Board of Radiology Core Examination. 

Conclusions
Performance of radiology trainees is positively correlated with years of radiology training. 

Most trainees pass the quiz after completion of orientation lecture series indicating the orientation program is adequate for most trainees. 

References (maximum three) 

Nickerson JP, Koski C, Anderson JC, Beckett B, Jackson VP. Correlation Between Radiology ACGME Case Logs Values and ABR Core Exam Pass Rate. Acad Radiol. 2020 Feb;27(2):269- 273. doi: 10.1016/j.acra.2019.10.004. Epub 2019 Nov 4. PMID: 31694780. 

Shieh Mei Lai¹
Kim Poh Chan², Rabind Antony Charles³, Li Yi Seah⁴, Rupeng Mong¹, Elaine Ching Ching Tan¹ and Yvonne Guat Keng Goh¹
1 Changi General Hospital
2 Sengkang General Hospital
3 Woodlands Health
4 Joint Committee on Specialist Training

Background

The COVID-19 pandemic affected medical education and examinations around the world, forcing many institutions to cancel examinations, or adapt to the situation with different assessment modes. At the height of the pandemic, Singapore’s Ministry of Health (MOH) instructed healthcare workers to avoid interaction between staff from different institutions. The Emergency Medicine Clinical Viva Exit Examination is a high-stakes examination which, if cancelled, would delay specialist registration. Hence the decision was made in July 2020 to conduct it virtually, using the video conferencing platform Zoom. 

The Clinical viva examination consists of 8 stations, each run by 2 examiners, containing clinical scenarios, with electrocardiograms, radiographs, or laboratory data for interpretation. On examination day, the examiners logged into Zoom using their laptops from home or hospital, and breakout rooms were created for each station. The candidates were at the examination venue, sitting in their own physical room with a laptop. An administrative assistant invigilated, and helped them log into the correct breakout room at each change of station. 

6 candidates sat this examination, and pass rate was 100%. During the examination we encountered problems with network connectivity. One examiner lost connection in the middle of questioning, and the other examiner had to take over for a while. Extra time was allocated to each round, to give allowance for technical difficulties. 

When feedback was obtained, candidates preferred the virtual examination, as it was less intimidating than facing the examiners directly. However, the examiners preferred a physical examination, as it was more stressful for them to share files on Zoom, and deal with technical glitches. 

We found that it was feasible to conduct a postgraduate oral examination virtually during the COVID-19 pandemic. However, good logistical support, reliable internet connection, and extra time allocation, are essential to its smooth running. 

References (maximum three) 

1. Papapanou M, Routsi E, Tsamakis K, Fotis L, Marinos G, Lidoriki I et al. Medical education challenges and innovations during COVID-19 pandemic. Postgrad Med J. 2022 May;98(1159):321-327. doi: 10.1136/postgradmedj-2021-140032. Epub 2021 Mar 29. PMID: 33782202. 

2. Gado AS, Khater RA. Conducting a medical examination in the COVID-19 era: an Egyptian experience. Egypt J Intern Med. 2021;33(1):9. doi: 10.1186/s43162-021-00038-z. Epub 2021 Mar 1. PMID: 33679124; PMCID: PMC7916992. 

3. Gupta VS, Kapur M, Naik M, Mohammad A. Post-graduate exams amidst COVID-19 pandemic: Our experience. Indian J Ophthalmol. 2020 Nov;68(11):2630-2631. doi: 10.4103/ijo.IJO_2672_20. PMID: 33120720; PMCID: PMC7774125. 

Rasmus Soegaard Hansen¹
Michael Dall², Christine Dichmann³, Sune K N Laugesen⁴, Anja Karina Fabrin⁵ and Niels Thomas Hertel⁶
1 Dept. of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
2 Board of Directors, Odense University Hospital, Odense, Denmark
3 Centre for Postgraduate Medical Education, Dep. of Clinical Development, Odense University Hospital, Odense, Denmark
4 Emergency Department, Odense University Hospital, Odense, Denmark
5 Centre for Postgraduate Medical Education and Dept. of Cardiac, Thoracic and Vascular surgery, Odense University Hospital, Odense, Denmark
6 H C Andersens Childrens Hospital, Odense University Hospital, Odense, Denmark 

Background:
Assessing how residents experience their autonomy, learning environment and social support is important, and the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire investigate this. The purpose of this study was to explore which factors that were associated with a high PHEEM score of autonomy, good learning environment and social support. 

Summary of work:
We evaluated PHEEM responses from 2015 to 2022 for residents of any medical specialty and all levels working at Odense University Hospital (1). Besides PHEEM responses, data regarding age, gender, department, medical specialty, job position and number of meetings with supervisor were assessed. 

Results: 
During the study period, 4399 residents were invited, of which 3389 completed the PHEEM questionnaire. Total PHEEM score was significantly lower in female residents than male residents, and residents in introductory positions had significantly higher total score than residents in specialty training or basic clinical training. No association between age and PHEEM score was found. Residents that had meetings with a supervisor once every second month (0.5 meetings per month) reported a significantly higher PHEEM score than residents had meetings with a supervisor once every fifth month (0.2 meetings per month). 

Discussion:
A systematic review of 30 PHEEM studies found no association between gender and PHEEM score, and further found that entry-level residents had a higher PHEEM score than senior-level (2). However, the included studies were small with about 100 responses in each study. Taking this and our findings into account, indicates that further studies on the potential difference and reasons for such is needed. 

Conclusion:
Our study suggest that male gender, introductory position and more frequent meetings (0.5 meetings per month) with a supervisor is associated with a higher PHEEM score. 

References (maximum three) 

1 Hansen RS, Dall M, Dichmann C, Laugesen SKN, Fabrin AK, Hertel NT (2023). Key Factors Associated with a High Postgraduate Hospital
 Educational Environment Measure (PHEEM) score. (Manuscript in 

preparation). 

2 Chan CY, Sum MY, Lim WS, Chew NW, Samarasekera DD, Sim K. Adoption and correlates of Postgraduate Hospital Educational Environment Measure
 (PHEEM) in the evaluation of learning environments - A systematic review. 

Med Teach 2016;38(12):1248-55. 

Interns' Self-Assessment of Clinical Skills and Upskills Needs 

Dr.Chestsada Tonusin,MD.

Sunprasitthiprasong Hospital, Thailand

The Thai Medical Council (TMC) has launched an internship program for newly graduated doctors since 1994 to enhance skills needed for medical practice. During internship, all interns are assessed by using workplace-based assessment (WPA); EPA, DOPS, and multi-source feedback to assess clinical skills, procedural skills, attitudes, communication skills, and professionalism, by the intern training center. About 2,700 doctors participate in internship each year, but their individual learning needs during this period might be specific. The program does not focus on their needs and views. This study focuses on interns' perspectives during their internship and aimed to find out which tasks interns perceived as weak points in their medical practice and need to improve before finishing an internship.

Forty-seven doctors who participated in the internship program at Sunpasitthiprasong Hospital in 2023 were assigned to complete online questionnaires. The questionnaires assessed their self-rated proficiency in clinical and procedural skills based on the TMC criteria and their identification of areas needing improvement. Thirty-nine from 47 questionnaires were sent back.

Interns rated their clinical skills fair to exellent(94.9%, 37 interns), and need to improve (5.1%,2 interns). Interns expressed highest confidence in history taking(37.9%, 30 interns), physical examination(26.6%, 21 interns), Diagnosis(15.2%, 12 interns), investigation and interpretation(19%,15 interns). During internship, 33 of 39 interns requested more training mainly on medical procedures, including emergency procedures. 11 interns requested emergency management training, one requested information on the referral system, and four requested no further training.

According to their self-assessments, 94.9% of interns met TMC clinical skill standards. While most interns need to upskills , especially on clinical procedures and emergency management.

The intern training center should provide faculty activities focused on clinical procedures during internship. Future researches direction on exploring types of procedural training for interns should be performed.

Targeted procedural training during internship boosts confidence and preparedness for emergencies.

Reference:

1.         Thai Medical Council. (2023, February 14). Internship program 2023. Retrieved from https://www.tmc.or.th/tmc_clinical/Clinical-2566.php

Sandy Kujumdshiev¹
Ulrich Sack², Mohamed Farag³, Claude Lambert⁴, Rachid Soulimani⁵, Eleni Efthimiadou⁶, Working group⁷, Mahmoud Seddik⁸ and Reham Hammad⁹
1 Clinical Immunology, Medical Faculty, Leipzig University, Germany; DHGS German University of Health and Sport, Berlin, Germany
2 Clinical Immunology, Medical Faculty, Leipzig University, Germany
3 Immunology Lab, Botany and Microbiology Department, Faculty of Science (for Boys) Al- Azhar University, Cairo, Egypt
4 Clinical Immunology, St. Etienne University Hospital, France
5 Neurotoxicology, Development and Bioactivity, University Lorraine, France
6 Department of Chemistry, National and Kapodistrian University of Athens, Greece
7 IMCert staff educators from Al-Azhar, Cairo, Ain-Shams, Damanhour and Aswan University, Egypt
8 Vice president of Al-Azhar University for Postgraduate and Research, Al-Azhar University, Cairo, Egypt
9 Clinical Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt

Background
IMCert is an approved proposal in the “Capacity building in the field of higher education” Erasmus plus. The aim was to develop a postgraduate study course in cooperation between Egypt, France, Germany and Greece. Before implementation of all nine modules of the certificate we piloted three of them. 

Summary Of Work
44 participants from Egyptian universities (Al-Azhar, Cairo, Ain-Shams, Damanhour and Aswan University) attended the three Al-Azhar University’ modules. Nine medical, 11 pharmaceutical and 24 natural sciences participants (18 males) were selected by questionnaire and expert interview from 1835 applicants. Teaching included theoretical parts online and in physical presence, practical lab parts, PBL cases, videos, worksheets and group discussions. Assessment consisted of written assessment and research proposal writing and presentation. 

To assess the process of the piloting we used questionnaires for participants and teachers. We asked the participants how competent they felt before and after each module (1 not competent at all to 10 very competent). 

Results
In written assessment of the three modules 49 to 75 per cent were answered correctly by the participants. 

Participants rated their competency in basic immunology with 6.97 (SD 2.4; mean ± SD). before and 8.67 (SD 1.99) after the module. Molecular biology was rated 7 (SD 2.29) before and 8.57 (SD 1,95) afterwards. 

Four of five in teams produced research proposals were very mature.
Public health competency was rated 7.8 (SD 2.31) before and 8.11 (SD 2.19) after. Discussion 

Piloting newly developed curricula before implementing is very important. Participants’ feedback was very good, praising teachers’ expertise. Practical parts need more subgrouping and more teachers to optimize the hands-on learners’ success. 

Conclusions
Optimal teaching methods and assessments together with constructive alignment resulted in increasing participants’ competencies. 

Take-home message
Implementation is starting in September 2023. We will be continuously evaluating and optimizing. 

Belinda Balhatchet
Heike Schutze¹ and Nicole Williams2,3
1 University of New South Wales
2 University of Adelaide
3 Women & Children's Hospital Adelaide

Background
Surgical trainees are at increased risk of burnout and poor wellbeing compared to the general population. Whilst many wellbeing programs have been reported, few have been evaluated from the perspective of those delivering and receiving surgical training. The aim of this study was to evaluate the effectiveness of trainee wellbeing programs in Australian hospitals from the perspective of supervisors and trainees. 

Summary of work
A mixed-methods online survey was distributed to surgical trainees and supervisors across Australia. Participants were asked to identify trainee wellbeing programs at their hospital and provide details of the program, along with their views on their effectiveness in promoting wellbeing. Participants were also asked to identify one change that they would implement to improve trainee wellbeing, and any barriers to implementation. Demographic frequencies were calculated and qualitative data were analysed using an inductive-deductive process using the Job Demands-Resources Model as a scaffold. 

Results
Sixty responses were received. Thirteen (22%) were aware of one or more trainee wellbeing programs at their hospital. Nine of those did not feel that the program was effective and three were unsure of its effectiveness. Key workplace demands identified for targeting with future interventions included: (i) excessive working hours and workload; (ii) lack of support networks; (iii) demanding physical work environment; and (iv) demanding psychological work environment. 

Conclusion
Few surgical supervisors and trainees report being aware of wellbeing programs in their hospitals, and programs that do exist are generally viewed as ineffective. Future interventions should target the most pervasive demands of surgical training including excessive working hours and workload, lack of support networks, and work environments that are physically and psychologically demanding. Collaborative development and active promotion of wellbeing resources with long-term support and funding may improve the effectiveness of interventions for surgical trainee wellbeing. 

References (maximum three) 

Bakker, A. B., & Demerouti, E. (2007). The Job Demands-Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115 

Robert Sedlack¹
1 Mayo Clinic, Rochester MN, USA 

Background & Aims:
In the United States, general surgical residents are required to complete 50 colonoscopies during training.[1] This is felt to be inadequately low by most in the gastroenterology (GI) community, as GI fellows have been repeatedly shown to require on average 250-275 colonoscopies to achieve defined competency thresholds as measured by the Assessment of Competency in Endoscopy (ACE) evaluation tool.[2] This study defines the learning curves of surgical trainees using the ACE tool to determine if CRS fellows can indeed achieve the same competency thresholds earlier. 

Methods: 
In a single center, retrospective descriptive study, 6 years of ACE scores were examined from colonoscopies performed by CRS fellows. Average scores were calculated at intervals of every 25 procedures, and the learning curves described for each metric measured by the ACE tool. 

Results:
17 CRS fellows (M:F 11:6) had an average experience of 108 colonoscopies (range 50-266) prior to CRS fellowship. During fellowship, an average of 138 colonoscopies (range 116 -173) were recorded. Most ACE metrics reached the defined competency thresholds around 300 to 350 procedures. 

Conclusion:
No CRS fellow had achieved the competency thresholds for any ACE metric at the onset of fellowship despite an average of over 100 procedures experience. On average, CRS fellows reached competency in colonoscopy around 300 to 350 procedures of experience, a trajectory similar to slightly delayed compared to previously reported averages for GI fellows. These results call into question the required procedure volumes recommended in surgery training guidelines for colonoscopy. 

References (maximum three) 

[1] Vassiliou MC, Kaneva PA, Poulose BK, et al. How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy? Am J Surg 2010;199:121-5. 

[2] Sedlack RE, Coyle WJ, ACE Research Group. Assessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for colonoscopy. Gastrointest Endosc 2016;83: 524-526. 

Maryam Wagner¹
Carlos Gomez-Garibello², Allan Okrainec³, Neal Seymour⁴ and Melina Vassiliou¹
1 McGill University
2 Institute of Health Sciences Education - McGill University
3 University of Toronto
4 UMass Chan Medical School – Baystate

The Fundamentals of Laparoscopic Surgery (FLS) program is a training and assessment program created to meet the need for the safe introduction of minimally invasive techniques into the clinical environment. Since its launch 15 years ago, over 10,000 candidates have completed the program across 30 countries. However, the developments in the field of laparoscopic surgery have demanded an examination of the program to meet the needs of today’s surgical residents. This paper summarizes the process and key findings of a validation study used to examine FLS uses and interpretations, and the central framework that was developed to inform the development of an updated program. 

An argument-based validity approach1 was used to examine the ways in which FLS is used, and its test outcomes are interpreted. The study yielded six validity claims about the contributions of FLS to education and assessment. Through this process we recognized the need to define the construct of laparoscopic surgery to serve as a ‘framework of reference’ to evaluate the current FLS program (and associated validity claims). This framework was developed through: a literature review, and multiple retreats with subject-matter experts. 

The framework was articulated through a series of 10 entrustable professional activities2 (EPAs) and associated competencies defining the knowledge, skills and attitudes associated with performing laparoscopic surgery at a fundamental level. 

The robust validation study established the need for developing a framework of reference. This EPA-based framework provides: a systematic and meaningful approach to synthesizing numerous competencies; and a framework to create articulated curriculum initiatives, relevant instruction opportunities and trustworthy methods of assessment. 

This paper exemplifies an argument-based validation process to provide actionable guidance to health science education researchers also conducting validation work. Further, it illustrates methods for developing an EPA-based theoretical framework. 

References (maximum three) 

1. Kane MT (1992). An argument-based approach to validity. Psychological Bulletin 112, 527–535. 

2. ten Cate O. Entrustability of professional activities and competency-bases training. Medical education. 2005;39:1176-7. 

Michelle Schlipalius^1,2,3
Kate Reid³
1 Monash University, Melbourne, Australia
2 Monash Health, Melbourne Australia
3 The University of Melbourne, Melbourne, Australia

The apprenticeship model of medical education has been the traditional method to teach procedural skills. However, patient safety concerns, combined with a reduction in working hours, has led to fewer opportunities to acquire procedural skills through practise in the clinical environment. As medical education develops from being based on time and procedure numbers to a competency-based approach, simulation-based mastery learning (SBML) becomes essential, as it enables learners to gain competency at their own pace, without a risk to patients and is independent of opportunities available in the clinical environment(1). 

A scoping review was undertaken to address the research question “what are the outcomes of using SBML to teach healthcare professionals clinical procedural skills?” Ovid Medline, CINAHL Plus, Ovid Emcare, Pubmed and Embase were searched using the terms “simulation- based mastery learning” OR “deliberate practice and mastery learning”. From 736 initially identified articles, 70 met the inclusion criteria. The methodological quality of each article was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). 

The studies were published between 2008 and 2022. Most were performed in the USA, involved post-graduate medical learners, had small participant numbers and involved a single institution. The median MERSQI score was 13.5. Studies evaluated outcomes at Kirkpatrick level one (47% of articles), two (83%), three (27%) and four (14%). Nearly all studies showed an improvement in Kirkpatrick level outcomes. Studies investigating skill retention showed that skill retention and skill decay occurred almost equally. 

The current literature suggests that SBML works!(2) The challenge is for healthcare professional learners, educators, researchers and institutions to acknowledge this, integrate SBML into their curriculums and advance research. Medical education needs to move from the old paradigm of “see one, do one, teach one” to a new era of “see one, practice many, do one”(3). 

References (maximum three) 

1. Nataraja RM, Webb N, Lopez PJ. Simulation in paediatric urology and surgery. Part 1: An overview of educational theory. J Pediatr Urol. 2018;14(2):120-4. 

2. McGaghie WC. Research opportunities in simulation-based medical education using deliberate practice. Acad Emerg Med. 2008;15(11):995-1001. 

3. Hughes PG, Crespo M, Maier T, Whitman A, Ahmed R. Ten tips for maximizing the effectiveness of emergency medicine procedure laboratories. J Am Osteopath Assoc. 2016;116(6):384-90.