Byunghoon Ahn¹
Myriam Johnson1, Negar Matin¹, Jean-Sébastien Pelletier^1,2, Liane Feldman^1,3,4, Gerald Fried^5,6,7, Allison Pang^1,2, Taylor Godfrey¹, Byul Han¹, Xinran Zhang¹ and Jason Harley^1,6,4,8
1 McGill University
2 Jewish General Hospital
3 McGill University Health Centre
4 Research Institute of the McGill University Health Centre
5 Steinberg Centre for Simulation and Interactive Learning
6 Education Technology and Innovation
7 Institute of Health Sciences Education

Background
Amid calls for anti-harassment education, scarce research has examined factors for successful interventions. Emotions are recognized as pivotal in simulation-based education[1]; we therefore investigated the roles of emotions when medical residents received harassment bystander simulation training. Our research asked: What emotions pertaining to the bystander simulation were related to different intervention strategies? 

Summary of Work
We analyzed 20 of 32 residents attending the surgical foundations’ objective structured clinical examination (OSCE). Our bystander intervention station required residents to place a central line on a mannikin while a senior resident (actor) verbally harassed a medical student (actor). We assessed six emotions (enjoyment, curiosity, anxiety, boredom, frustration, hopelessness) via the multiple object foci emotion questionnaire (MOFEQ), and identified residents’ intervention strategies (from Right to Be’s 5D strategies[2]) via a checklist. We conducted Kendall’s tau-b tests for analyses. 

Results
The “direct” strategy was significantly negatively correlated to hopelessness (τb(18) = .443, p = .037). The “distract” strategy was significantly positively correlated to frustration (τb(18) = .439, p = .040), but negatively to enjoyment (τb(18) = -.464, p = .030). 

Discussion
Prior emotions research links loss of control to hopelessness[3]; we speculate learners who perceived the risk of challenging the hierarchy conceded control of the situation, thus viewed “direct” as hopelessly unviable. Those using "distract" showed less enjoyment and more frustration, likely driven to intervene by the disruptive nature of the harassment and a desire to regain control. 

Conclusions
Dealing with harassment is an emotionally charged task. Various emotions can be linked to whether residents more directly or passively intervene harassment. 

Emotion-aware training can guide educators on how to better deliver individualized training. Future training and research can target the source of these emotions with the aim of fostering helpful emotions for effective interventions while dampening counterproductive emotions. 

References (maximum three) 

1. LeBlanc VR, Posner GD. Emotions in simulation-based education: friends or foes of learning? Adv Simul. 2022;7(1):3. doi:10.1186/s41077-021-00198-6 

2. The 5Ds of Bystander Intervention. Right to Be. https://righttobe.org/guides/bystander- intervention-training/ 

3. Pekrun R. Achievement emotions: A control-value theory perspective. In: Emotions in Late Modernity. Routledge; 2019:142-157. 

Rachel Winter¹
Andy Ward¹
1 Stoneygate Centre for Empathic Healthcare, Leicester Medical School 

Background:
There is growing recognition that empathy plays a vital role in effective healthcare with multiple benefits for patients and practitioners. Universities and healthcare providers are becoming more invested in empathy training for students and practitioners but evidence suggests this currently lacks consistency, specific learning outcomes and rigorous evaluation. 

Summary of work
The Leicester Foundation Year offers an alternative route into a medical degree for students from less advantaged backgrounds whilst providing an empathy-focused curriculum. The course is assessed via an empathy scale, written reflection, empathy-focused OSCE stations and patient-focused presentations. We asked: 1) What impact does an empathy-focused curriculum have on medical student empathy? 2) How do medical students experience an empathy-focused curriculum and how do they value it? 

A mixed methods approach was employed. Medical students who successfully completed the foundation year between 2017 and 2022 were eligible to take part. Students completed the Jefferson Scale of Empathy questionnaire prior to and after the foundation year. Data was analysed using the paired t-test. Focus groups were carried out with students to explore their experience of the foundation year with thematic analysis used to identify themes. 

Results
One hundred and one responses from four student cohorts were analysed with a significant increase in mean scores post curriculum identified across all cohorts. Themes emerging from four focus groups with third, fourth and fifth year medical students included: real patients provide real learning and empathy is a fundamental to practice. 

Discussion
This study demonstrates that empathy-focused curriculums can enhance student empathy and serve to demonstrate to students the importance of empathy in healthcare practice. Students learning and satisfaction can be enhanced by integrating an empathy-focused approach into the medical school curriculum. 

Take home message
Medical educators should consider integrating activities to enhance empathy in students throughout the curricula 

References (maximum three) 

Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Reiss H. The influences of the patient- clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomised controlled trials. PLoS ONE. 2014;9(4):e94207 

Winter, R., Ward, A., Norman, R.I. et al. A survey of clinical empathy training at UK medical schools. BMC Med Educ 23, 40 (2023). https://doi.org/10.1186/s12909-022-03993-5 

Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159(9):1563–9 

Jung G Kim¹
Christy Boscardin², Eric Holmboe³, Karen Hauer², Kenji Yamazaki⁴, Isabel Chen⁵ and Dowin Boatright¹
1 NYU Grossman School of Medicine
2 UCSF
3 Accreditation Council for Graduate Medical Education
4 Kaiser Permanente Bernard J Tyson School of Medicine

Studies have examined competency rating differences associated with residents’ race/ethnicity and gender, with assessments of professionalism particularly prone to bias.1-3 Program-related factors including racial representation of faculty and the community training site may influence professionalism ratings but are relatively unknown. 

Racial factors with the ACGME professionalism competency for U.S. residents in ACGME- accredited internal medicine programs were examined. ACGME Milestones data were linked with the AAMC and U.S. Area Health Resource File demographic datasets, with two dichotomous graduation outcomes: significantly low and exceedingly high scores. Logistic regression analyses on 14,288 residents graduated in 2017 and 2018 were examined for differences by underrepresented in medicine (URiM) residents, faculty URiM representation, and % non-White residents at the county-level. 

URiM residents had similar mean {SD} scores (7.3 {.84}) with non-URiM (7.4 {.86}). For every quartile increase of URiM program faculty, the odds of having significantly lower scores for all residents increased 30.2 {7.3–125.7; p<.001} and 6.4 (1.4-29.6; p=.02). Increasing odds for exceedingly high scores were found for every quartile increase of URiM faculty: 1.3 (CI=1.2–1.4; p<.001) and 1.5 (CI=1.4–1.6; p<.001). Programs with mostly URiM faculty (46.7%) had residents with lower odds (0.8; CI 0.7–0.8; p<.001} of receiving exceedingly high scores. For every quartile increase of non-White county residents, the odds of having significantly lower scores increased 5.0 {2.3–11.0; p<.001}. 

Racial characteristics for faculty and county-level populations across U.S.-accredited internal medicine residencies predicted differing professionalism assessment graduation scores for all residents versus URiM resident status alone, which did not indicate greater odds of receiving significantly low or exceedingly high scores. 

Further study is needed on program environmental factors that may influence the assessment of residents of core physician competencies such as professionalism during training. 

Trainees may be subjected to differing graduating competency-based ratings based on demographic factors within and outside of residency program settings. 

References (maximum three) 

1. Edgar L, Roberts S, Holmboe E. Milestones 2.0: A Step Forward. J Grad Med Educ. 2018;10(3):367-369. doi:10.4300/JGME-D-18-00372.1 

2. Boatright D, Anderson N, Kim JG, et al. Racial and Ethnic Differences in Internal Medicine Residency Assessments. JAMA Netw Open. 2022;5(12):e2247649. doi:10.1001/jamanetworkopen.2022.47649 

3. Hauer KE, Jurich D, Vandergrift J, et al. Gender Differences in Milestone Ratings and Medical Knowledge Examination Scores Among Internal Medicine Residents. Academic Medicine. 2021;96(6):876-884. doi:10.1097/ACM.0000000000004040 

Kanokrot Kovjiriyapan 

Empathy is the ability to understand other persons feelings and perspectives. In healthcare setting, it improves patient satisfaction, increases adherence to therapy and gets better health outcomel. To improve patient care, promoting empathy in medical students toward colleagues and patients is necessary. 

Summary of work 

At the beginning of the new clinical academic year, we conducted an interprofessional activity for fourth year medical students to enhance empathy. They were assigned to work with hospital porters, operating room workers, nurse aids, pharmacists, nurses for 1 day. After that, a self- report questionnaire is used to evaluate students’ empathy score toward their colleagues and compare with third, fifth and sixth year medical students’ empathy score. 

Results 

There were 26 males and 26 females medical students participating in interprofessional activity. The mean empathy scores in male and female were no significant differences. The mean empathy score (53.46) was highest in sixth-year medical students. The mean empathy score of fourth-year medical students who participated in interprofessional activity was 50.14. 

To improve patient care, the development of empathy among medical students is the important goal for medical educators. There are many methods for promoting and teaching empathy to medical students such as patient narratives, simulated teaching, and interprofessional skills training. It was possible that holistic approach plays a key role in empathy in sixth year students, so the empathy score was highest. On observation the empathy score in fourth year medical students who participated in interprofessional activity was also high. This activity helps them understand the colleagues’ feelings and perspective. However, teaching empathy to medical students needs to continue and using a multimodality approach to shape student empathy during their time in medical school. 

Conclusion
Medical students’ empathy can be promoted by interprofessional activity


Take-home messages 

Medical students’ empathy should be continued to develop. 

References (maximum three) 

Prianna M, Salman YG, Salman GS. A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students. Front Med 2021;758377. 

Megan Anakin¹
1 University of Otago 

Background
Assessing professional conduct can be a challenging task in medical programmes.1 It requires that experienced clinicians find suitable opportunities to observe students in a variety of professional contexts involving patients, other clinicians, and their peers. Clinicians are expected to document their observations and provide constructive feedback to students to support their learning about professional conduct. A clinical educator may be required to interpret feedback from clinical colleagues who have limited opportunities to observe students and who may hold different understandings of the curriculum and standards expected of professional conduct. 

Summary of work
The aim of this work was to use a model of faculty development to design guidance for clinicians who are involved with assessing professional conduct. A reflective exercise was performed on personal notes written from conversations with clinicians, educators, administrators, and students about their experiences related to the assessment of professional conduct. A model of faculty development2 was used to identify cultural, and contextual factors that could complicate and ease the assessment of professional conduct in clinical learning environments. 

Results
The constructed guidance contains a matrix designed to identify possible assessment challenges and address them with constructive advice. The guidance targets specific issues and constraints imposed by the local context while using consistent and familiar language to promote shared expectations among those involved in assessing professional conduct. 

Discussion
This approach to constructing guidance may useful to faculty developers who provide assessment support and advice at their institutions. 

Conclusions
Guidance to assess of professional conduct can be constructed by using a model of faculty development that accounts for social, cultural, and contextual factors related to assessment. 

Implications for further practice
A next step will be to study the impact of this guidance on quality of assessment information generated about students’ professional conduct at our medical school. 

References (maximum three) 

1. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. Academic Medicine. 2009; 84(5):551-8. 

2. O'Sullivan PS, Irby DM. Reframing research on faculty development. Academic Medicine. 2011; 86(4):421-8. 

Marie Therese Lussier¹
Claude Richard², François Goulet³, Bernard Martineau⁴, Olivier Jamoulle⁵, Issam Tanoubi⁶ and Jocelyne Bonin⁷
1 Family Medicine and Emergency Medicine Department, Faculty of medicine, Université de Montréal
2 Centre intégré de santé et des services sociaux de Laval
3 Department of FM and EM, Université de Montréal
4 Family Medicine and Emergency medicine Department, Université de Sherbrooke
5 Department of paediatrics, Université de Montreal
6 Department of anesthesiology, Université de Montréal
7 Collège des médecins du Québec

Background:
Effective professional communication is essential to, and inextricably linked with, quality care. Recent transformations in society and healthcare systems have influenced the way in which healthcare providers (HCP) and patients interact. HCP thus need to acquire both technical/clinical knowledge as well as communication/relational skills to cope with the growing complexities of the healthcare environment. Although major improvements in medical school pre-graduate and graduate communication curricula have occurred in recent decades, relatively few communication skills programs are offered in continuing professional development (CPD) activities. 

Summary of work:
The Collège des médecins du Québec (CMQ) is the professional order for Quebec (Canada) physicians. Its Professional Development and Remediation Department’s (PDRD) responsibilities include the development and dispensation of various types of professional development, upgrading and remediation activities for physicians in practice. A health care communication workshop has been offered by the PDRD since 2010. The aim of this e-poster is to present the structure and content of the “Défis et opportunités de la communication professionnelle” workshop as well as the varied pedagogical approaches (theoretical frameworks, lectures, clinical vignettes, video clips, discussions) applied. Specifically, recent workshop adaptations to include experiential learning activities (reflective exercises and role playing) better suited to the mastery of communication skills will be presented as well as the workshop assessments by the participating practicing physicians. 

Results
At the time of the conference, a description of the workshop and its recent updates will be presented. Also, a four-year trend in workshop attendance statistics and participant evaluations will be available. Evaluation forms comprise the following items : 1) Socio-professional data; 2) Format type (virtual or onsite) 3) Quality of teaching materials; 4) Quality of workshop facilitation; 5) CanMeds roles covered; 6) Pre-post workshop comparison of degree of comfort with the stated objectives; 

References (maximum three) 

7) Communication changes to be put in practice; and 8) Perceived areas of professional communication improvement. 

Discussion 

The multimodal pedagogical approaches used in this CPD learning activity seems well suited to the development of professional communication competency. Of all the workshops developed by the CMQ, it is the most popular and the demand is increasing. 

Conclusions 

Through its interactive format and with the help of relevant and realistic scenarios, this workshop leads physicians in practice to use tools and frameworks to support harmonious and effective communication with patients, colleagues and other healthcare professional 

Take-home message 

Educational programs aiming at improving communication competency require both theoretical content and opportunity to practice skills. 

Richard C, Lussier MT (Scientific editors). La communication professionnelle en santé. Second Edition, (2016) Pearson-ERPI, Montreal, 828p. 

Silverman J, Kurts S, Draper J. Skills for communicating with patients. Third Edition (2013). CRC Press, London UK, 305p. 

Melanie Fentoullis¹
Megan Kalucy¹, Amanda Burdett¹ and John Booth¹
1 UNSW

Increasingly, cutting-edge health care requires multidisciplinary team-based care, with ever more sophisticated teamwork and communication skills needed, to enhance and deliver safe high-quality patient care. Globally, there have been repeated calls for wider-scale implementation of IPL across education and clinical settings[i]. 

In 2021 we designed a program bringing together UNSW’s exercise physiology and medical students to learn in clinical teams within a simulated workplace “Tele-hospital” (Microsoft Teams platform). Asynchronous online activities prepared students to: 

Students engaged in facilitated interdisciplinary peer group discussion through online workshops or as self-directed group sessions within the ‘Tele-hospital’. 

Modelling authentic real world clinical practice, the medical students review a patient medical record and write a referral to their exercise physiology student peers regarding their patient’s care. Similarly, the exercise physiology students receive this referral and determine if it is within their scope of practice. The exercise physiology students then review this patient’s assessment and generate a report to the referrer, in which they communicate which aspects of the patient’s care were addressed in response to the referral and those which are outside their scope of practice. 

The provision of immediate actionable feedback is facilitated through guided assessment forms (rubric) enabling students to evaluate one another’s professional written communication. Through guided reflection on the peer feedback received, students authentically enhance their understanding of the diverse roles, and thus appropriate engagement with, the various professionals in our healthcare teams. 

Our program can be readily adapted to other disciplines, health professional training programs, and healthcare workplaces that value and recognise the importance of enhanced teamwork and communication skills to enable multidisciplinary teams to deliver safe high-quality patient care. 

References (maximum three) 

[i] Reeves S., Fletcher S., Barr H., Birch I., Boet S., Davies N., McFadyen A., Rivera J, & Kitto S. (2016) A BEME systematic review of the effects of interprofessional education (update). BEME Guide No 39. Medical Teacher 38.7 

Claire Mustchin¹
1 University Of Melbourne 

Background:
The University of Melbourne Bachelor of Oral Health (BOH) is a 3-year undergraduate degree that prepares students for entry to practice as an Oral health therapist (OHT). The Australian Dental Council (ADC) competencies (1) state that practitioners must be patient-centred, prevention-focused reflexive. Communication skills (CS) and behavioural sciences are taught longitudinally across the BOH curriculum to ensure students attain these competencies. Assessing students and providing personalised feedback assists students in developing these critical skills (2). Students receive feedback on their CS in the teaching clinic and via a reflective assessment in the 2nd year Health Promotion subject. 

Summary of work:
In a role-play scenario, students work in groups and take turns to undertake a conversation about oral health behaviour change (OHBC) with a simulated patient (peer). Using a feedback guide, students provide their group members with feedback about the application of core CS after the conversation takes place. The recorded conversation is submitted with an individual reflection focused on the CS used in the conversation. 

Discussion:
By completing this assessment task, students practice communication for OHBC in a supported environment, receiving feedback from peers and the educator. Reflecting on this experience and peer feedback, students develop new knowledge and determine their own pathway for further practice and development. 

Conclusion:
Reflective practice is a powerful tool for deep learning, critical thinking, and metacognition. It affords students the opportunity to critically engage with their communication style and create a plan for further development of patient-centred communication for behaviour change. 

1. Reflective practice is a powerful learning and assessment tool that supports students in gaining confidence and skills in communication. 

2. Creating supportive settings outside patient clinics allows students to practice and reflect on CS in a low-stakes environment. 

References (maximum three)