Caitlin Louey¹
Antonia Zeng², Simone Roberts³, Michelle Leech³, Julia Harrison³, Claire Palermo³ and Arunaz Kumar³
1 Melbourne Health
2 Eastern Health
3 Monash University

Preparedness for practice (P4P) encompasses experience, knowledge, confidence, self- awareness, accountability, resilience and competency (1). While studies have defined P4P, few have evaluated P4P and the influence of assessment on it from the medical student perspective. This study examined how prepared medical students feel for practice and the experiences which contributed to or hindered this. 

A survey was conducted with 365 of 442 (82.6%) final-year medical students from Monash University, evaluating their perceived preparedness across eight competency areas defined by the Australian Medical Council criteria (2); core clinical competencies, features of working within a hospital system and skills involving patient management, documentation, procedures, self-management, teamwork and professionalism. Using Likert scales (1=no confidence to 5=very confident) and open-ended responses, students rated and elaborated on their confidence levels in various skills. Descriptive statistics analysed quantitative data and content analysis was applied to qualitative data. 

Results showed a median Likert rating of 4 across six of the eight competency areas. Assessment was raised as a key factor which both helped and hindered student perception of their preparedness. Assessment with feedback was identified as beneficial for learning because albeit stressful, it provided a motivating opportunity for revision and improvement. Other factors influencing confidence included adequacy of opportunities to practice, experiences relating to clinical placement, supportive or unsupportive learning environments, personal attributes, life experience and curriculum design. 

Overall, students reported feeling well prepared for most areas of practice and reported greater confidence in areas with increased high quality practice opportunities. This highlights the importance for medical curricula to provide ample skill practice opportunities and incorporate supportive learning environments that mirror real-life clinical settings to help facilitate students' transition to the workplace. 

References (maximum three) 

Laura Culver Edgar¹
Kenji Yamazaki² and Eric Holmboe¹
1 ACGME
2 Accreditation Council For Graduate Medical Education

The Accreditation Council for Graduate medical Education (ACGME) accredits over 12,000 post-graduate medical education (PGME) programs in the USA and ACGME-International accredits nearly 200 programs in 11 countries. Systems-based practice (SBP) is a core competency for these programs. This competency ensures physicians are prepared to work in complex care systems, identify necessary resources, provide transitions of care, and other tasks while ensuring patient safety and continual practice improvement. To ensure development of this competency, PGME learners are assessed against developmental descriptors specific to SBP throughout their training. These assessments are submitted by all PGME programs to ACGME and ACGME-I biannually. The preparation and assessment of future physicians in systems-based practice is codified through a set of developmental trajectories called Milestones organized by competency and subcompetency. The Milestones are described from Level 1 (novice), Level 2 (advanced beginner), Level 3 (competent), Level 4 (proficient), and Level 5 (expert). It is intended that PGME physicians will achieve these levels at various times during their training programs. The subcompetencies include: patient safety and quality improvement, coordination of care, transitions of care, local population health, health care cost/payment, and physician roles in healthcare systems. 

However, implementation around these subcompetencies remains a challenge due to multiple factors including: 1) lack of programmatic and faculty expertise in SBP; 2) difficulties in designing and implementing curricular experiences; 3) lack or ineffective use of assessment methods. 

PGME leadership continues to struggle with assessing competencies related to the working in the healthcare system. By having more explicit definitions and descriptions of these competencies we can plan better assessment and ongoing training. 

The objectives are to: develop an understanding of the identified subcompetencies; identify how they are assessed (Milestones); using data collected from ACGME and ACGME-I accredited programs demonstrate how PGME physicians grow in these areas – data will include national box plots by post graduate year and validity data regarding longitudinal learning trajectories by subcompetency. Important validity studies will be highlighted; and finally, the panelists will discuss how the SBP competency data indicates the substantial variation in the preparation of PGME physicians entering unsupervised practice. 

Who should participate?
ALL


Level of workshop
ALL 

Despite the clear need for all physicians to possess these key abilities to meet population and healthcare system needs, the data demonstrates on-going global challenges with these important concepts and abilities. The Milestones data clarifies these challenges, supporting changes in curriculum and assessment in PGME training programs. 

We must also recognize the interdependence of physicians' abilities with the challenging hospital environment. Hospitals will need to help all professionals learn and apply systems- thinking, finding ways to reduce unnecessary complexity in clinical care, increasing learning opportunities for PGME physicians to better prepare them for practice, and work as interprofessional teams to ensure that PGME physicians of today are able to thrive and succeed as partners tomorrow. 

References (maximum three) 

Rebecca Roubin¹
James Pan¹, Rebekah Moles¹ and Betty Chaar¹
1 The University of Sydney Pharmacy School

Background
Work-readiness, a blend of competencies and attributes favourable to employers, is vital in various professions, including pharmacy. Four significant determinants of an individual's work-readiness include personal characteristics, organisational acumen, work competence, and social intelligence. In the context of pharmacy, the Australian Pharmacy Council's accreditation standards define fitness-to-practise from both personal (capability) and competency perspectives. 

Summary of Work
The study compared indicators of work-readiness between final year students in 4-year undergraduate B.Pharm and 2-year accelerated graduate-entry M.Pharm programs between 2018-2020. A mixed-methods approach was adopted, with quantitative analysis of similar competency-based assessments, including simulated case marks, overall tutorial performance, and final unit marks. Triangulation of data was carried out through focus groups and analysed using inductive content analysis, mapping to self-determination theory to explore students' perceptions of work-readiness. 

Results
Analysis revealed no significant differences in competency-based assessment performance criteria between B.Pharm and M.Pharm programs. Focus groups exhibited high confidence levels in both programs with no major disparities in four emerging themes: Learning on Clinical Placements, Work Experience, Simulation-Based Learning and Assessment, and Community Pharmacy Focus. 

Discussion
The lack of disparities between the two programs challenges conventional perceptions about the differences in undergraduate and graduate-entry education. This suggests that both programs effectively nurture the required attributes for work-readiness. Themes emerging from the study reflect essential aspects of work-readiness, reiterating the importance of real-world experience and simulation-based learning in the curriculum. 

Conclusions

Both undergraduate and graduate-entry programs equally prepare students for entry-level pharmacist work-readiness. The balanced focus on theoretical knowledge, hands-on clinical experience, and attitudinal aspects could be contributing to this alignment in competencies. 

Take-homeMessages
Since both educational paths appear equally effective, emphasis might shift to individualised learning experiences. Such understanding paves the way for more adaptive, student-centred approaches in pharmacy education and may serve as a model for other health professionals. 

References (maximum three) 

Caballero CL et al (2011) J Teach Learn Grad Employability, 2:41-54 

STEPHEN TOBIN¹
Caroline Joyce² and Carl Parsons³
1 ANZAHPE, ASME, WSU Medicine
2 Western Sydney Univiersity
3 Western Sydney University

Work readiness as a concept has emerged strongly over the last few years. Well-structured clinical experiences, progressive assessment with workplace-based assessments (WBAs) and examinations can assure medical schools that their final-year medical students are meeting the standards expected and required for internship (PGY1). 

Students at Western Sydney University (WSU) participate in learning through clinical immersion, complemented by a system of assessment including entrustable professional activities (EPAs), term reports, long-case examination (also in workplace), online applied knowledge examinations, prescribing skills assessment, and case-based discussions (CBD), This system ensures that students are meeting graduate outcomes. Extensive use of EPAs and term reports have provided much quantitative and qualitative data since 2020. Dynamic analytics have been developed and trialled in 2023. Evaluation was conducted to determine the value and role of EPAs within this system. 

Results have shown correlations between the online applied knowledge examinations and the prescribing skills assessment. The number of EPAs (mean 52) did not significantly correlate with the summative assessment scores. CBD assessments replicate clinical reasoning and management. There was some association between the number of completed EPAs and CBD performance. 

This system of assessment tests applied knowledge and clinical performance. It assures that standards are met and demonstrates preparedness for PGY1. EPAs and term reports demonstrate that final-year medical students can be entrusted with common clinical tasks at specified supervision levels. CBDs provide a checkpoint. The evidence that supports the School of Medicine decision (initially COVID-19 related) to discontinue final-year OSCEs. 

Our take-home messages are that EPAs have a valid role for senior stage medical students, late-in-course OSCEs are not required and that applied examinations should remain. Apart from active monitoring and coaching, the School intends to develop this system towards progress panel review. 

References (maximum three) 

Norcini J et al, 2018 Consensus framework for good assessment Medical Teacher 2018; 40:1102-1109 

Heeneman S et al, Ottawa 2020 consensus statements for programmatic assessment - 1. Agreement on the principles Medical Teacher 2021; 43: 1139-1148 

Torre D et al, Ottawa 2020 consensus statements for programmatic assessment - 2. Implementation and practice Medical Teacher 2021; 43:1149-1160