Mary Pinder1^,2,3
Sandra Carr³ and Charlotte Denniston⁴
1 Sir Charles Gairdner Hospital, WA
2 College of Intensive Care Medicine
3 UWA
4 University of Melbourne 

The FCICM Second Part Examination is a high-stakes assessment in the progression to specialist with the College of Intensive Care Medicine of Australia and New Zealand (CICM) with the pass rate 35-65%. Exam failure has devastating effects on trainees, personally and professionally. Pre-existing research exploring behaviours enabling exam repeaters to succeed is limited and relates to other learner contexts. 

This qualitative study aimed to understand how CICM trainees make the transition from failure to success and their lived experience of the journey, using grounded theory methodology. Individual in-depth interviews were conducted via Zoom with eleven participants who were multiple exam repeaters before succeeding. The interviews were recorded, de-identified, transcribed into text and coded. Data collection and analysis happened contemporaneously to identify emerging themes and theories. 

To achieve exam success participants needed to accept self and acknowledge their competence as an intensivist. This occurred by reconstructing their sense of self, exploring and acknowledging failure; and exam preparedness, becoming ‘match-fit’. Participants needed time to process the emotions of grief and loss, negotiate personal challenges, and rebuild their sense of self. A mindset shift to a learning orientation for professional development rather than exam success was key. The emergent theory was Identifying as an Intensivist. 

Identifying as an Intensivist encompasses the psychosocial, sociocultural and cognitive processes underlying the transition to exam success. Developing this professional self enabled the participants to overcome failure, and was, in turn, enabled by achieving success. 

Conclusion
The findings resonate with those from other learner contexts suggesting broad applicability. 

Recovery for high-stakes exam repeaters should include psychological support, wellbeing advice, and effective learning strategies. 

Medical colleges should be aware of their influence in shaping professional identity and ensure that their activities reflect the diversity of the broader community. 

References (maximum three) 

Dadpe AM, Shah DY, Vinay V, Shetkar P. Factors Facilitating Academic Success in Dental Students After Initial Failure: A Qualitative Study. J Dent Educ. 2018 Nov;82(11):1155-1161. 

Minson S, Adodra A, Brightwell A. Failure of high stakes postgraduate medical exams - what is the impact on trainees and how can they achieve success after multiple failures? AMEE 2013 “Colouring outside the lines”; 24-28 August 2013; Prague. 2013 p. 619-620Available from: https://amee.org/conferences/amee-past-conferences/amee-conference-2013 

Harry V, Bethelmy A. Failing postgraduate exams. BMJ. 2007;335(7630):s200-s201. 

Punnose Kattil¹
Helga Olson², Nirusha Lachman¹, Uma Pandalai¹ and Wojciech Pawlina¹
1 Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
2 Department of Surgical Services, Mayo Clinic College of Medicine and Science, Rochester, MN

Attaining competency in an anatomy course may require a second attempt at taking the examination. In Mayo Clinic, a 6-week hybrid clinical anatomy course for Surgical First Assistants (SFA) provided both online components (lectures and daily audience response formative assessment) and laboratory experience with prosected specimens. Knowledge competency was assessed using multiple choice-based and image-based practical examinations. Students who were unable to meet the grade requirement were offered to remediate anatomy oral examinations using online platform that integrated critical thinking, structure identification and relational concept driven understanding of surgically oriented anatomy. The exam was conducted by a faculty panel over a videoconferencing platform using specific rubric. Students had access to a bank of anatomy images that were relevant to students’ encounters in their surgical training and experiences in the operating room. 

The purpose of this study was to assess student perception of the remedial examination approach in helping them to attain minimum required competency. Cohort of students who underwent remediation were invited to take part in structured interviews utilizing pre-designed questions. Qualitative approach based on grounded theory was used in analyzing data. Study obtained ethical approval by the institutional ethical review board. 

In general students were supportive of the examination format. Three major themes emerged from the study related to study strategy, uncertainty related to examination format, and reflections on the oral examination. 

Analysis of themes revealed that the provided format was effective, and students valued clear communication of expectations for the examination. The unexpected finding was that students with learning disabilities found the oral examination format to be more beneficial in demonstrating their level of acquired knowledge and more conducive to overcome some aspects of their learning disabilities. 

Structured cadaveric image-based online oral examinations offer an effective tool for assessment of core competency especially for students with learning disabilities. 

References (maximum three) 

1. Pawlina W, Drake RL. 2016. Authentic learning in anatomy: A primer on pragmatism. Anat Sci Educ. 9(1):5-7. 

2. Frellsen SL, Baker EA, Papp KK, Durning SJ. 2008. Medical school policies regarding struggling medical students during the internal medicine clerkships: Results of a national survey. Acad Med. 83(9):876-81. 

3. Nixon LJ, Gladding SP, Duffy BL. 2016. Describing failure in a clinical clerkship: Implications for identification, assessment and remediation for struggling learners. J Gen Intern Med 31(10):1172-9. 

Pamela Timanson¹
1 Alberta College of Pharmacy; University of Alberta 

Background
Continuing professional development (CPD) is a learner-driven, quality improvement approach that assumes a practitioner can self-appraise and address practice gaps, but this is not always the case. A competence program based exclusively on CPD is limited in its structure to support the remediation of pharmacy professionals. The purpose of this research was to develop a conceptual framework that could be implemented to identify and support pharmacy professionals experiencing competence drift. 

Summary
This research utilized a basic qualitative approach and design methods. These included a literature review, environmental scan, and discussion with and review by experienced colleagues. The theoretical basis for the framework is informed by workplace learning, informal and formal professional learning, knowledge cultures, collaboration, competence development, reflective practice, and remediation. 

Results
The constructed practice improvement framework (PIF) provides a variety of educational activities (e.g., peer coaching, workshops). Learning is strategically supported formally and informally through collaboration and defined milestones and assessments. Participants are identified from prior competence assessments, inspections/investigations, or complaints processes. 

Discussion
The PIF recognizes the value of situated workplace learning, collaboration, and engagement. Through a learner-centred approach, pharmacy professionals are supported in changing practice behaviours or developing competence. These changes are evaluated through periodic assessments (e.g., practice visits, practice reviews). 

Conclusions
Implemented as a pilot program in 2021, the PIF has demonstrated benefits in supporting practitioners (e.g., community pharmacists) to change practice behaviours and develop competence. Limitations of this framework include dedicating sufficient resources and grouping participants with similar practice or competence deficiencies. 

The PIF is a necessary, useful, and novel approach to facilitate the remediation of sub-optimal performance in practitioners as an augmentation to CPD. Further research is needed to evaluate the pilot program (e.g., interviews, program data) and validate the framework. This framework could be adapted by other healthcare professional regulatory bodies or educators. 

References (maximum three) 

Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San Francisco, CA: Jossey-Bass. 

Suikki, R., Tromstedt, R., & Haapasalo, H. (2006). Project management competence development framework in turbulent business environment. Technovation. 26. 723-738. doi:10.1016/j.technovation.2004.11.003 

Van der Waldt, G. (2020). Constructing conceptual frameworks in social science research. The Journal for Transdisciplinary Research in Southern Africa, 16(1), a758. https://doi.org/10.4102/td.v16i1.758 

Tyler Clark
Nidhi Garg¹, Lauren O'Mullane¹ and Deborah O'Mara²
1 The University of Sydney
2 University of Sydney Medical School/ AMEE/ ANZAHPE

Programmatic Assessment (PA) involves a longitudinal mix of high and low stake assessment (Schuwirth & Van der Vleuten, 2011). Handling extensive and intricate data can lead to challenges, such as a reluctance to identify struggling students (Ryan et al., 2023). 

In the 2021 implementation of PA at Sydney Medical School some students with a borderline assessment portfolio officially progressed but were told in writing that the Portfolio committee had concerns about their content knowledge, clinical skills, or professionalism. 

The purpose of this research is to evaluate the use of progression with concern decisions by tracking the performance of these students in subsequent years. The study is based on the 314 students who completed Year 1 in 2021, focusing on those who were required to complete further assessment (FA) as their portfolio did not meet expected standards. 

Almost 1 in 5 students (17%) who progressed from Year 1 to Year 2 completed FA, half (55%) progressed with concerns. 

Most (70%) met Year 2 expected standards with no FA; 18% advanced to Year 3 after FA and 12% were required to repeat Year 2. Students with concerns were more likely to repeat Year 2 or FA (49%), compared to those without concerns (8%). Year 3 results will be available 2023. 

The dynamics of qualifying academic transcript progression decisions with faculty correspondence will be discussed as well as the student support required. 

The Year 2 academic performance gap between students with and without concerns highlights the supplementary classification's importance. Consequently, a Student Support Liaison role was established based on best practice (Van Der Vleuten, 2015) to aid those identified with academic issues. 

A tiered progression decision, with expert judges noting students with concerns, assist those making difficult decisions with PA data and ultimately students. 

References (maximum three) 

Schuwirth, L. W., & Van der Vleuten, C. P. (2011). Programmatic assessment: from assessment of learning to assessment for learning. Medical teacher, 33(6), 478-485. 

Ryan, A., O’Mara D, Tweed, M. (2023) Evolution or revolution to programmatic assessment: considering unintended consequences of assessment change. FOPE, 50th Anniversary Edition (In press). 

Van Der Vleuten, C, P., Schuwirth L. W., Driessen, E.W., Govaerts, M. B., & Heeneman, S. (2015). Twelve Tips for programmatic assessment. Medical Teacher, 37(7), 641-646.