Sapawan Seesuwan¹
1 Lampang hospital

Background
Radiograph interpretation is a crucial skill for medical professionals. However, traditional film reading classes may not fully engage students or provide a joyful learning experience. Recently, online games have gained popularity as a means to enhance learning experiences, and we aim to utilize them to improve medical students' skills in radiograph interpretation. 

A prospective interventional cohort study was conducted with 4th-year medical students during radiology department rotation, divided into two groups. The first group participated in traditional film reading classes, while the second group used the Kahoot game online application. We compared examination scores in multiple-choice questions (MCQs), film reading test, and radiology grades between the two groups, and gathered feedback after the classes. Statistical analysis was performed using t-tests and Chi-squared tests. 

Forty-nine 4th-year medical students were included, with 25 in online game group and 24 in traditional film reading group. The mean MCQ score for online game group was 32.8±7.45 (95%CI = 29.72-35.87), while traditional film reading group was 31.5±6.62 (95%CI = 28.70-34.29), with a P-value of 0.52. The mean film reading test scores were 110.22±23.46 (95%CI = 100.53-119.91) and 86.60±31.51 (95%CI = 73.29-99.91) respectively, with P-value of 0.0045. There was no statistically significant difference in radiology grades between the two groups, with P-value of 0.807. 

Online game with several clinically relevant questions, moving beyond traditional film teaching focused solely on radiographic findings and diagnosis. This approach helps students grasp the bigger picture of the patient, making it easier for them to recognize and retain information while enjoying the class. Resulting in statistically significant higher film reading test scores in online game group. 

Using an online game in film reading class not only enhances plain radiograph interpretation skills among 4th-year medical students but also makes the learning experience enjoyable. 

Pornpimon Nittiwatthanawit¹
1 Medical Education Center Phayao Hospital 

Background:
Although the global average birth rate is trending to decline, emergency obstetrics and gynecology are persisting important clinical skills for general physicians in community hospitals which need a precise diagnosis and considerate initial management to prevent morbidity and mortality before referring to secondary care hospital. 

Summary of work:
During the internship orientation program, we randomly divided the eighteen internships from various medical education centers (MEC) and medical schools into groups of three to four to imitate real-world situations which are unexpected and scarce for obstetricians and gynecologists. Each group attends the different simulations for 5 minutes. After that, the attendees express reflection and get feedback from observers and mentor for 3 minutes. Self-assessment questionnaires were collected at first and at the end of the class. 

Summary of results:
Self-assessment confidence scores rose to a mean of 72.5% compared with 47.5% initially. Overall clinical skills including necessary investigation, accurate diagnosis, and proper management are beyond the requirement. However, two-thirds of the participants were still concerned about procedural skills due to insufficient experience. Most of the attendees were satisfied and gained the advantage with this assessment with a mean of 90.5% and 94.4% respectively. 

Discussion:
Correspondingly to the professional standards of The Medical Council of Thailand, many MEC and medical schools are disciplined with procedural skills teaching to clinical medical students. Surpassingly to formative assessment, diagnostic assessment is not only helpful to evaluate what the attendees have learned in the past with different classes and teachers but also beneficial to evaluate the performing procedural skills, which can inform the mentor to instruct more effectively. 

Conclusion:
Diagnostic assessment appears to be another practical evaluation for postgraduates. 

Take Home Messages:
Postgraduate backgrounds should be evaluated with a diagnostic assessment initially for a more effective class. 

References (maximum three) 

Jennie Tookoian. What is a Diagnostic Assessment. Edulastic[Internet]. 2022 [cited 2023 August 07]. Available from: https://edulastic.com/blog/diagnostic-assessment/ 

Aungsumalin Sukthongsa¹
Penprapa Siripaopradist¹ and Kengkaj Unrit
1 Mahasarakham hospital

Background:
During the COVID-19 pandemic, virtual instruction became essential to reduce the risk of exposure for 4th year medical students. However, the inability to attend COVID wards could affect students’ ability to learn how to diagnose and manage pediatric COVID patients. A flipped virtual classroom combined with telemedicine was used to improve the virtual educational experience. 

Objective:
Evaluating the efficacy of a flipped virtual classroom plus telemedicine in teaching pediatric COVID-19 patient management to medical students. 

Method:
Fourth year medical students were randomly allocated by block randomization to a control group (traditional lecture) and an intervention group (flipped virtual classroom plus telemedicine).The intervention group was provided with a study guide on pediatric COVID-19 infection 1 week prior to class. At the start of the class, students were assessed using two readiness tests (IRAT and GRAT) followed by facilitator feedback and case scenarios. Finally, students were exposed to a real clinical scenario via telemedicine.Pretest and post test scores were collected in both groups.Student satisfaction was measured using a Likert scale. Statistical analysis was performed using the MannWhitney U-test. 

Results:
A total of 13 students were enrolled in this study (6 in the intervention group and 7 in the control group). Pre-test scores were not significantly different between both groups. Post test scores were significantly higher in the flipped virtual classroom plus telemedicine group (p = 0.025). Student satisfaction scores in the intervention group tended to be higher than the control group, but this was not statistically significant (p = 0.082). Qualitatively, open-ended student feedback was very positive for the flipped virtual classroom. 

Conclusion:
The flipped virtual classroom plus telemedicine resulted in significantly improved exam scores. Student feedback was highly positive. We conclude that this method is more effective than a traditional lecture and it is a novel and effective pedagogical option when clinical placements are limited. 

References (maximum three) 

1. The perceived impact of the Covid-19 pandemic on medical student education and training– an international survey. BMC Medical Education, 2021, 21: 1-8. 

2. HEW, Khe Foon; LO, Chung Kwan. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC medical education, 2018, 18: 1-12. 

3. WEES, Isabel, et al. Improving the care of patients with COVID-19 with a medical student- run telemedicine clinic. BMJ Open Quality, 2022, 11.1: e001646. 

Pongthorn Jantataeme¹
1 MNST Medical Education Center, Thailand 

Background:
Advancement in technology is improving the practice of medicine globally. Advanced medical tests are widely available for medical diagnosis. However, in many rural hospitals in Thailand cannot afford to pay some medical tests. In this situation, knowledge of pathogenesis and progression of disease, history taking, and physical examination skill will help doctor to make clinical decision. However, the history taking, and physical examination skill must practice repeatedly until mastered. So, we must promote the attitude in medical students to improve their skill by practice repeatedly on their own. 

Summary of work:
The participants in this study included 34 undergraduate sixth-year medical students. They are divided in two to three person per group. Group discussion about advance investigation machines and medical tests in modern clinical practice guideline and how to apply clinical decision without these tools was done. We had simulation many situations to realize the situation in rural hospital. A self-administered questionnaire regarding importance of history taking and physical examination skill, increase attitude to promoting in their skill, and limitation in diagnostic tests in rural hospital was used as a data collection instrument. Each question is rated on a 5 scale, with 5 being the highest. 

Summary of Results:
34 students completed a questionnaire. All of them gave score 5 for question important of history taking and physical examination skill. 30 students (88.2%) gave score 5 and 4 students gave score 4 for question increase attitude to promote history taking and physical examination skill. All of them gave score 4 for question limitation in diagnostic tests in rural hospital. 

Discussion and conclusions:
Group discussion and simulation situation can promote attitude in medical student to improve their history taking and physical examination skill. 

Take-home messages:
Simulation as a tool for promoting attitude to improve history taking and physical examination skill. 

References (maximum three) 

Oyedokun A, Adeloye D, Balogun O. Clinical history-taking and physical examination in medical practice in Africa: still relevant? Croat Med J. 2016 Dec 31;57(6):605-607. doi: 10.3325/cmj.2016.57.605. PMID: 28051286; PMCID: PMC5209934. 

Chao Yen Huang¹
Ming Che Tsai¹ and Sai Wei Ho¹
1 Chung Shan Medical University and Hospital 

Assessment is crucial in healthcare education, but psychiatric ward staff lacks practical experience in emergencies, leading to suboptimal patient care. To address this, we introduced in-situ simulation and evaluated its effectiveness through qualitative analysis. 

A scenario involving a patient with arrhythmia after acute delirium was designed, recorded, and replayed using mobile video systems for debriefing. Trainees completed reflective writing, and thematic analysis was conducted on their essays. 

Results:
Twelve essays revealed four main themes: 

1. Practical application: In-situ simulation is more effective than traditional classroom teaching in converting knowledge into practical patient care. 

2. System-based practice: The diverse patterns of patients and ward designs influence the efficiency of resuscitation. Therefore, trainees can implement changes directly in the clinical environment after completing the curriculum to enhance resuscitation quality. 

3. Interprofessional teamwork: The curriculum is instrumental in fostering effective team resource management. 

4. Future Improvement: Trainees recommended printing ACLS algorithm cards to minimize errors due to unfamiliarity. In addition, redesigning the ward by incorporating suggestions like installing an oxygen wall or resuscitation bed can positively impact patient outcomes. 

Trainees reported that in-situ simulation improved patient care by transforming knowledge into practice, directly implementing changes in the clinical environment, facilitating team resource management, and suggesting improvements to enhance patient safety. 

In-situ simulation proved highly effective in enhancing knowledge and behavior, as evidenced by the proposed improvement plan. In addition, using clinical equipment in the workplace familiarized trainees with algorithms and improved their performance in emergencies. Overall, in-situ simulation improved resuscitation quality, teamwork, and patient safety in the psychiatric ward. Such assessments are crucial for advancing healthcare education and training. 

In conclusion, the assessment of in-situ simulation in the psychiatric ward demonstrated its effectiveness in improving resuscitation quality, fostering effective teamwork, and enhancing patient safety. 

References (maximum three) 

1. Yu J, Lee w, Kim M, et al. Effectiveness of simulation-based interprofessional education for medical and nursing students in South Korea: a pre-post survey. BMC Medical Education 2020;20:476. 

2. Wakeman D, Langham MR. Creating a safer operating room: Groups, team dynamics and crew resource management principles. Seminars in Pediatric Surgery 2018;27:107-113. 

Ali Manji¹
1 University of Oxford, Medical Sciences Division 

Background:
The ABCDE framework is a fundamental tool in the assessment of the critically unwell patient, and is commonly assessed in Medical School clinical examinations. In this study, 26 fifth-year medical students at the University of Oxford received an ABCDE assessment teaching session in either an interactive tutorial setting (discussing cases) or low- fidelity simulation setting (assessing a manikin with basic resuscitation equipment). Students completed a quantitative feedback form and multiple-choice questionnaire (MCQ) before and after the session. 

Results:
Students reported a significant improvement in their baseline confidence in performing an ABCDE assessment post-session, as well as feeling that the session directly improved their confidence, although there was no significant difference in score improvements between groups. However, students in the simulation group reported significantly improved confidence in airway management compared to the tutorial group. The session was highly rated by both groups for interactiveness, delivery, content, usefulness and enjoyability. Student MCQ scores improved by 1.3 points out of 10 (p < 0.01) post-session. 

Discussion:
This study demonstrated that students found an interactive session on emergency assessment enjoyable and useful for their exams. Access to basic airway equipment in a safe simulated setting significantly improved confidence in airway management versus discussion alone. Students demonstrated good post-session knowledge retention, particularly for questions relating to procedural skills. 

Conclusion:
Simulation teaching may improve student confidence and competence in performing clinical skills, and may warrant further inclusion in Medical School curricula. However, reported confidence in emergency assessment overall, and rating of the session delivery and enjoyability, did not differ significantly between groups. Further study is warranted to assess higher-fidelity simulation in larger groups, for a wider range of commonly examined clinical assessments. 

References (maximum three) 

1. Thim, T., Krarup, N. H. V., Grove, E. L., Rohde, C. V. & Lofgren, B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int. J. Gen. Med. 5, 117 (2012). 

Nikolaos Christidis¹
Viveca Lindberg² and Maria Christidis^3,4
1 Karolinska Institutet, Department of Dental Medicine
2 Stockholm University
3 The Swedish Red Cross University, Department of Health Sciences
4 Karolinska Institutet, Department of Neurobiology, Care Sciences and Society

Background:
Clinical records create the basis for clinical reasoning, diagnostics, treatment planning, as well as for the outcome of the treatment (1). Therefore, the aim of this study was to explore clinical protocols of last year dental students to find patterns of adequate and inadequate content. 

Summary of work:
Thirty-three clinical protocols that comprised patient history, clinical findings, treatment planning, an evidence-based reflection of diagnostics/causalities/treatments/prognostics, and epicrisis were collected. The protocols were subject to thematic analysis (2). 

Results:
Only one of 33 protocols was acceptable in its original form. Most common inadequacies concerned descriptions of a) patient-complaints regarding localization, pain/headache characteristics, jaw-dysfunctions, factors affecting complaints, and on general health; and b) findings related to the clinical examination. Further, these inadequacies resulted in inaccurate diagnostics, treatment approaches presented in their reflection. Finally, students had difficulties providing adequate/relevant references to the statements in their reflection. 

Discussion:
The inaccuracies and inadequacies points to an imminent risk for patient-safety. Incomplete information may lead to incorrect diagnoses and in turn to inappropriate or wrong treatment-approaches (1). This study emphasizes the challenges professional higher education faces to give students opportunities to integrate academic and professional texts, ensuring that health professionals can produce high-quality clinical notes (3). 

Conclusions:
Dental students in their last year of education have difficulties to correctly reproduce and describe what patients say and what students observe in their clinical examination. A second challenge for the students is to integrate academic content in a professional context, in this case in terms of relevant references for their clinical reflection. 

Take-home messages:
This study emphasizes the need to develop teaching in professional higher education regarding literacy practices. Students need to be given opportunities to train their writing in relation to what they hear and to what they observe, and to integrate academic texts to professional contexts. 

References (maximum three) 

1. Jorunn B, Victor V, Mari OR. Patient Safety Through Nursing Documentation: Barriers Identified by Healthcare Professionals and Students. Front Comput Sci. 2021(01 June 2021). 

2. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative research in psychology. 2021;18(3):328-52. 

3. Lindberg V, Jounger SL, Christidis M, Christidis N. Literacy as part of professional knowing in a Swedish dental education. BMC Med Educ. 2021;21(1):373. 

Jinelle Ramlackhansingh¹
Fern Brunger¹
 1 Memorial University 

Clinical skills are part of the formal undergraduate medical education curriculum. Medical students are assessed through OSCEs to determine whether their preparedness for clinical work. Medical students need to demonstrate competence, including professionalism in clinical skills. 

This critical ethnography examines professional identity development in pre-clinical medical students. Monthly focus groups were conducted with students, supplemented by faculty and administrative staff interviews. Participant observation of classes and governance meetings contextualized the data. The theoretical frameworks of Bourdieu and Foucault were used in analysis. 

The esearch revealed that some students are in collusion, sharing OSCE cases amongst themselves. A student frankly stated, “the people that went in the morning [OSCE] were telling people what was on the exam in the afternoon”. The practice was kept hidden from faculty and administrators; as student representatives at medical school governance meetings did not disclose the practice, even though they disagreed with it. For those who did not participate collusion, the concern was that it would result in their own lesser demonstration of success, when others were cheating, giving the impression of clinical skills excellence. 

Student practice of unethically sharing OSCE cases puts the medical school's academic integrity into question. However, beyond that obvious concern, my research illustrated that non-cheating students were concerned about their grades rather than the unprofessional behaviour of colleagues. The issue was not addressed at governance meetings, reflecting a culture of silence and tacit acceptance of this unprofessional behaviour. 

Medical schools should be wary of placing too much importance on clinical competence at the expense of an emphasis on the value of professionalism. Medical schools should consider 

rotating OSCE cases, so students are not disadvantaged. The emphasis should focus on being competent for patient care rather than being competent only to pass the exam. 

References (maximum three) 

The Royal College of Physicians and Surgeons of Canada. (n.d.c). Professional. 

http://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-professional-e 

The Royal College of Physicians and Surgeons of Canada. (2019). The maintenance of certification program. http://www.royalcollege.ca/rcsite/cpd/cpd-educators-e 

American Medical Association & Council on Ethical Judicial Affairs. (2016). Modernizing the AMA Code of medical ethics. https://www.ama-assn.org/about-us/code-medical-ethics