Kellie Charles¹
Jennifer Shone², Carl Schneider¹, Nicholas Buckley^3,4 and Sarah Hilmer^5,6
1 Sydney Pharmacy School, University of Sydney
2 Sydney Medical School, University of Sydney
3 School of Medical Sciences, University of Sydney
4 Royal Prince Alfred Hospital
5 Northern Clinical School, University of Sydney
6 Royal North Shore Hospital

 

Background:
Addressing the lack of preparedness among final year medical students for effective prescribing is a critical concern globally (1,2). The constraints of teaching clinical pharmacology and prescribing skills in the final year exacerbate the challenge. However, the optimal educational strategies for enhancing prescribing skills among these students remain uncertain. 

Summary of Work:
This study employed the Stanford 5-step design thinking model to devise a theoretically-informed, vertically-integrated therapeutics curriculum alongside a longitudinal programmatic evaluation framework. Design thinking leverages student insights to iteratively develop solutions aligned with their needs. Starting in 2020, a series of authentic prescribing assessments, supplemented by structured individual and group online feedback, were formulated, and delivered to the geographically diverse final year medical student cohort. A realist evaluation was conducted to uncover “What aspects of the prescribing curriculum and assessment works, for whom, in what respects, to what extent, in what contexts, and how?” 

Results:
Final year students affirmed the educational value of the tasks (82% agreement, n=210). Subsequent refinements over the ensuing 18 months were shaped by ongoing student feedback. Notably, student input guided the early inclusion of the prescribing program within the Year 2 curriculum and the integration of a team-based inter-professional prescribing module. In-depth realist interviews conducted at three time with 11 students in the 2022 cohort revealed that within the context of limited experience in practical prescribing, the prescribing assessments equipped students with incremental exposure to the intricacies of prescribing. Notably, students who “owned their learning” alongside active integration of theory into practice, coupled with proactive feedback-seeking from clinical supervisors, reaped the greatest rewards from the prescribing preparation curriculum. 

Conclusion:
Utilising a design-theory framework enriched curriculum development, and a realist evaluation provided deeper insights into 'how' and 'why' of the curriculum's impact. The study's findings continuously inform curriculum refinement. 

References (maximum three) 

Caroline Wright¹
Kristie Matthews¹
1 Monash University 

Background
The clinical capabilities of radiation therapists (RTs) are evolving into areas of advanced practice (AP) beyond those traditionally associated with the RT role.(1) This is occurring under the guidance of the radiation oncology multidisciplinary team (radiation oncologists, radiation oncology medical physicists, nurses and allied health professionals). Assessment plays a crucial role in evaluating AP capability and should therefore be fit for purpose, allowing RTs to demonstrate knowledge and clinical competence. 

Summary of work
The creation of appropriate clinical assessment regimes for AP requires design partnership, leveraging not only the pedagogical content knowledge of the academic, but the practice expertise of clinicians. This paper will discuss how academics and a multidisciplinary team of clinicians across two radiation oncology centres collaborated to create a curriculum, which embedded an authentic and meaningful clinical assessment regime. 

Results
Assessments were aligned with learning outcomes, clinician expectations, professional society advanced practice domains and international standards through a collaborative mapping process. Use of a clinical capability framework based on the work of Miller(2) and Benner(3), contextualised with radiation therapy practice facilitated assessment of clinical skills. Assessment ‘of’, ‘as’ and ‘for’ learning approaches were intentionally designed and integrated to align with practitioner development and the program outcomes. 

Discussion
The co-design process highlighted the importance of combining educational design, content and practice expertise to develop context-specific assessment, flexible enough to meet the diversity of the clinical setting. 

Conclusions

Collaborative curriculum design enabled the creation of a learning and assessment program that proactively meets the needs of future practice. 

Pedagogical content knowledge and practice expertise are required for the creation of advanced practice capability assessment. Collaboration is crucial to develop an authentic and flexible assessment regime. 

References (maximum three) 

1. Matthews K, Duchesne G, Baird M. Navigating uncertainty: the implementation of Australian radiation therapy advanced practitioners. Technical Innovations & Patient Support in Radiation Oncology. 2021 Mar 1;17:82-8. 

2. Benner P, Tanner C, Chesla C. From beginner to expert: Gaining a differentiated clinical world in critical care nursing. Advances in nursing science. 1992 Mar 1;14(3):13-28. 

3. Miller GE. The assessment of clinical skills/competence/performance. Academic medicine. 1990 Sep 1;65(9):S63-7. 

Arunaz Kumar¹
Julia Harrison¹ and Michelle Leech¹
1 Monash University

Background
Patient perspectives are rarely incorporated in student learning especially in a formal assessment. Patients are well placed to comment on the clarity of a student’s communication and how comfortable they feel with the student’s bedside manner(1). 

Summary of work
We sought a mechanism to enable patient perspective feedback for 500 final year medical students. We introduced a slower-paced competency-based Assessment of Physical Examination (APEx) skills using trained Simulated Patients (SPs) as a more accurate and educationally powerful assessment compared to an OSCE station. SPs were examined by students and contributed to feedback discussion with assessor (senior doctor) and student at the end of each assessment. 

The qualitative study follows a social constructionist viewpoint where knowledge is co-created with SPs, who were recruited and interviewed to capture thick descriptions of patient perspectives. The interviews were recorded verbatim, and transcripts thematically analysed (2). 

Results
The five key themes were - Collaborating with examiner (felt they could add value with feedback but with hesitancy about what aspects to comment on), collaborating with students (providing feedback to students such as response to patient concerns/ pain or appreciating kindness and empathy) authenticity of doctor-patient interaction, APEx assessment characteristics and SPs’ motivation to assist in student transition to becoming thorough, responsive, empathetic and caring doctors. 

Discussion
We present a feasible way to incorporate patient perspective feedback into assessment. SPs appreciated the role and were comfortable to contribute alongside an experienced clinical examiner, that has led to creating exam preparation materials for students. 

Conclusions
SPs have a role in giving feedback to students in a summative exam setting and can assist examiners in assessing students. 

Take-home message
SPs can be trained for providing feedback to medical students especially for communication skills and empowered to assist examiners in assessment. 

References (maximum three) 

1. WykurzG, KellyD. Developing the role of patients as teachers: literature reviewBMJ 2002; 325 :818 doi:10.1136/bmj.325.7368.818 

2. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa 

Thao Vu¹
Hasini Rathnasara¹, Nesha Chek¹, Thomas Nguyen¹, Xiaolin Du1¹, Long Tran¹, Michael Ja¹, Harjit Khera¹ and Daniel Malone¹
1 Monash University

Via co-creation, educators and students collaborate to design and improve learning and assessment experience by incorporating students’ inputs. Although co-creation is an important and well researched phenomenon in Higher Education, not much is known about student-staff co-creation in Health Profession Education (HPE), especially in co-creating assessments. 

This qualitative auto-ethnography study, situated within an interpretivist paradigm, was conducted to explore how a group of six students experienced co-creating clinical cases for formative assessments with their educators, and how they perceived the effects of co-creation on themselves. Data included 60 reflection entries collected during the process. Data was analysed using thematic analysis. 

The study found that these students' very first experience of co-creation involved various emotions ranging from confusion, anxiety, frustration and defeat at the beginning, to increased confidence, motivation, optimism and self-assurance towards the end of the process. They utilised various tools, most importantly the simulation platform where the cases were created, feedback, a self-created case matrix, online collaboration and conferencing tools. Enablers included shared goals, peer and educator feedback, fair workload distribution, regular check- in and communication of expectations, whilst challenges pertained to occasional delays in communication with staff and case guidelines. Through this co-creation experience, students felt that they further developed their skill to communicate and teamwork with one another and educators, feedback literacy, deeper understanding of the subject matter, skill to design assessment cases, reflective practice and confidence to cope with uncertainty of new experience. 

The research supports previous findings outside HPE about the benfits of co-creation for students’ engagement and learning. It also offers new and rich insights into how students experienced co-creation and how its positive impacts were made possible in a specific context. 

We suggest designing co-creation learning experience embedded with self-awareness, shared goals, mentorship, feedback literacy, effective communication, among other enablers found in this study. 

References (maximum three) 

Deeley, S. J., & Bovill, C. (2015). Staff student partnership in assessment: Enhancing assessment literacy through democratic practices. Assessment & Evaluation in Higher Education, 42(3), 463–477. Retrieved from: https://doi.org/10.1080/02602938.2015.1126551 

Könings, K. D., Mordang, S., Smeenk, F., Stassen, L., & Ramani, S. (2020). Learner involvement in the co-creation of teaching and learning: Amee guide no. 138. Medical Teacher, 43(8), 924–936. Retrieved from: https://doi.org/10.1080/0142159x.2020.1838464 

Zarandi, N., Soares, A., & Alves, H. (2022). Strategies, benefits and barriers– A systematic literature review of student co-creation in higher education. Journal of Marketing for Higher Education, 1–25. Retrieved from: https://doi.org/10.1080/08841241.2022.2134956