Special Session 5 - Innovation in Medical Education under Hospital Authority

One of the many education outcomes among medical graduates is to prepare their readiness to serve the public or to embark on specialist training. Clinical training would be essential to achieve these objectives. Apart from the two university-affiliated teaching hospitals (Prince of Wales Hospital and Queen Mary Hospital), clinical training of medical students in Hong Kong relies heavily on exposure in various HA hospitals. However, with the increasing number of medical students, teaching and learning in the congested ward setting have become more difficult.
Many medical educators maintain the view that real patients with real pathologies are essential for clinical training, but the availability of training opportunities or accessibility to real patients presents a real challenge. The ever-changing service demand and development of specialties have imposed significant pressure on the already-packed curriculum. Technological and information technology advancement has revolutionised the care model but if our future healthcare professionals are not ready, our patients will suffer.
The use of innovative education pedagogies such as simulation training is expected to lessen the need for real patients. Ethical practice should be enhanced through training in professionalism and bioethics. Also through dedicated training in crew resource management, human factors or non-technical skills, we can prepare our future healthcare professionals to work in healthcare teams where quality and safety in clinical practice can be ensured.
Medical schools cannot do all these alone. We need to partner with all the major stakeholders including healthcare providers such as the Hospital Authority and our local regulator. Active participation in the education processes won’t benefit only our future healthcare professionals, it could be a powerful change agent to the current staff and the service units and will bring mutual benefit. Through synergizing our effort, we can produce safe and competent doctors to serve our patients in the community.
 

There are challenges of teaching junior doctors on patient safety. For junior doctors, particularly interns, those at the start of their professional career, found it difficult to identify with patient safety as a discipline, so they did not prioritize it. In part this was because those with little clinical experience found it hard to relate to patient safety when presented as an abstract academic concept. The lack of explicit focus on patient safety was an obstacle, as was competition for interns’ attention from other aspects of their busy clinical duties.  
Junior doctors responded positively to several ways of learning patient safety. These include:  (1) learning from patients, particularly through patients’ stories. Story-telling is an effective form of communication.  (2) Learning from medical errors and adverse events, and applying tools such as root cause analysis to identify lessons that could be learnt from them. Real-life incidents capture the attention of interns and junior doctors instantly. Complicated incidents and lessons learnt can be illustrated with a combination of images, audio and movement in an animated story. Animated stories present heavy content in a refreshing and interesting way, make learning engaging and interactive for contemporary doctors.  (3) Integrating safety teaching into clinical placements, with an explicit focus on patient safety, offer to interns’ actual or simulation training module. 
 

Recent pedagogical focus has shifted from teacher-orientated knowledge transfer to outcome-based learning. In an undergraduate orthopaedic teaching module, Student Learning Outcomes (SLO) are explicitly specified right at the start of the module. To help students cope with the SLO through harnessing advancement in information technology (IT), a web-based SLO Mapping Platform (the SMP) supporting multimedia teaching materials was constructed in phases. 
SMP-I represented the first phase through incorporation of three key components within one single hub: (i) the learning outcomes mapped with (ii) a comprehensive archive of electronic homemade learning materials and (iii) self-assessment exercises. Following the success with the initial SMP-I, an upgrade version was developed, the SMP-II, engineered with an advanced attribute-based Performance Analysis Reporting (PAR) System that was coupled with a MCQ bank and its attribute-dependent examination paper generator. In addition, a discussion platform was installed for student’s upload of questions on academic topics, constructive messages regarding teaching arrangement or appreciative remarks that can be most incentivizing for teachers to continue teaching out of their busy work schedule.
To understand whether the SMP was serving our students well, surveys were conducted to collect feedback questionnaires and other outcome measures. Among 232 students recruited to fill in acceptance and usefulness questionnaires with a “1-6” Likert Scale, the average scores for various items ranged from 4.67 to 5.08 indicating very satisfactory outcomes. As for the PAR System, 168 Year-5 medical students underwent a mid-module Formative Assessment (FA) of 30 A-type MCQs covering ten orthopaedics sub-topics. PAR was released shortly after the FA for students’ reference on study adjustment. Feedback questionnaires were used to evaluate users’ acceptance. The performance at the final examination was compared between two consecutive years without and with PAR respectively. Feedback questionnaires' average scores for various items ranged from 4.01 to 4.36 in students (n=147) and from 4.50 to 5.25 in teachers (n=14) indicating good results. Mean scores on A-MCQ items at the final examination increased from 27.04±3.03 in 2014 (n=167, without PAR) to 28.33±3.26 in 2015 (n=168, with PAR) (p< 0.05).
The evaluation so far indicated a very satisfactory outcome with the SMP, both for its initial form and the subsequent SMP-II. Students found the SMP a useful learning tool with clear layout. Given its acceptance and usefulness for an undergraduate program, and improvement in students’ academic performance associated with its use, the SMP is an effective web-based teaching and learning tool not only for orthopaedic modules, but also for other professional training programs requiring low cost for long-term administration of this IT platform. 
This project was supported by UGC Teaching Development Grant (2009-12 & 2012-15 Triennium)