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Show More. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. The aim of this study was to determine the impact of the ESSQ e-learning programme in supporting the early academic development of surgical trainees in their preparation for professional examination.
The success of trainees in completing their MSc degree and in securing their professional examination MRCS was assessed and the quality of the programme determined by securing direct student feedback. Applications were accepted only from trainees in possession of a medical degree from their country of origin MBChB or equivalent and who were based within a training environment. The programme provides academic recognition of trainees' acquisition of knowledge and development; the ESSQ leads progressively to a Certificate year 1—basic science relevant to surgery , Diploma year 2—clinical surgery and an MSc in Surgical Sciences year 3—research component over a 3-year period of part-time study that runs alongside and complements full-time clinical training.
Summative assessment of knowledge is undertaken through an end-of-year examination comprising single best answer questions and extended matching item questions in a similar format to the MRCS examination. In addition, there is an in-course assessment score reflecting the student's performance in various aspects of the course throughout the year.
During the second year, students are also introduced to the basic concepts relating to their academic development in preparation for the final year, in which students are afforded the opportunity to undertake a period of novel research leading to a dissertation and the award of MSc in surgical sciences. Although the primary objective of the third year is to consolidate academic principles and learning, many individuals go on to publish their work in peer-reviewed journals.
Academic data regarding performance and assessment end-of-year scores were sourced from student records relating to academic years — to — of the MSc in Surgical Sciences programme at the University of Edinburgh, in partnership with the Royal College of Surgeons of Edinburgh. Demographic data collected included age, gender, and the training post held at the time of entry to the programme. In years 1 and 2, students were assessed on the basis of completion of in-course MCQ, discussion board contributions, essays year 2 only , and final examination marks.
In year 3, students completed a research project proposal and summary, an e-poster, and a final e-dissertation, all of which contributed to the end-of-year score. All examination questions were quality assured including Angoff standard setting and the examination and in-course assessment results were ratified by a programme Board of Examiners at the University of Edinburgh, which included 2 external examiners, both consultant surgeons with academic appointments at other UK institutions, which included responsibilities for postgraduate clinical teaching.
The selection of external examiners and conduct of the board of examiners were done in accordance with the University's Taught Assessment Regulations and Guidelines. Anonymized student feedback was examined over the same period using archived responses to online questionnaires.
MCQs and EMQs in Surgery
Such feedback was sought on agreed pro forma that were circulated to students at the end of each academic year. A search of PubMed and Web of Knowledge was undertaken using ESSQ student name, supervisor name, and research topic to identify published research articles and abstracts resulting from the dissertation topic.
The MRCS is designed especially for surgical trainees in Great Britian and Ireland and is normally taken during the first 24 months of surgical training. Part A of the MRCS is a written examination on generic surgical sciences and applied knowledge, whereas the Part B Objective Structured Clinical Examination integrates basic surgical scientific knowledge and its application to clinical surgery.
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Immediately after their correlation with performance in the MSc programme, all data relating to individuals' MRCS examination scores were anonymized. Differences between group means were identified using Student t test for 2-group comparisons, and 1-way analysis of variance for multiple group comparisons. The influence of age, gender, and level at entry on end-of-year scores was assessed using the Cox proportional hazards regression model.
A total of surgical trainees from 40 countries Fig. The recruitment and overall progression rates of the ESSQ programme over the 5 completed academic years are shown in Table 1. Of the remaining 89 trainees, 68, 18, and 3 students were in the first, second, and third years, respectively, of a surgical training programme Fig. Level of work experience at entry to programme was not found to influence performance across each of the 3 years of the programme Fig.
On multivariate analysis, age, gender, and level of work experience at entry were not found to be predictors of end-of-year scores Table 2. Surgical training structure in the United Kingdom. The trainee has to demonstrate the acquisition of knowledge and technical skills in the workplace and negotiate examinations of the Royal College of Surgeons Membership, MRCS, and Fellowship, FRCS , which are mandatory requirements in demonstrating competency in surgery.
The influence of level at entry to the ESSQ programme and academic performance — Furthermore, there was a significant correlation between MRCS examination performance and overall performance in the first 2 years of the MSc programme Fig. Respondents consistently reported that they found the ESSQ an enjoyable experience. Search of PubMed and Web of Knowledge revealed that there have been 26 full research papers and 27 abstracts published to date relating to ESSQ research dissertations submitted May onwards.
The learning style provides students the options of a problem-oriented entry or systematic learning illustrated through subsequent problem solving, delivered in modules scheduled in blocks of time that accommodate and complement the student's clinical training demands.
Since its inception, the ESSQ has consistently exceeded its recruitment target with the highest student numbers of any postgraduate programme at the University of Edinburgh. Although targeted specifically at surgical trainees based in the United Kingdom, it has attracted more than students from 40 countries in the last 6 years.
The programme appears, therefore, to have a growing international reach with applicability to the early years of surgical training in many countries. This may be related to the current general reduction in working experience for doctors; the requirement to reduce working hours in Europe, North America, and Australasia 1—3 has diminished considerably the trainee's exposure to both common and less frequently encountered surgical conditions.
The high recruitment to the programme and positive feedback from students would endorse this view. The design of the ESSQ programme is underpinned by the pedagogical principles of e-learning, whereby students are supported as members of an online community with clearly defined learning objectives and use of materials that are active, engaging, collaborative, and relevant.
Central to course design, Blanchard and Frasson 11 emphasize the importance of roleplay to enhance constructivist learning.
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Labyrinth was designed in-house with the goal of supporting development of richly engaging, narrative medical cases that invite users to take control of their own decisions—and, by extension, their own learning—and develop the critical analysis skills to face effectively the consequences of those decisions. Greater experience held by more advanced trainees may be offset by a longer period away from formal academic study, conferring an advantage to recent graduates who are more accustomed to intensive study.
Furthermore, it is recognized that each student within a particular level of foundation intern or surgical training can have a very different profile of skills and experience compared with others at the same level, accounting for the lack of a relationship between performance and level at entry to the programme. Given that one of the principal aims of the ESSQ programme was to prepare the surgical trainee better for the individual components of the MRCS examination that were covered in the first 2 years to Diploma level, monitoring pass rates for those students who have presented themselves for MRCS examination in the United Kingdom has provided a valuable assessment of outcome.
The correlation between performance in the ESSQ programme and MRCS examination scores and the positive feedback from students further demonstrates that the programme is fit-for-purpose. The programme, however, was also intended to support the academic development of the surgical trainee at an early stage, and it is noteworthy that students who enrolled in the programme since its launch in continued to complete a postgraduate degree.
This has provided them with a strong academic foundation irrespective of their final career intentions. It may encourage some to pursue an additional period of research training, whereas for others, the academic exposure may replace the traditional approach, which has required surgical trainees in the United Kingdom to pursue 2 or 3 years out of surgical programme training to secure a postgraduate qualification that may make them competitive to progress thought-advanced surgical training.
Although, at the present time, there is insufficient follow-up of MSc postgraduates to determine whether their participation will impact on their future surgical training plans or academic development, it is encouraging to note that 26 full research articles have been published directly from content relating to the MSc dissertation project.
There is considerable potential for distance learning programmes to have a major impact on the future delivery of surgical training. The data from this study are relatively immature to determine whether it has contributed to a major change, but it has been demonstrated that the online ESSQ programme supports the academic development of trainees in the early years of surgical training, is well received by students, and is associated with improved success in their professional examination. They thank the many e-tutors involved, both past and present, for their vital contributions to the online activities and assessments of the ESSQ programme.
Reprints: O. E-mail ku. Disclosure: The authors declare no conflicts of interest. First of all thank you very much for the honor of reviewing this paper. Second, congratulations for the nice work in a very important area; that of education. They provide answers - and they Do viewing up. Some of these children are read sooner than the breakthroughs.
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