LISTENING AND ACTING ON PARTICIPANT VOICES; IMPLEMENTING THE RECOMMENDATIONS FROM A PRACTICAL SKILLS LOG EVALUATION STUDY.

Williams S.E. (williamsse17@cardiff.ac.uk) Webb K. L. (marshkl1@cf.ac.uk) and Monrouxe L.V. (monrouxelv@cardiff.ac.uk) Clinical Skills and Simulation Centre, 3rd Floor Cochrane Building, Heath Park Campus, School of Medicine, Cardiff University, CF14 4YU
Background and Purpose The General Medical Council (GMC) stipulates undergraduate medical students must be able to perform 32 practical skills or procedures to a satisfactory standard1. These should be performed in clinical areas under close supervision by a Healthcare Professional (HCP). One method of assessing practical skills includes direct observation: a log book is used to record the students competency. This study was conducted to provide an insight into the thoughts, experiences and conceptualisation of students and assessors involved in a Practical Skills Log (PSL) process to shed light onto to the research question: What are the personal experiences and opinions of students and HCPs who use a Practical Skills Log for assessment purposes within a clinical setting?

Discussion
The study highlights participants viewpoints of the PSL process that could be viewed as positive in nature, such as student empowerment and acting as an incentive (see Table 1). It also found numerous examples where students could have been better supported by HCPs in the clinical area. Some professional dilemmas highlighted in the student narratives mirrors earlier work4.

Methods
Using an interpretivist narrative enquiry methodology, 29 students and 5 HCP assessors participated in group and one-to-one interviews in order to examine their narratives of their PSL experience. An analytical coding framework was developed from the transcribed data and audio recordings. Data were coded within Atlas.ti using the developed framework. We are completely at the mercy of the people who sign these things. (Year 5, Male Student) it is good for me I think because I tend to shy away from practical stuff cos Im a bit...under confident so I think it's good that there's something that sort of...makes me do it. (Year 5, Female Student)

Table 2

Other themes and Sub themes Preference for simulation in assessment Assessment similar to that used by postgraduates Professionalism lapses

Recommendations
We have a number of recommendations arising from the study (Figure 3). The concept of Skills Champions is discussed in the literature5. These individuals are selected to work in health care environments where students are placed, actively encouraging and supporting students, and essentially creating and promoting a vision of good observation, feedback skills, and assessment standardisation. In addition, the analysis of a larger survey questionnaire should be undertaken in order to add to the findings and discussion of this study.

Results
Three main themes and 11 sub themes were identified within the data (Highlights indicated in Table 1 & 2). Student participants talked of a tick box mentality, supporting the findings in other research2, lack of supervision, apathy towards work place assessment, embarrassment in requesting assessment and examples of poor professionalism. In contrast, student participants also found the PSL a tool that legitimised asking HCPs for assessment and an incentive to get skills signed off. HCP participants talked about students needing to get used to work place assessments, and the importance of good feedback. HCP narratives indicated some evidence of the phenomenon failure to fail3. Table 1

Figure 3

Further research using linguistic word tool

Students(s)and assessors (a) positive perceptions of the PSL process Legitimises interaction with HCPs (s) Provides an incentive to ask for assessment (s) Receiving useful feedback (s) Receiving useful feedback (a) Getting used to similar assessments later in career (a) References

Students (s) and assessors (a) negative perceptions of the PSL process PSL is a Tick box exercise. (s) Embarrassment in asking assessors to participate (s) Receiving no feedback (s)

Improved process information from School to students

Skills Champion

Improved links with assessors in placement sites

Faculty and assessor development

Communication issues with School/Placement site (s) Reluctance to use the PSL formatively (s)
Take Home Message A Practical Skills Log enables students to legitimately ask placement site HCPs for assessment and feedback in practical skills. Students need to be well informed about the purpose of the PSL and assessors have a professional responsibility to ensure they engage with students to enable them to learn and be assessed in practical procedures in the health care environment.

1.General Medical Council. (2009). Tomorrows Doctors. London: GMC 2. Bindal, T., Wall, D. & Goodyear, H.M. (2011). Trainee doctors views on workplace-based assessments: Are they just a tick box exercise? Medical Teacher. 33: 919 - 927 3. Cleland, J. A., Knight, L.V., Rees, C. E., Tracey, S., & Bond, C. M. (2008). Is it me or is it them? Factors that influence the passing of underperforming students. Medical Education . 42: 800809 4. Monrouxe, L.V., & Rees, C.E (2012). "It's just a clash of cultures": emotional talk within medical students' narratives of professionalism dilemmas. Advances in Health Science Education: Theory & Practice.17: 5. 671-70 5. Hauer, K.E, Holmboe, E.S & Kogan, J.R. (2011). Twelve tips for implementing tools for direct observation of medical trainees clinical skills during patient encounters. Medical Teacher. 33: 27 - 33