ePoster Manager

ePoster

Wiki use for optimising scarce clinical resources!

Authors

Karen Ives-Smith Advanced Nurse Practitioner & Senior Clinical Educator
David Foreman Senior Lecturer in Nursing & Healthcare Practice

Theme

eLearning

INSTITUTION

Derby Hospitals, UK
University of Derby, UK

Background

This audit aims to explore the use of open access wiki technology to offer efficient and effective use of clinical resources for medical students in the surgical department.

Managing student’s expectations is becoming a significant role for lecturers, teachers and practice educators. Responding to the demands that students are placing upon clinical areas is a key responsibility in providing effective clinical education, in a stretched clinical environment.

Collecting feedback from students is often the easiest way to ‘canvas’ opinion, however, once feedback is collected, and presented, the results of the feedback have to be taken into consideration when developing courses, modules and teaching sessions. If the feedback is not taken used, then it may be seen as a tokenistic exercise with no worth to either the student or the body responsible for collecting and collating the data.

As a result of data collection from several groups of final year medical students undertaking their surgical attachment, it became clear that they felt there was a distinct shortage in availability of out-patient clinics and operating theatre lists for them to attend. This was in stark contrast to what was being reported by the clinical educators on those areas i.e. there were plenty of clinical and theatre slots not being utilised by those medical students.

Matching those students expectations with the reality of clinical opportunities within the surgical department proved to be a challenge. How could the opportunities be opened up to all students without ‘bottlenecks’ occurring at popular sessions such as certain clinicians theatre lists? How could this be kept up-to-date in line with the reality of hospital life? How could this be communicated with the students effectively?

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Summary of Results

Our demographic data showed what we expected from a mixed undergraduate and graduate entry cohort. (77.5% undergrads and 22.5% GEM). 70% of repsondents were female althought this is not representative of the course. The ages of the studets ranged from 22-37 years with the majority (80%) being in the 21-24 age bracket.

In terms of their social media use, 75% used social networking sites at least once per day (half of those admittied to multiple times per day). 2.5% suggetsed that they rarely or never used social networking. However, when asked about thier familiarity with 'wikis' 57.5% said that they were 'not at all' familiar.

Our wiki was designed to be user friendly and eaily accessible, and the students agreed that most of the features were 'easy' or 'about right' in terms of difficulty to perform. They were able to access the wiki from home, the hospital and university computors, however, they complained about the inability to use smartphones to access the wiki.

Half of the students accessed the wiki 2-3 times per week, with a quarter accessing it daily and another quarter accessing less frequently.

While we considered that there may be many uses for the wiki, students overwhelmingly used the wiki for very specific functions: 95% used it for signing up to clinical sessions, and 47.5% used it to find out what was ahppening in thier clinical subspecialty. Updates from the undergraduate administrators and finding contact details were also useful functions of the wiki.*

When we asked the students what the ideal way for this information to be delivered they overwhelmingly responded by suggesting that a fuly editable wiki was rthe most useful way of sharing all information apart from updates from the undergraduate administrators which would like to recieve via text message.**

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Conclusion

The conclusion of the work will focus on the students qualitative comments when asked how the wiki could be improved.

The comments were generally constructive, with the majority of comments relating to the inability to edit the wiki using smartphones.

There were several comments made regarding the students having too much access to clinical sessions and that some students were signing up to more (too many) sessions than others.

There were a few requests for it to be integrtaed with the current VLE, as this would keep all the data in one place. However, the VLE is owned and managed by the university and not the Hospital Trust therefore this function is not available to the team.

Manage students expectations is always the result of seeking student feedback. Often the most vacal feedbackers are those with issues with the course and the way things are run. In our response to student feedback we developed and tested a mechanism to attempt to allow students more access to more clinical opportunities, which was reflected in this year's feedback.

The methods of using a wiki were good in pronciple, however, with a significant number of contributors and a systems that doesn't necessarily fit the with technological requiresments of the students, there were faults in the system, which escalated over the year.

On the whole, the experience of running a wiki, and the benefits of using this technology are clear to see. The project will need to be refined in order that it is fully functional in the future.

Summary of Work

The students’ and educators’ opinions of the wiki have been sought in the form of a focused anonymous questionnaire using Surveymonkey (www.surveymonkey.com). This data is presented alongside some of the themes that emerge from feedback received from students in the year before the wiki ‘went live’ and the last year where students have had to use the wiki to be able to function within the surgical department.

The feedback collected from the students in the year preceding the implementation of the wiki contained some relevant general themes relating to availability of clinical opportunities. These were:

Not enough out-patient clinics
Some students were signing up (on a noticeboard) to more clinical activity than others
Cancellations were not communicated (= wasted time)
Lots of clashes between teaching and clinical opportunities.

This feedback was the catalyst for introducing the wiki.

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Take-home Messages

Our take home message for this project are simple.

Only seek student feedback if you are planning to do something with the results!
If you have an idea to make things easier try it out!
Using technology for technology's sake is a bad idea.
If using technological solutions, make sure your whole team are either 'digital natives' or 'digital tourists'
Plan well and have a mechanism for feedback!

References

British Medical Association (2008) Role of the Patient in Medical Education, www.bma.org.uk

Foreman D. (2008) Using technology to overcome some traditional barriers to effective clinical interprofessional learning Journal of Interprofessional Care, 22(2): 209 – 211

General Medical Council (2011) Patient and public involvement in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009) www.gmc.org.uk

Howe A. and Anderson J. (2003) Involving patients in medical education. British Medical Journal Vol 327 pp.326-328.

Prensky M.(2001) "Digital Natives, Digital Immigrants Part 1", On the Horizon, 9:5, pp.1 - 6

Background

The British Medical Association (2008) state that patient contact is at the heart of learning; it provides students with an opportunity to learn and then apply their knowledge ands skills in real and teaching sessions.

The General Medical Council (2011) highlight that patients have always had a role in medical education, albeit somewhat passive, to illustrate symptoms or procedures. This is due to medical education being based on an apprentice model.

While Howe & Anderson (2003) claim that this cannot be achieved solely through opportunistic patient contact, adequate numbers of clinical opportunities should be made available for students to attend. They will often meet patients who are experts in their condition, exemplars of their disease and facilitators for the students development of appropriate professional skills and attitudes. (Howe & Anderson 2003)

It was decided that a trial of a ‘wiki’ should be undertaken as a way of offering interactive real time, remote, communication with students to try to make the most of clinical availability, and to increase the effectiveness of the delivery of clinical education.

A ‘wiki’ is just a website which can be edited by it’s viewers. The most popular ‘wiki’ is Wikipedia. This website is visited by millions of people a day to try to find information on any subject. The unique feature of Wikipedia is that all of the information contained within the pages are uploaded and completed by the viewers themselves.

The wiki chosen for this project is a free on-line wiki which can be accessed easily by all users. www.pbwiki.com allows a free set-up and use, however, paid premium services which allow larger numbers of users, and different levels of security/editing rights was felt to be more appropriate in this context. The cost was $100 (£63) per year. The wiki was set-up initially to show the welcome page on entering the site, and then to signpost students to the pages of their chosen subspecialty. there was a separate page for each of the surgical subspecialties:

Colorectal

Vascular

UpperGI/HPB

Urology

Breast Surgery/Surgical Assessment Unit

There were also pages for:

Weekend sessions

Additional sign up sessions

General surgery contact details

An overview of the attachment

Clinical assessments

Over the course of the year, other pages were added including specific pages for OSCE teaching, ABPI teaching, Consent teaching depending on what was happening in the academic timetables.

Each subspecialty pages was edited by the clinical educator within the subspecialty to ensure that sessions offered were going ahead and that extra sessions could also be offered to maximise the number of clinical opportunities available to the students.

The initial set-up process included agreeing of a standard format for the subspecialty pages, and to provide support for the clinical educators and administrators in using the wiki and how to add students and how to set editing privileges and troubleshoot issues with the wiki. It was soon discovered that many of the internet browsers within the hospital needed to be upgraded in order that the wiki software was able to open properly and be edited smoothly and effectively. The IT department were happy to do this when certain machines were identified, and all of the library, education centre and mess computers were upgraded automatically.

Summary of Results

Of the students that replied to the surveymonkey 77% were undergraduate students, and 23 were Graduate Entry Medical (GEM) students. 70% were female which is slightly more than the percentage of female students at about 60%. Most of the students were under 30 years old, with most of the students (75%) admitting to accessing social media such as Facebook, Twitter, MSN at least daily. Half of these stated that they visited these sites on multiple occasions daily. Interestingly, only five of the students (12.5%) said that they were either quite or very familiar with wikis. The other 87.5% of the students were ‘not very’ or ‘not at all’ familiar with wikis.

It would have been interesting to see how many of these students had used Wikipedia in the last few months to access information. It would also be interesting to find out how many student were aware that Wikipedia was in-fact a wiki that they could edit?

When the student were asked to comment specifically on the surgical wiki and how easy it was to use, the results were generally pleasing. with most students saying that ‘logging in’, ‘navigation from the front page’, ‘finding the sub-spec pages’, ‘ editing the sub-spec pages’, and receiving updates were all either ‘easy’ or ‘about right’.

Most students did not change their own personal profile within the wiki.

Students accessed the wiki from many locations using different devices. At home they generally used laptops, in the hospital/university/library they used the Trust/university PCs. Interestingly, they also used smartphones in all of those locations. This highlighted the problem that the wiki could not be edited on smartphones. A problem that is highlighted throughout all of the feedback.

The majority of students accessed the wiki 2-3 times per week with some looking daily and one student only looking during weeks one and five.

The students ranked what they used the wiki for and this was as expected:

1. signing up for sessions

2. finding out what is happening in own specialty

3. reading updates from the undergrad office

4. finding out what was happening in other specialties

5. looking at presentations

6. finding contact details

7. finding consultants/teaching fellows etc.

The students were asked how they would prefer to perform the functions above, would they prefer a weekly meeting, a booklet, a notice board, the wiki or by text message. On the whole, students would like all of the functions above to be communicated via the wiki apart from reading updates from the undergrad office which they would like to receive via text message (this was the norm before the wiki). The students also liked the comfort of having a booklet containing contact details and consultant/teaching fellow whereabouts!