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Introduction: The failure to fail, and elevated grades in Workplace-Based Assessment (WBA) are well-documented phenomena and assessors play a major role in this process. The resulting WBA appears to be of little real use to any of the stakeholders involved. What do assessors think is the problem and what do they think would improve the situation for them? If we develop and trial WBA designed to suit the assessor and use their expertise, will this result in WBA that is more useful for everyone? Summary of Methodology: To explore this question, a search of the literature was first conducted aiming to summarise understanding of the way clinical assessors make decisions regarding WBA results. The following research was conducted in the context of undergraduate medical student training and assessment in the workplace, at the University of Wollongong, Australia. To begin with, clinician assessors of medical students were surveyed regarding their attitudes to failing a student, and other difficulties they face in WBA. Following analysis of the initial survey, qualitative interviews of 16 experienced clinician assessors were conducted to further tease out survey responses. Suggestions from both the literature and the assessors were then used to design a WBA system intended to respect both the assessors’ expertise, and their relationship with their student. The new WBA trial incorporated the following changes: all WBA by the student’s preceptor was formative and focussed on feedback for learning; summative WBA grades were awarded by senior supervisors and were not delivered face to face to the student; grades included a ‘conditional pass’ grade allowing assessors to pass the student but define a problem for early remediation; assessment of developing skills was graded using clinical language of entrustment; and preceptors were asked to write confidential narrative observations on student performance for supervisors. WBA student results were compared before and after the new

Background Although teleconsultations have been used for many years in Australia, there has been a recent increase following new government incentives. There is a paucity of literature on enabling medical students to acquire the relevant skills. With a focus on equipping students for practice in rural and remote areas, our medical school has developed an innovative clinical skills lesson to prepare our students for their rural practice placements. Methods This lesson was delivered to all students in their third year of training in small groups to enable interactive learning. The objectives of the lesson were to familiarise students with: the various methods of conducting teleconsultations currently in use; the legal and ethical considerations; the technical and procedural issues; and the barriers and benefits for patients and doctors. Students rotated through four different stations over 2 hours and the lesson was evaluated using a student survey. Results Medical students self-reported statistically significant improvements in understanding the issues and procedures, and in confidence in conducting a telehealth consultation. Discussion Analysis of the results and student comments demonstrated that students recognise the value of telemedicine learning, and benefit from formal teaching on all aspects of telemedicine, including technology, ethics and protocols. Interestingly, the students found the opportunity to discuss areas such as the ethics of, and barriers to, the use of teleconsultations to be the most challenging and helpful of all of the stations.

of an oral presentation at the ANZAHPE/AMEA 2015 Conference, 29-31 March, Newcastle, Australia.

Background A Clinical Log was introduced as part of a medical student learning portfolio, aiming to develop a habit of critical reflection while learning was taking place, and provide feedback to students and the institution on learning progress. It was designed as a longitudinal self-directed structured record of student learning events, with reflection on these for personal and professional development, and actions planned or taken for learning. As incentive was needed to encourage student engagement, an innovative Clinical Log station was introduced in the OSCE, an assessment format with established acceptance at the School. This study questions: How does an OSCE Clinical Log station influence Log use by students? Methods The Log station was introduced into the formative, and subsequent summative, OSCEs with careful attention to student and assessor training, marking rubrics and the standard setting procedure. The scoring process sought evidence of educational use of the log, and an ability to present and reflect on key learning issues in a concise and coherent manner. Results Analysis of the first cohort's Log use over the four-year course (quantified as number of patient visits entered by all students) revealed limited initial use. Usage was stimulated after introduction of the Log station early in third year, with some improvement during the subsequent year-long integrated community-based clerkship. Student reflection, quantified by the mean number of characters in the 'reflection' fields per entry, peaked just prior to the final OSCE (mid-Year 4). Following this, very few students continued to enter and reflect on clinical experience using the Log. Conclusion While the current study suggested that we can't assume students will self-reflect unless such an activity is included in an assessment, ongoing work has focused on building learner and faculty confidence in the value of self-reflection as part of being a competent physician.

A study of people’s attitudes and responses to the presentation of health education by a doctor.

An OSCE clinical log station: driving reflection on clinical competence development Hudson JN, Rienits H, Graduate School of Medicine, University of Wollongong Background: An electronic clinical log was introduced at an Australian 4-year graduate entry medical school with the first intake of students in 2007. While some students embraced this log to record and reflect on their early clinical experiences, initial uptake of the log was low. Among the strategies used to encourage student use of this learning resource was the introduction of an innovative clinical log OSCE station. What was done: The clinical log station aimed to foster longitudinal recording and reflection on clinical experience and identification of significant learning issues in relation to patient and self-care, health promotion, teamwork and quality and safety. The scoring process sought evidence of educational use of the log. Demonstration of the marking sheet and standard setting procedure will illustrate how assessors scored performance using the following 3 main criteria: quantity and diversity of recorded experiences; case presentation; and reflection on development issues in relation to the presentation. Evaluation Findings: Student log use increased following introduction of the OSCE log station, but decreased following the final examinations. Student performance increased with experience of station expectations. Conclusions: While student ‘logging’ of clinical experience is important for quality assurance and to facilitate support of individual student development, assessment of this activity appears crucial to drive student engagement.

Delivering health education is, as we all know, done for the purpose of trying to encourage people, either individually or as a community, to change their behaviour with the intention of improving their health and well being and preventing certain lifestyle caused illnesses. We would all admit that changing behaviour is difficult and it often takes repeated health messages and much encouragement to effect behavioural change in a person or community. With the aging population and rise in preventable illnesses in our communities, health education has become the responsibility of all health professionals in all forms of contact with individuals or groups. Many studies have shown that doctors have enormous credibility in the eyes of many in the general public and this should be utilised to its maximum potential. Doctors often do not deliver health education as well as they could and it is necessary that we ask why not; and how could we better prepare our future doctors for this aspect of their work. Studies show we only deliver HE a third as often as we should.

Background Health professional education uses video recordings as self-analysis and reflection tool in clinical skill and communication skill development. Described benefits encompass better skill development, greater skill retention, enhanced ability to self-assess and reduced need for faculty input in the learning process. Summary of work We offered year 1 and year 2 medical students who showed deficits in their skills development, video-analysis of their skill performances as an additional remediation tool. The students were free to analyse the video on their own, with a peer or with a teacher. We collected qualitative data from consenting students and conducted a thematic analysis on ten semi-structured interviews. Summary of results The results confirmed findings from previous research, but also revealed self-affirmation as a significant theme. Students identified this confirmation of achievement as a valuable confounder to reduce assessment anxiety and stress. Conclusion Video self-analysis is a useful tool to affirm students' skill and to build early confidence, provided clear process guidelines are available to the students. Take home messages Students who lack confidence may use video-analysis of skills in exam preparation and for remediation work to control their assessment anxiety and stress.