1. Medicine, Nursing and Health Sciences
Using technology to maintain
course quality: Delivering a city
course in the country
Rural Curriculum Innovation Conference, Dec 2012
Dr. Hung The Nguyen
Clinical education and Professional Development Unit,
School of Primary Health Care
hung.nguyen@monash.edu
hung

2. Acknowledgements
**Course design
Associate Professor Lyn Clearihan
Dr. George Zaharias
Dr. Hung The Nguyen
**Tutors
Dr. Nizar Farjou
Dr. Mohammad R.Al-Magableh
Dr. Nadida Kachkouche
**Course administration
Ms. Caroline Menara

3. Background
 International Medical Graduates make up a significant workforce in the rural
Australia
• Australian health system is increasingly reliant on IMGs (HWA Health
Workforce 2025, 2012)
• 25% of the medical workforce are IMGs (AMWAC, 2005)
• 23% work in regional areas and 13% in rural and remote areas (Hawthorne
et al, 2003)
• Permanent resident OTDs fill the gap in vocational training programs
(AMWAC, 2005)
• 43% of Victorian GPRs were PR OTDs (RWAV, 2004)
• 36% of the GP workforce in rural Victoria were IMGs (RWAV, 2010)

4. Background
 IMGs require adequate educational, supervisory and other socio-
cultural supports for themselves and their family (Lost in the
Labyrinth report, 2012):
• Introductory support (clinical and professional orientation,
cultural awareness training; social and cultural orientation for
their families)
• Ongoing support (education and professional development,
examination preparation, mentoring and peer support
programs)
 IMGs can travel great distances to access educational activities they
need

5. Monash University IMG Clinical Bridging Course
Based in Notting Hill
8 days
Tutorials, lectures
Workshops – demonstrations, role play, simulated patients
Clinical exam practice

6. 3D Intensive Clinical Bridging Course
Based in Mildura
3 days
Tutorials
Workshops – demonstrations, role plays and simulated patients
Clinical exam practices
Pre-course and at home in-course activities activities
Google sites

7. Learning concepts and tools
 Challenges:
• How to maximise classroom efficacy? = in-class tools AND
out-of class study
• How to structure out-of-class study? = content AND delivery
• How to maximise peer-peer instruction? = building team spirit
AND safe learning environment
 The "flipped" classroom
• Information transfer takes place in advance.
• students study before rather than during or after class.
• the classroom becomes a place for active learning, questions,
and discussion.
• facilitators spend their time addressing students' difficulties
rather than lecturing.

8. Learning concepts and tools
 Content
• Developed by the Unit
• Available on the web
 Delivery of content - Google Sites
• Available: web-based
• Accessible: easy to sign up and sign in, staff/students can
collaborate
• Affordable: free
• Appropriate/Acceptable: ?

9. Learning concepts and tools
 Educational instructions
• Before the course:
• readings (clinical guidelines, cultural competency concepts
and principles, clinical interview tips and strategies, study
plan and learning objectives),
• videos (demonstration physical examinations);
• case studies (history, physical examination, management
strategies)
• In-course:
• minute paper; safe learning environment; peer-peer feedback
• role play, simulated patients and immediate feedback
• Between sessions:
• revision of reading;
• preparation for the next day

10. Google Sites
 Structured out-of-class learning activities
• readings (clinical guidelines, cultural competency concepts
and principles, clinical interview tips and strategies, study plan
and learning objectives),
• videos (demonstration physical examinations);
• case studies (history, physical examination, management
strategies)

11. Minute paper
 To investigate how well students understand important concepts
presented during a class period, and to improve instruction in the
succeeding class by modifications in delivery/presentation.
• Real time feedback
• During or at the end of a session
• Anonymous
 What we were interested in:
• Learning environment
• Delivery
• Relevance
• Learning achievements

12. Safe Learning Environment
 SLE = engaging, inclusive, challenging, supportive AND culturally
safe
• foster peer to peer feedback
• increase group interactions
• “Giving it a go”
• honest and meaningful feedback

13. Our first class...
n = 21
all in working in general practice or hospital
most from rural victoria, NSW/ACT and SA =12
Melbourne (4)
interstate - WA (4), Qld (1)
IMGs working in general practice, have AMC part 1, studying for AMC
part 2 or FRACGP/FACRRM

14. Did the minute paper help?
D2 D1

15. Did the minute paper help?
D2 D1

16. Did the minute paper help?
D2 D1

17. Did the minute paper help?
 The questions:
• learning environment
• relevance
• delivery
- scored 4-5/5 in all areas, with improvements on D2
 learning achievements
• D1 - physical examination skills, communication skills, history taking skills,
interpreting x-rays
• D2 - mock exam cases, physical examination skills
- practical skills > knowledge
- practice cases > case studies
 Changes to the sessions:
• D3 “expert” individual feedback in front of peers, before peer-peer discussions

18. Was Google Sites acceptable?

19. Was Google Sites acceptable?

20. Was Google Sites acceptable?

21. Was Google Sites acceptable?

22. Was Google Sites acceptable?

23. Was Google Sites acceptable?
• very useful, focused, gives us option to read what you
need and not everything in a typical section
• what about joining IMG remotely for a few online bridging
course and study program; maybe more videos made by
examiner as he is a good teacher
• I would be happy to pay a yearly fee for the site

24. Acceptability of the “flipped class”
 Evaluation:
- What was the best?
• delivery - interactive, hands on, OSCEs are a good way to
learn
• feedback - personal, individual, immediate
• environment - friendly, non-judgemental
• content - comprehensive, perfect and precise
- What could be better?
• more time, more cases
• obstetrics, gynaecology, paediatrics

25. Acceptability of the “flipped class”

26. Acceptability of the “flipped class”

27. Conclusion
 A successful approach (flipped class, google sites)
• To manage available time for the application of knowledge, skills
and attitudes
• To allow learning in a place, at a time and at a pace students
most benefit
• To maximise instruction and feedback time with expert facilitator
 Does this suggest changes to the main course?
• A different cohort
• Teacher resistance
 Other tools?
• Resource development (videos, virtual patients)
• Online tools egNB