A web-based system for teaching, assessment and examination of the undergraduate peri-operative medicine curriculum

An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study

Background

Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19–related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange.

Objective

This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations.

Methods

A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire.

Results

In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians’ examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive.

Conclusions

The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination–based research questions.

A Secure, Social Media-Based "Case of the Month" Module in a Neurocritical Care Unit

BACKGROUND

Systems to meet the on-demand learning needs of nurses in intensive care units are not well studied beyond the traditional classroom models.

OBJECTIVE

To study the feasibility and effect of implementing an online discussion forum for nurses in a busy neuroscience intensive care unit.

METHODS

A baseline survey was done to highlight the areas of educational need in the unit. Freeform-a password-protected, online discussion forum supported by the university-was used for the pilot project. Freeform has functions similar to Facebook, with "likes," "follow," discussion/comment spaces, and the capacity for uploading images and files. A page called "All things NeuroCritical Care" was created. All nurses working in the intensive care unit were automatically enrolled. Clinical vignettes relevant to neurocritical care were posted once a month with 1 to 2 lead questions. All participation was voluntary, and topics were chosen on the basis of the needs survey. At the end of each case, a recent review article on the topic was posted for secure download.

RESULTS

Eight sentinel diagnoses have been presented as clinical vignettes, and 34 of 76 members formally follow the page. The mean number of discussion strings per case is 8.3 posts. The number of unique visitors to the page during active case discussions exceeds 100.

CONCLUSION

A secure, online, problem-based learning discussion format is a feasible point-of-care learning opportunity that can help overcome some of the traditional barriers to ongoing nursing education needs in a busy intensive care unit.

Systematic Review of Computer Based Assessments in Medical Education

Medical schools, postgraduate training institutes, licensing and certification bodies have developed and implemented many new methods for accurate, reliable, and timely assessments of the competence of medical professionals and practicing physicians. The underlying objective of all these assessments is to not only evaluate the students' learning and educational goals but also to establish the graduating individual's skills and professionalism. Computer based assessment (CBA) has emerged in recent years as a viable alternative to traditional assessment techniques. It has also infiltrated and influenced the medical curriculum where it has been employed for assessment tasks. This study presents how CBA offers pedagogical opportunities and analyzes its usage pattern over the past three decades. We examined 47 CBAs in medical education and analyzed several assessment components, including application area, assessment purpose, assessment type, assessment format, student level, and emphasized the interplay among these components. Our analysis determined that formative assessment is the most frequently used type and 75% of all assessment types employed used the multiple choice questions format.

A survey of undergraduate anesthesia rotation in medical colleges of Pakistan

BACKGROUND

Student perceptions of specialties influence career choice decisions. It is important to expose undergraduates to the scope of rewarding careers in specialties like anesthesia by ensuring a good quality educational experience during anesthesia rotation. Our objective was to survey the curriculum structure and placement of the anesthesia undergraduate rotation in all the medical colleges of Pakistan recognized by the Pakistan Medical and Dental Council.

MATERIALS AND METHODS

A standardized survey questionnaire was distributed by direct contact, postal mail or e mail to one identified anesthetist in all recognized medical colleges with enrolment of 100 or more students. The response rate was 75%. We received responses by hand, email and postal mail.

RESULTS

We received responses from 15 out of 20 anesthetists contacted. 11 reported undergraduate anesthesia rotation while 4 reported absence of this rotation in their undergraduate curriculum. The rotation placement, duration and curriculum showed a wide variation and lack of standardization.

CONCLUSION

Our survey indicates that the inclusion of anesthesia rotation in undergraduate medical education is not mandatory and standardized. The rotation duration, placement and curriculum need to be standardized to enhance the quality of the experience and promote the scope of the specialty for rewarding careers.

Implementing a hybrid web-based curriculum for an elective medical student clerkship in a busy surgical intensive care unit (ICU): effect on test and satisfaction scores

OBJECTIVE

To determine whether a hybrid traditional and web-based curriculum improves test scores and enrollment among senior medical students in an elective critical care rotation.

DESIGN AND SETTING

Retrospective study in a surgical ICU at a major academic center.

SUBJECTS

One hundred twenty-one fourth year medical students completing an elective ICU clerkship between 2007 and 2010.

INTERVENTIONS

Pre-test and post-test during a 4-week rotation.

METHODS

We implemented a hybrid curriculum that involved both traditional teaching methods and a new online core curriculum that incorporating audio, video, and text using screen capture technology. The curriculum was hosted on a secure online portal called ICON (Desire2Learn Inc., Ontario, Canada). The core curriculum covered topics that were considered essential to meet the didactic objectives of the rotation. MEASUREMENTS AND EVALUATIONS: A pre-test was administered online on day 1 of the rotation. A post-test was administered on the second to last day of the rotation. Both tests were composed of 20 questions randomly chosen from a question bank of 100 questions. The tests are managed (administering, grading, and reporting) exclusively online.

RESULTS

One hundred twenty-one medical students have successfully completed the clerkship since implementing the new curriculum. Each group of students showed an improvement in the mean post-test score by at least 17%+ to 10%. The satisfaction scores of the clerkship improved consistently from 2007 and is currently rated at 4.31 ± 0.85 (on a 5-point scale). The rotation is in the top 25(th) percentile of all clinical clerkships offered at the University of Iowa.

CONCLUSION

A systematically implemented hybrid web-based critical care curriculum can improve knowledge based test scores and overall clerkship satisfaction scores in a busy surgical ICU.

Web-assisted assessment of professional behaviour in problem-based learning: more feedback, yet no qualitative improvement?

Although other web-based approaches to assessment of professional behaviour have been studied, no publications studying the potential advantages of a web-based instrument versus a classic, paper-based method have been published to date. This study has two research goals: it focuses on the quantity and quality of comments provided by students and their peers (two researchers independently scoring comments as correct and incorrect in relation to five commonly used feedback rules (and resulting in an aggregated score of the five scores) on the one, and on the feasibility, acceptability and perceived usefulness of the two approaches on the other hand (using a survey). The amount of feedback was significantly higher in the web-based group than in the paper based group for all three categories (dealing with work, others and oneself). Regarding the quality of feedback, the aggregated score for each of the three categories was not significantly different between the two groups, neither for the interim, nor for the final assessment. Some, not statistically significant, but nevertheless noteworthy trends were nevertheless noted. Feedback in the web-based group was more often unrelated to observed behaviour for several categories for both the interim and final assessment. Furthermore, most comments relating to the category 'Dealing with oneself' consisted of descriptions of a student's attendance, thereby neglecting other aspects of personal functioning. The survey identified significant differences between the groups for all questionnaire items regarding feasibility, acceptability and perceived usefulness in favour of the paper-based form. The use of a web-based instrument for professional behaviour assessment yielded a significantly higher number of comments compared to the traditional paper-based assessment. Unfortunately, the quality of the feedback obtained by the web-based instrument as measured by several generally accepted feedback criteria did not parallel this increase.

Does medical students' preference of test format (computer-based vs. paper-based) have an influence on performance?

BACKGROUND

Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE.The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats.

METHODS

Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured.

RESULTS

Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format.

CONCLUSIONS

Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.

IT-based activity in physiology education: an experience from a developing country

Information technology (IT)-based components are included as active learning activities in medical curricula that have been shown to be more effective than most passive learning activities. In developing countries, these activities are not popular compared with developed countries. In this study, an IT-based assignment was carried out in physiology for undergraduates in Sri Lanka. We assessed certain basic IT capabilities before the assignment and found that the capability of using MS Word, e-mail, and the internet was limited to 68.3%, 62.0%, and 49.2% of students, respectively, with 40.8% of students having some other IT capabilities. We found a considerable variation in IT capabilities among the students, which depended on IT learning at schools and the geographical locations where students came from. The main source of IT knowledge for students was an introductory IT course given in the medical school with the second source being private IT learning centers. Response to the IT-based assignment was very poor. The reasons for poor participation included a lack of time due to parallel subjects, poor IT knowledge, and poor IT resource availability. However, students were willing to have optional IT-based components and were aware that IT knowledge is important for medical students as well as doctors. This study shows the importance of improving IT knowledge in students and the need of improving IT resources in medical schools. With these improvements, physiology education can be enriched with more interactive IT-based learning activities, which help students to acquire knowledge more efficiently and effectively in developing countries like Sri Lanka.

The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario

Medical students have difficulty calculating drug doses correctly, but better teaching improves their performance in written tests. We conducted a blinded, randomised, controlled trial to assess the benefit of online teaching on students' ability to administer drugs in a simulated critical incident scenario, during which they were scored on their ability to administer drugs in solution presented as a ratio (adrenaline) or percentage (lidocaine). Forty-eight final year medical students were invited to participate; 44 (92%) attended but only nine of the 20 students (45%) directed to the extra teaching viewed it. Nevertheless, the teaching module significantly improved the students' ability to calculate the correct volume of lidocaine (p = 0.005) and adrenaline (p = 0.0002), and benefited each student's overall performance (p = 0.0007). Drug administration error is a very major problem and few interventions are known to be effective. We show that focusing on better teaching at medical school may benefit patient safety.

De la création à l'évaluation d'un site Internet pédagogique en anesthésie-réanimation

OBJECTIVES

The aim of this study was to conceive, create, validate and assess a pedagogic site to teach students.

STUDY DESIGN

Survey with questionnaires.

METHODS

First, we performed an educational need assessment in that field, conducting a review of legal regulations and international guidelines and a survey of 91 students. Afterwards, we drew up a reference document based on proven scientific data, with selected bibliography and we wrote a list of specific teaching objectives. We then created a pedagogic Web site including illustrated references, documents, a selected bibliography and useful Internet links. These pedagogic Web sites could be associated to well-conducted tutorial sites by qualified senior physicians in an academic process to improve procedural skill teaching. After internal and external validation, this educational Web site was evaluated by students. This evaluation used the questionnaire proposed by "Régie Régionale de la Santé et des Services Sociaux de Montréal" (regional authority control of health and social services of Montreal). Our pedagogic Web site obtained 76 out of 100 and can be considered satisfactory.

CONCLUSION

This study demonstrated that adapted multimedia tools can improve procedural skill teaching in anaesthesia and intensive care.

Influence of improved teaching on medical students’ acquisition and retention of drug administration skills

BACKGROUND

Drug administration error is a major problem causing substantial morbidity and mortality worldwide. Lack of education about drug administration appears to be a causative factor. We devised an online teaching module for medical students and assessed its short- and long-term efficacy.

METHODS

One hundred and thirty clinical medical students were invited to undertake additional, online, teaching about drug administration. Those participating were identified and the number of web pages viewed recorded. The students' knowledge retention was tested by means of drug administration questions incorporated into routine assessments and examinations over the next 6 months. Other indices of all students' performance were recorded to correct for confounding factors.

RESULTS

Just over half (52%) responded to the invitation to participate. The amount of interest they showed in the teaching module correlated positively with their performance in questions about drug administration, although the latter waned over time. Surprisingly, correcting for students' general ability and keenness revealed that the less able students were most likely to undertake the teaching module.

CONCLUSIONS

Additional online teaching about drug administration improves students' knowledge of the topic but clearly requires reinforcement; however, only about half the students took up the option. Medical students must acquire these fundamental skills, and online teaching can help. Medical educators must ensure that drug administration is taught formally to all students as part of the curriculum and must understand that it may require additional teaching.

Integrated approaches to academic anaesthesia - the Cambridge experience

There is mounting concern about the pressures experienced by University Departments of Anaesthesia, which, if lost, could threaten undergraduate peri-operative medicine teaching, development of critical appraisal skills among anaesthetists, and the future of coherent research programs. We have addressed these problems by establishing a foundation course in scientific methods and research techniques (the Cambridge SMART Course), complemented by competitive, fully funded, 12-month academic trainee attachments. Research conducted during academic attachments has been published and used to underpin substantive grant applications allowing work towards higher degrees. Following the attachment, a flexible scheme ensures safe reintroduction to clinical training. Research at consultant level is facilitated by encouraging applications for Clinician Scientist Fellowships, and by ensuring that the University Department champions, legitimises and validates the allocation of research time within the new consultant contract. We believe that these are important steps in safeguarding research and teaching in anaesthesia, critical care and peri-operative medicine.