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Zhang W, Jiang M, Zhao W, Li S, Li F, Feng F, Wang Y, Li Y, Liu L. Evaluation of the effectiveness of using flipped classroom in puncture skills teaching. BMC MEDICAL EDUCATION 2024; 24:176. [PMID: 38395791 PMCID: PMC10885647 DOI: 10.1186/s12909-024-05132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The effectiveness of flipped classroom (FC) on puncture skills in medical education is still uncertain. This study aimed to assess the role of the FC model in puncture skills and investigate the acceptance and approval of FC among medical students and instructors. METHODS A mixed research approach of quasi-experimental research design and descriptive qualitative research was conducted in September 2022 for one month, using an FC teaching method that combined instructional videos and group learning. The study participants were 71 fifth-year medical students from two classes at a Chinese medical school and four instructors. The medical students were randomly divided into two groups: the traditional classroom (TC) group (Group A) and the FC group (Group B). For teaching, Group B used FC, and Group A used PowerPoint-based TC. The effectiveness of the two teaching models was assessed with Objective Structured Clinical Examination (OSCE), and questionnaires were distributed to the medical students and instructors after the assessment. Two independent sample t-tests were used to analyse the differences in demographic data and the OSCE scores of the two groups of medical students. RESULTS Group B scored higher in puncture skills than Group A, especially regarding abdominal puncture (p = 0.03), thoracentesis (p < 0.001), bone marrow puncture (p < 0.001) and average performance of puncture skills (p < 0.001). For lumbar puncture, no difference in skill scores was observed between groups A and B (p > 0.409). The medical students thought that the FC improved their self-learning ability and helped them acquire knowledge. Regarding the OSCE of their skills, most medical students thought that it was more innovative and objective than traditional examinations and that it was better for assessing their overall abilities. Both the FC and OSCE were supported by the medical students. The instructors were also satisfied with the students' performance in the FC and supported the teaching model, agreeing to continue using it. CONCLUSIONS This study shows that FC teaching that combines instructional videos and group learning is a reliable and well-received teaching method for puncture skills, which supplements and expands existing teaching methods in the medical field.
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Affiliation(s)
- Weihao Zhang
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Miao Jiang
- Clinical Skill Training Center, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Wei Zhao
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Shuai Li
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Fan Li
- Department of Neurology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Feifei Feng
- Department of Respiration, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Yongjing Wang
- Department of Hematology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Yan Li
- Clinical Skill Training Center, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Lan Liu
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China.
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Hatt D, Zimmerman E, Chang E, Vane J, Hollenbach KA, Shah A. First-Person Point-of-View Instructional Video on Lumbar Puncture Procedure. Pediatr Emerg Care 2023; 39:953-956. [PMID: 38019714 DOI: 10.1097/pec.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Tutorial videos filmed from a first-person point of view (FP-POV) are generally well received. Pediatric residents are expected to be competent in performing the lumbar puncture (LP). The educational effectiveness of a FP-POV in lumbar puncture procedure training for resident physicians has yet to be evaluated. We compared a FPPOV LP video with a standard in-person demonstration of the LP. METHODS We designed an assigned cohort study to compare a FP-POV procedural instructional video of a simulated pediatric LP to the standard in-person procedure demonstration.After the intervention, residents completed an LP observed by one of two blinded reviewers who assessed the procedure using a modified, published assessment tool.Participants completed preintervention and postintervention surveys to rate self-confidence and usefulness of the FP-POV educational method. The data was analyzed using a Wilcoxon Rank sum test. z Scores were calculated on the raw assessment scores. RESULTS Eighteen first year pediatric residents participated, nine in each group. The median modified assessment tool score was 17 in the FP-POV group (min, 14; max, 17; IQR:, 1.5) and 14 in the standard demonstration group (min, 6; max, 17; IQR, 4.5), with the higher score being more successful. There was a statistical difference between the assessment scores between the 2 groups (z score = 2.18, P = 0.04). Postintervention survey data demonstrated relative satisfaction with the FPPOV educational method. CONCLUSIONS This study supports the educational effectiveness of a FP-POV procedure tutorial.Future studies with a larger sample size are needed.
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Affiliation(s)
| | | | | | | | | | - Ashish Shah
- Pediatric Emergency Department, University of California, San Diego, CA
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Kodikara K, Seneviratne T, Premaratna R. Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability. BMC MEDICAL EDUCATION 2023; 23:729. [PMID: 37803328 PMCID: PMC10559527 DOI: 10.1186/s12909-023-04722-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated. METHODS A prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student's communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT). RESULTS Fifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)]. CONCLUSION Simulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.
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Affiliation(s)
- Kaumudee Kodikara
- Department of Medical Education, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Thilanka Seneviratne
- Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjan Premaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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O'Connor P, Reid A, Mongan O, Egan C, Reid-McDermott B, Augusthinose PP, Smith M, Cooney R, Byrne D. An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice. BMC MEDICAL EDUCATION 2023; 23:565. [PMID: 37559003 PMCID: PMC10413605 DOI: 10.1186/s12909-023-04545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Upon entering the healthcare system, junior doctors may lack the skills required to care for patients, and feel unprepared for their role, with considerable variation in the level of proficiency in the performance of particular clinical procedures. OBJECTIVE To compare the performance and proficiency (self-report and observed) of the performance of nine basic clinical procedures. METHODS Seventeen interns were observed performing nine clinical procedures in a simulated setting in June 2021 (Assessment 1) and January 2022 (Assessment 2). The observers identified whether each step in the procedure was performed correctly, and provided an overall assessment of proficiency. The participants also rated their own level proficiency. RESULTS At Assessment 1 the number of steps performed correctly ranged from a mean of 41.9-83.5%. At Assessment 2 the number of steps performed correctly ranged from a mean of 41.9-97.8%. The most common median proficiency rating for Assessment 1 was 'close supervision', and was 'indirect supervision' at Assessment 2. There was a significant and large effect size in the improvement in performance from Assessment 1 to Assessment 2. Low correlations were found between observer and self-reported proficiency in performance of the procedures. CONCLUSIONS The large improvement in performance across the two assessments is encouraging. However, there is a need to address the variability in performance on graduation from medical school, and to ensure that any assessment of proficiency is not only reliant on self-report.
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Affiliation(s)
- Paul O'Connor
- Department of General Practice, School of Medicine, University of Galway, 1 Distillery Road, Newcastle, Co Galway, Galway, H91 TK33, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland.
| | - Ambyr Reid
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Orla Mongan
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Cara Egan
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Bronwyn Reid-McDermott
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Philip Parackal Augusthinose
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
| | - Michael Smith
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Ruth Cooney
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
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Cai F, Santiago S, Southworth E, Stephenson-Famy A, Fay E, Wang EY, Burns RN. Does the Degree Matter? MD and DO Students Who Match Into OB/GYN Report Different Experiences in US Undergraduate Medical Education. J Grad Med Educ 2023; 15:500-504. [PMID: 37637350 PMCID: PMC10449345 DOI: 10.4300/jgme-d-22-00693.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/04/2023] [Accepted: 06/12/2023] [Indexed: 08/29/2023] Open
Abstract
Background Although allopathic (MD) and osteopathic (DO) students have similar curricular requirements, little is known about differences in MD and DO preparedness for obstetrics and gynecology (OB/GYN) residency. Objective To assess differences in experiences and confidence of MD vs DO students who matched to OB/GYN. Methods This cross-sectional survey study was open to all fourth-year medical students who matched to OB/GYN in the United States in April 2021. The survey included demographic data, clinical experiences, confidence (5-point sliding scale), and a 11-item knowledge test. Survey responses were compared to assess for disparities in experiences and confidence. Results Survey response rate was 72.0% (1057 of 1469) students matched to OB/GYN postgraduate year 1 positions. Of the 871 MD and 175 DO responding students, MDs were more likely to have clerkships ≥6 weeks (78.1% vs 15.4%; P<.001) and a home sub-internship (92.0% vs 53.4%; P<.001). DOs reported more hands-on experiences with procedures (MD median=35 [20-35] vs DO median=40 [25-65]; P=.002). There was no difference in self-reported confidence in knowledge, technical skills, or having a realistic sense of internship, and no difference in baseline knowledge test scores. DOs felt less confident about their medical school preparation (aOR 0.40; 95% CI 0.25-0.66; P<.001) and were more likely to perceive inequity of residency preparation (aOR 1.88; 95% CI 1.18-3.00; P=.002). Conclusions MD students matched to US OB/GYN residency programs reported longer clerkship and more home sub-internships, while DO students reported more hands-on experiences. Despite reporting similar confidence in knowledge and skills, DO students felt less prepared for internship.
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Affiliation(s)
- Fei Cai
- Fei Cai, MD, is a PGY-7 Maternal Fetal Medicine Fellow, Hospital of the University of Pennsylvania
| | - Sarah Santiago
- Sarah Santiago, MD, is a PGY-3 Obstetrics and Gynecology Resident, University of Michigan
| | - Elizabeth Southworth
- Elizabeth Southworth, MD, is a PGY-3 Obstetrics and Gynecology Resident, University of Michigan
| | - Alyssa Stephenson-Famy
- Alyssa Stephenson-Famy, MD, is Associate Professor of Obstetrics and Gynecology and Associate Residency Program Director, Division of Maternal Fetal Medicine, University of Washington Medical Center
| | - Emily Fay
- Emily Fay, MD, is Assistant Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington Medical Center
| | - Eileen Y. Wang
- Eileen Y. Wang, MD, is Clinical Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania; and
| | - R. Nicholas Burns
- R. Nicholas Burns, MD, is a PGY-7 Maternal Fetal Medicine Fellow; University of Washington Medical Center
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Kerluku J, Wessel L, Ling D, Nguyen JT, Felix KJ, Sutton KM, Fufa DT. Assessing Gender Differences in Technical Skills and Confidence in Orthopaedic Surgery Residency Applicants. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202307000-00004. [PMID: 37410809 PMCID: PMC10328664 DOI: 10.5435/jaaosglobal-d-22-00265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Variations in confidence for procedural skills have been demonstrated when comparing male and female medical students in surgical training. This study investigates whether differences in technical skill and self-reported confidence exist between male and female medical students applying to orthopaedic residency. METHODS All medical students (2017 to 2020) invited to interview at a single orthopaedic residency program were prospectively evaluated on their technical skills and self-reported confidence. Objective evaluation of technical skill included scores for a suturing task as evaluated by faculty graders. Self-reported confidence in technical skills was assessed before and after completing the assigned task. Scores for male and female students were compared by age, self-identified race/ethnicity, number of publications at the time of application, athletic background, and US Medical Licensing Examination Step 1 score. RESULTS Two hundred sixteen medical students were interviewed, of which 73% were male (n = 158). No gender differences were observed in suture task technical skill scores or mean difference in simultaneous visual task scores. The mean change from pre-task and post-task self-reported confidence scores was similar between sexes. Although female students trended toward lower post-task self-reported confidence scores compared with male students, this did not achieve statistical significance. Lower self-reported confidence was associated with a higher US Medical Licensing Examination score and with attending a private medical school. DISCUSSION No difference in technical skill or confidence was found between male and female applicants to a single orthopaedic surgery residency program. Female applicants trended toward self-reporting lower confidence than male applicants in post-task evaluations. Differences in confidence have been shown previously in surgical trainees, which may suggest that differences in skill and confidence may develop during residency training.
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Affiliation(s)
- Jona Kerluku
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Lauren Wessel
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Daphne Ling
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Joseph T. Nguyen
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Karla J. Felix
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Karen M. Sutton
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
| | - Duretti T. Fufa
- From the Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY (Ms. Kerluku and Dr. Fufa); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Wessel); the Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Dr. Ling); the Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (Dr. Ling); the HSS Research Institute, Hospital for Special Surgery, New York, NY (Dr. Ling); the HSS Research Institute, Biostatistics Core, Hospital for Special Surgery, New York, NY (Mr. Nguyen); the Department of Academic Training, Hospital for Special Surgery, New York, NY (Dr. Felix); and the Department of Orthopaedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY (Dr. Sutton)
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Fujikawa H, Son D, Mori H, Kondo S, Horita S, Izumiya M, Eto M. Development and assessment of a vaccine administration training course for medical students. BMC MEDICAL EDUCATION 2023; 23:385. [PMID: 37231480 DOI: 10.1186/s12909-023-04299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Vaccine administration skills are very important for physicians, especially in the era of global pandemics. However, medical students have reported that practical sessions to develop these skills are insufficient. Therefore, the aim of our study was to develop a vaccination training course for medical students. We also examined its educational effectiveness. METHODS 5th- and 6th-year medical students at the University of Tokyo were recruited to attend the vaccine administration training course in 2021. These students were our study participants. Our course consisted of an orientation part, which included a lecture on the indications, adverse events, and vaccination techniques of flu vaccines and practice on a simulator, and a main part in which the staff of the University of Tokyo Hospital were actually vaccinated. Before and after the main part of the course, study participants completed an online questionnaire that assessed their confidence in vaccine administration technique through a five-point Likert scale. We also surveyed their feedback about the course content and process. At the beginning and end of the main part, their technical competence in vaccination was assessed by two independent doctors. These doctors used a validated checklist scale (ranging from 16 to 80) and a global rating scale (ranging from 0 to 10). We used their mean scores for analysis. The quantitative data were analyzed through the Wilcoxon signed-rank test. For the qualitative data of the questionnaire, thematic analysis was conducted. RESULTS All 48 course participants participated in our study. Participants' confidence in vaccination technique (Z = -5.244, p < 0.05) and vaccination skill significantly improved (checklist rating: Z = -5.852, p < 0.05; global rating: Z = -5.868, p < 0.05). All participants rated the course as, "overall educational." Our thematic analysis identified four emerging themes: interest in medical procedures, efficacy of supervision and feedback, efficacy of "near-peer" learning, and very instructive course. CONCLUSIONS In our study, we developed a vaccine administration course for medical students, assessed their vaccination techniques and confidence in those techniques, and investigated their perceptions of the course. Students' vaccination skills and confidence improved significantly after the course, and they positively evaluated the course based on a variety of factors. Our course will be effective in educating medical students about vaccination techniques.
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Affiliation(s)
- Hirohisa Fujikawa
- Center for General Medicine Education, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Hiroko Mori
- General Education Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Center for Medical Education and Career Development, Graduate School of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Medical Education, School of Medicine, Teikyo University, Itabashi-ku, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Burns RN, Southworth E, Santiago S, Stephenson-Famy A, Fay E, Wang EY, Cai F. Volume, Distribution, and Inequities by Race and Gender of Clinical Experiences Reported by Medical Students Entering Obstetrics and Gynecology Residencies. JOURNAL OF SURGICAL EDUCATION 2023; 80:657-665. [PMID: 36801203 DOI: 10.1016/j.jsurg.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess for inequities by race and gender of fourth year medical students' (MS4s) self-reported clinical experience in obstetrics and gynecology (Ob/Gyn). DESIGN This was a voluntary, cross-sectional survey. Participants provided demographic data, information regarding their preparation for residency, and self-reported numbers of hands-on clinical experiences. Responses were compared across demographic categories to assess for disparity in pre-residency experiences. SETTING The survey was open to all MS4s matched to Ob/Gyn internships in the United States in 2021. PARTICIPANTS The survey was distributed primarily via social media. Eligibility was verified by participants supplying the names of their medical school of origin and their matched residency program prior to completing the survey. 1057/1469 (71.9%) MS4s entering Ob/Gyn residencies participated. Respondent characteristics were not different from nationally available data. RESULTS Median clinical experience numbers were calculated for hysterectomies (10; IQR 5-20), suturing opportunities (15; IQR 8-30), and vaginal deliveries (5.5; IQR 2-12). Non-White students had fewer hands-on experiences with hysterectomy, suturing, and cumulative clinical experiences when compared to White MS4s (p values <0.001). Female students had fewer hands-on experiences with hysterectomies (p < 0.04), vaginal delivery (p < 0.03), and cumulative experiences (p < 0.002) than male students. When assessed by quartiles, non-White students and female students were less likely to be in the top quartile for experience and more likely to be in the bottom quartile for experience than their White and male counterparts, respectively. CONCLUSIONS A significant number of medical students entering Ob/Gyn residency have minimal hands-on clinical experience with foundational procedures. Additionally, there are racial and gender disparities in clinical experiences of MS4s matching to Ob/Gyn internships. Future work should identify how biases in medical education may affect the access to clinical experience in medical school, and potential interventions to mitigate inequities in procedures and confidence prior to residency.
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Affiliation(s)
- R Nicholas Burns
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington.
| | - Elizabeth Southworth
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Sarah Santiago
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Alyssa Stephenson-Famy
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Emily Fay
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Eileen Y Wang
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fei Cai
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Ormonde C, Igwe EO, Nealon J, O'Shaughnessy P, Traynor V. Delirium education and post-anaesthetics care unit nurses' knowledge on recognising and managing delirium in older patients. Aging Clin Exp Res 2023; 35:995-1003. [PMID: 37014618 PMCID: PMC10149476 DOI: 10.1007/s40520-023-02390-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a major complication following a surgical procedure. There is evidence that improving knowledge about POD could enhance POD care and patient outcomes. AIM The study aimed to evaluate whether the amount of delirium education among registered nurses working in post-anaesthetics care units (PACU) impacts on their self-reported confidence and competence in recognising and managing delirium as well as prior knowledge on factors that influence the risk of delirium onset for older people. METHOD The current study utilised an online survey on delirium care practice among registered nurses in PACUs. The survey consisted of 27 items. There were questions about confidence and competence in delirium care, knowledge about delirium risk factors, and ranked responses to two case scenario questions to evaluate the application of POD care. There were also demographic questions, including previous experience with delirium care education. RESULTS A total of 336 responses were generated from registered nurses working in PACU. Our findings found substantial variability among the respondents about their delirium care education. The amount of delirium education did not influence the PACU registered nurses' confidence or competence in delirium care. In addition, previous education did not have an impact on their knowledge about delirium risk factors. DISCUSSION AND CONCLUSION These findings suggested that the quantity of prior education about delirium did not improve the confidence, competence, knowledge, or case scenario questions of PACU registered nurses. Thus, delirium care education needs to be transformed to ensure it has a positive effect on delirium care clinical practice by registered nurses in PACU.
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Affiliation(s)
- Callum Ormonde
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Ezinne O Igwe
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia.
| | - Jessica Nealon
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
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Ragsdale JW, Seelbach EB, Vick S, Schadler A, Hall AM. Practice Doesn't Make Perfect: Clinical Experience With Procedures Does Not Correlate Well With Competence in Third-Year Medical Students. JOURNAL OF SURGICAL EDUCATION 2022; 79:1441-1446. [PMID: 35933309 DOI: 10.1016/j.jsurg.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE There is limited data available about factors which promote competence with procedures in medical students. Specifically, the relationship between procedural clinical experience and performance on an assessment is unclear. We sought to determine whether a correlation exists between the amount and type of clinical experience with a procedure and student performance on a standardized assessment of that procedure. DESIGN Faculty performed standardized assessments of third-year medical students on ten procedures using simulation. We prospectively surveyed students about 3 types of experience (performed, observed, and simulated) with these procedures during their clerkships. We then analyzed whether a correlation exists between student experience and their competency assessment scores using Pearson's correlation. SETTING/PARTICIPANTS Third-year medical students at the University of Kentucky College of Medicine. RESULTS In 2018 to 2019, 131 students were assessed on procedural competency with 10 failures. One hundred and twenty students (91.6%) completed the clinical experience survey. Correlations between types of experience and competency scores were small to moderate, with only 5 of 40 being significant. We found no correlation between experience having performed a procedure and competency score. CONCLUSIONS Overall, we did not find convincing evidence of a correlation between experience with procedures during clerkships and performance on a competency assessment. This suggests other factors may be contributing to procedural competence, which has implications for how educators should develop procedural competence in students.
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Affiliation(s)
- John W Ragsdale
- University of Kentucky College of Medicine, Lexington, Kentucky.
| | | | - Sarah Vick
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Aric Schadler
- University of Kentucky College of Medicine, Lexington, Kentucky; University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Alan M Hall
- University of Kentucky College of Medicine, Lexington, Kentucky
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11
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Lu EL, Harris MK, Gao TZ, Good L, Harris DP, Renton D. Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills. MEDICAL SCIENCE EDUCATOR 2022; 32:1015-1022. [PMID: 35936650 PMCID: PMC9340706 DOI: 10.1007/s40670-022-01602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery. METHODS Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course. RESULTS Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive. CONCLUSIONS Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.
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Affiliation(s)
- Emily L. Lu
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Micah K. Harris
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Thomas Z. Gao
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Logan Good
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Daniel P. Harris
- Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - David Renton
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
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Scott RW, Fredriksen K. Extracurricular work experience and its association with training and confidence in emergency medicine procedures among medical students: a cross-sectional study from a Norwegian medical school. BMJ Open 2022; 12:e057870. [PMID: 36167389 PMCID: PMC9516200 DOI: 10.1136/bmjopen-2021-057870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Proficiency in basic emergency procedures is important for junior doctors, but the amount of practical exposure may vary. We studied the association between students' extracurricular healthcare-related (ECHR) work experience and self-reported practical training and confidence in selected emergency medicine procedures. STUDY DESIGN Cross-sectional study. MATERIALS AND METHODS Medical students and first-year graduates answered a Likert-based questionnaire probing self-reported amount of exposure to ('training amount') and confidence with selected emergency medicine procedures. Participants also reported ECHR work experience, year of study, previous healthcare-related education, military medic training and participation in the local student association for emergency medicine (Tromsø Acute Medicine Students' Association (TAMS)). Differences within variables were analysed with independent samples t-tests, and correlation between training amount and confidence was calculated. Analysis of covariance and mixed models were applied to study associations between training amount and confidence, and work experience (primary outcomes) and the other reported factors (secondary outcomes), respectively. RESULTS 539 participants responded (70%). Among these, 81% had ECHR work experience. There was a strong correlation (r=0.878) between training amount and confidence. Work experience accounted for 5.9% and 3.5% of the total variance in training amount and confidence (primary outcomes), and respondents with work experience scored significantly higher than respondents without work experience. Year of study, previous education, military medic training and TAMS participation accounted for 49.3%, 8.7%, 6.8% and 23.6%, and 58.5%, 5.1%, 4.7% and 12.3% of the total variance in training amount and confidence, respectively (secondary outcomes). Cohen's D was 0.48 for training amount and 0.32 for confidence level, suggesting medium and weak medium-sized associations with work experience, respectively. CONCLUSION ECHR work experience is common among medical students and was associated with more training amount and higher confidence in the procedures. Year of study, previous relevant education and TAMS participation, but not military medic training, were also significantly associated with training amount and confidence.
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Affiliation(s)
- Remi William Scott
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut Fredriksen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
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Boggs ZD, Regalado LE, Makary MS. Procedural Fundamentals for Medical Students: Institutional Outcomes of a Novel Multimodal Course. Acad Radiol 2022; 29:1095-1107. [PMID: 34801346 DOI: 10.1016/j.acra.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES There is a gap in current medical student education pertaining to procedural skills' exposure and acquisition. The aim of this study is to evaluate the institutional experience of a novel medical student procedural course and its impact on procedural confidence. MATERIALS AND METHODS This is a single-center prospective study performed at a public medical school and its associated tertiary care medical center between June 2020 and January 2021. This study was deemed exempt by our Institutional Review Board and was performed with participant consent. The multimodal course developed by the radiology department consisted of four didactic lectures, four simulation sessions, and a minimum of 16 clinical rotation hours with the department's vascular access team. Primary outcomes were assessed by comparing participant pre and post course surveys including twenty-five 5-point Likert scaled questions. RESULTS Twenty-five self-selected students completed the course in its entirety. The curriculum and the corresponding survey analysis were stratified into sections by procedure modality. An increase in participant confidence to a moderate or greater level was observed when comparing pre and post course survey data for each procedure: vascular access (4% vs 52%, p < 0.01), thoracentesis (8% vs 48%, p < 0.01), paracentesis (8% vs 72%, p < 0.01), lumbar puncture (4% vs 44%, p < 0.01), and bone marrow biopsy (0% vs 48%, p < 0.01). CONCLUSIONS The creation of a medical-student-centric procedural course is feasible and fills a potential gap in undergraduate medical education. This study demonstrated that a comprehensive multimodal course, designed to include didactic, simulation and clinical experiences, increases participant exposure to, participation with, and confidence in bedside procedural performance abilities.
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Affiliation(s)
- Zak D Boggs
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Luis E Regalado
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210.
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Towers A, Dixon J, Field J, Martin R, Martin N. Combining virtual reality and 3D-printed models to simulate patient-specific dental operative procedures-A study exploring student perceptions. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:393-403. [PMID: 34498360 DOI: 10.1111/eje.12715] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Students face a number of challenges in translating the skills acquired in pre-clinical simulation environments to the delivery of real patient care. These are particularly emphasised for complex operative procedures such as tooth preparations for indirect restorations. This paper reports student perceptions of a novel approach designed to improving student confidence when undertaking operative procedures on patients for the first time, by providing patient-specific simulation using virtual reality (VR) and 3D-printed models of the student's real clinical case. MATERIALS AND METHODS Students practised on patient-specific models, in the presence of a clinical tutor, firstly using VR simulation then with 3D-printed models in a clinical skills laboratory. The students then carried out the operative procedure on their patients, on the third occasion of practice. After providing the treatment for their patients, students attended a semi-structured interview to discuss their experiences. The qualitative data were analysed using two forms of inductive analysis. RESULTS Students most frequently cited: the value of the educator, increased confidence and efficiency during the clinical procedure, improved patient confidence and the complementary benefits of the two simulation modalities. Thematic analysis of participants' responses uncovered five key themes: The value of virtual reality dental simulators The value of clinical skills laboratory simulation with 3D-printed models The value of educator engagement The impact on the clinical procedure and the patient The VR and clinical skills laboratory balance CONCLUSION: This paper reports the early findings of an intervention that improves dental student confidence through the use of patient-specific VR exercises and 3D-printed models. These provided an incremental learning experience for an operative clinical procedure, prior to treatment of the live patient. Early results suggest this is a positive experience for the students, providing a valuable contribution to their confidence and preparedness.
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Affiliation(s)
- Ashley Towers
- The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Jonathan Dixon
- The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - James Field
- Cardiff University, School of Dentistry, Cardiff, UK
| | - Rachel Martin
- The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Nicolas Martin
- The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
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Green P, Edwards EJ, Tower M. Core procedural skills competencies and the maintenance of procedural skills for medical students: a Delphi study. BMC MEDICAL EDUCATION 2022; 22:259. [PMID: 35397566 PMCID: PMC8994896 DOI: 10.1186/s12909-022-03323-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND It is well recognised that medical students need to acquire certain procedural skills during their medical training, however, agreement on the level and acquisition of competency to be achieved in these skills is under debate. Further, the maintenance of competency of procedural skills across medical curricula is often not considered. The purpose of this study was to identify core procedural skills competencies for Australian medical students and to establish the importance of the maintenance of such skills. METHODS A three-round, online Delphi method was used to identify consensus on competencies of procedural skills for graduating medical students in Australia. In Round 1, an initial structured questionnaire was developed using content identified from the literature. Respondents were thirty-six experts representing medical education and multidisciplinary clinicians involved with medical students undertaking procedural skills, invited to rate their agreement on the inclusion of teaching 74 procedural skills and 11 suggested additional procedures. In Round 2, experts re-appraised the importance of 85 skills and rated the importance of maintenance of competency (i.e., Not at all important to Extremely important). In Round 3, experts rated the level of maintenance of competence (i.e., Observer, Novice, Competent, Proficient) in 46 procedures achieving consensus. RESULTS Consensus, defined as > 80% agreement, was established with 46 procedural skills across ten categories: cardiovascular, diagnostic/measurement, gastrointestinal, injections/intravenous, ophthalmic/ENT, respiratory, surgical, trauma, women's health and urogenital procedures. The procedural skills that established consensus with the highest level of agreement included cardiopulmonary resuscitation, airway management, asepsis and surgical scrub, gown and gloving. The importance for medical students to demonstrate maintenance of competency in all procedural skills was assessed on the 6-point Likert scale with a mean of 5.03. CONCLUSIONS The findings from the Delphi study provide critical information about procedural skills for the Clinical Practice domain of Australian medical curricula. The inclusion of experts from medical faculty and clinicians enabled opportunities to capture a range of experience independent of medical speciality. These findings demonstrate the importance of maintenance of competency of procedural skills and provides the groundwork for further investigations into monitoring medical students' skills prior to graduation.
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Affiliation(s)
- Patricia Green
- School of Education, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Q 4072, Australia.
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Q 4229, Australia.
| | - Elizabeth J Edwards
- School of Education, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Q 4072, Australia
| | - Marion Tower
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Q 4072, Australia
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Vrillon A, Gonzales-Marabal L, Ceccaldi PF, Plaisance P, Desrentes E, Paquet C, Dumurgier J. Using virtual reality in lumbar puncture training improves students learning experience. BMC MEDICAL EDUCATION 2022; 22:244. [PMID: 35379253 PMCID: PMC8981937 DOI: 10.1186/s12909-022-03317-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lumbar puncture (LP) is a commonly performed medical procedure in a wide range of indications. Virtual reality (VR) provides a stimulating, safe and efficient learning environment. We report the design and the evaluation of a three dimensions (3D) video for LP training. METHODS We recorded a stereoscopic 180-degrees 3D video from two LPs performed in clinical settings in Fernand Widal Lariboisière University Hospital, Paris, France. The video was administered to third-year medical students as well as to a residents and attendings group during LP simulation-based training sessions. RESULTS On 168 participants (108 novice third-year medical students, and 60 residents and attendings with prior LP experience), satisfaction after video exposure was high (rated 4.7 ± 0.6 on a 5-point scale). No significant discomfort was reported (comfort score graded 4.5 ± 0.8 on 5). LP-naive students displayed higher satisfaction and perceived benefit than users with prior LP experience (overall, P < 0.05). Trainees evaluated favorably the 3D feature and supported the development of similar tutorials for other medical procedures (respectively, 3.9 ± 1.1 and 4.4 ± 0.9 on 5). CONCLUSION We report our experience with a 3D video for LP training. VR support could increase knowledge retention and skill acquisition in association to LP simulation training.
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Affiliation(s)
- Agathe Vrillon
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France.
- Université de Paris, INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France.
| | | | | | - Patrick Plaisance
- Université de Paris, Simulation department, iLumens Paris Nord, Medical School, Paris, France
| | - Eric Desrentes
- Université de Paris, Simulation department, iLumens Paris Nord, Medical School, Paris, France
| | - Claire Paquet
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France
- Université de Paris, INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France
| | - Julien Dumurgier
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
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Msosa A, Bruce J, Crouch R. Qualitative Perspectives of Teaching and Learning in Clinical Skills Laboratories in A Developing Country. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Farrell C, Dorney K, Mathews B, Boyle T, Kitchen A, Doyle J, Monuteaux MC, Li J, Walsh B, Nagler J, Chung S. A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services. Front Pediatr 2022; 10:903950. [PMID: 35774102 PMCID: PMC9237480 DOI: 10.3389/fped.2022.903950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Care of the critically ill child is a rare but stressful event for emergency medical services (EMS) providers. Simulation training can improve resuscitation care and prehospital outcomes but limited access to experts, simulation equipment, and cost have limited adoption by EMS systems. Our objective was to form a statewide collaboration to develop, deliver, and evaluate a pediatric critical care simulation curriculum for EMS providers. METHODS We describe a statewide collaboration between five academic centers to develop a simulation curriculum and deliver it to EMS providers. Cases were developed by the collaborating PEM faculty, reviewed by EMS regional directors, and based on previously published EMS curricula, a statewide needs assessment, and updated state EMS protocols. The simulation curriculum was comprised of 3 scenarios requiring recognition and acute management of critically ill infants and children. The curriculum was implemented through 5 separate education sessions, led by a faculty lead at each site, over a 6 month time period. We evaluated curriculum effectiveness with a prospective, interventional, single-arm educational study using pre-post assessment design to assess the impact on EMS provider knowledge and confidence. To assess the intervention effect on knowledge scores while accounting for nested data, we estimated a mixed effects generalized regression model with random effects for region and participant. We assessed for knowledge retention and self-reported practice change at 6 months post-curriculum. Qualitative analysis of participants' written responses immediately following the curriculum and at 6 month follow-up was performed using the framework method. RESULTS Overall, 78 emergency medical technicians (EMTs) and 109 paramedics participated in the curriculum over five separate sessions. Most participants were male (69%) and paramedics (58%). One third had over 15 years of clinical experience. In the regression analysis, mean pediatric knowledge scores increased by 9.8% (95% CI: 7.2%, 12.4%). Most (93% [95% CI: 87.2%, 96.5%]) participants reported improved confidence caring for pediatric patients. Though follow-up responses were limited, participants who completed follow up surveys reported they had used skills acquired during the curriculum in clinical practice. CONCLUSION Through statewide collaboration, we delivered a pediatric critical care simulation curriculum for EMS providers that impacted participant knowledge and confidence caring for pediatric patients. Follow-up data suggest that knowledge and skills obtained as part of the curriculum was translated into practice. This strategy could be used in future efforts to integrate simulation into EMS practice.
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Affiliation(s)
- Caitlin Farrell
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kate Dorney
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Bonnie Mathews
- Division of Emergency Medicine, Department of Pediatrics, UMass Medical School, Worcester, MA, United States
| | - Tehnaz Boyle
- Division of Emergency Medicine, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Anthony Kitchen
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Jeff Doyle
- Department of Public Health, Emergency Medical Services for Children, Boston, MA, United States
| | - Michael C Monuteaux
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Joyce Li
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Barbara Walsh
- Division of Emergency Medicine, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Joshua Nagler
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Sarita Chung
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Kumar A, Ameh C. Start here- principles of effective undergraduate training. Best Pract Res Clin Obstet Gynaecol 2021; 80:114-125. [PMID: 34952793 DOI: 10.1016/j.bpobgyn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/02/2022]
Abstract
Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.
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Affiliation(s)
- Arunaz Kumar
- Obstetrics and Gynaecology Monash Health, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
| | - Charles Ameh
- Emergency Obstetric Care and Quality of Care Unit, International Public Health Department, Liverpool School of Tropical Medicine, L3 5QA, United Kingdom.
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Battaglia F, Ivankovic V, Merlano M, Patel V, Sayed C, Wang H, McConnell M, Rastogi N. A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:34-39. [PMID: 34804286 PMCID: PMC8603885 DOI: 10.36834/cmej.71483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. METHODS A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. RESULTS Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. CONCLUSION Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students' transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.
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Affiliation(s)
- Frank Battaglia
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Maria Merlano
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Vishesh Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Céline Sayed
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Hao Wang
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Meghan McConnell
- Department of Innovation in Medical Education, University of Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
| | - Nikhil Rastogi
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
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Chan E, Botelho MG, Wong GTC. A flipped classroom, same-level peer-assisted learning approach to clinical skill teaching for medical students. PLoS One 2021; 16:e0258926. [PMID: 34679098 PMCID: PMC8535182 DOI: 10.1371/journal.pone.0258926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Clinical procedural skills are vital components of medical education. Increased student intake and limited capacity of medical schools necessitate more efficient ways to deliver clinical skill teaching. This study employed a flipped classroom, peer-assisted learning approach to deliver clinical skill teaching. It aimed to determine the influence of pre-class demonstration video watching and in-class student-student interactions on clinical skill acquisition. Methods In 2017, a cohort of 205 medical students in their penultimate year of undergraduate medical study were recruited, and they learned bag mask ventilation and intravenous cannulation during this study. The participants watched a demonstration video before class, and then underwent self-directed practice as triads. Afterwards, each participant video-recorded their skill performance and completed post-class questionnaires. The videos were evaluated by two blinded assessors. Results A hundred and thirty-one participants (63.9%) completed the questionnaire. For bag mask ventilation, participants who claimed to have watched the corresponding demonstration video before class achieved higher performance scores (those who watched before class: 7.8 ± 1.0; those who did not: 6.3 ± 1.7; p < 0.01). For intravenous cannulation, while there is no significant difference in performance scores (those who watched before class: 14.3 ± 1.3; those who did not: 14.1 ± 1.4; p = 0.295), those who watched the video before class received less interventions from their peers during triad practice (those who watched before class: 2.9 ± 1.8; those who did not: 4.3 ± 2.9; p < 0.05). The questionnaire results showed that most participants preferred the new approach of clinical skill teaching and perceived it to be useful for skill acquisition. Conclusion The flipped classroom, same-level peer-assisted learning model is potentially an effective way to address the current challenges and improve the efficiency of clinical procedural skill teaching in medical schools.
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Affiliation(s)
- Enoch Chan
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Michael George Botelho
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Gordon Tin Chun Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Anaesthesiology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- * E-mail:
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Huo B, MacNevin W, Smyth M, Miller SG. Medical Student Comfort With Procedural Skills Performance Based on Elective Experience and Career Interest. Cureus 2020; 12:e12374. [PMID: 33527055 PMCID: PMC7842240 DOI: 10.7759/cureus.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Despite increased efforts, studies suggest that exposure to procedural skills in undergraduate medical training is insufficient. As medical students have low self-reported competence in many skills, a significant concern is that medical students are underprepared for a clerkship. Furthermore, pre-clerkship electives selected based on student career interests can provide students with additional skills learning opportunities. The impact of career interest and elective choice on student comfort with procedural skills is unclear. This study examines the relationship between student procedural skills comfort, career interest, and elective choices. Materials and methods An evidence-based questionnaire was synthesized following a literature search using PubMed, Embase, and Google Scholar. Surveys were completed by second-year medical students. A Likert scale was used to evaluate students’ exposure, comfort, and motivation to learn common procedural skills. Descriptive, Pearson’s chi-square and Spearman’s rho correlation coefficient analyses were performed to evaluate the relationship between career interests, elective exposure, and procedural skills. Results Medical students (>60%) reported poor comfort levels for most skills, despite >80% of students displaying high motivation to learn. Elective choice impacted student comfort levels as students who completed electives in anesthesiology were more comfortable with performing intubation (23% vs 10%, p = 0.026) and IV insertion (38% vs 13%, p = 0.002). Those with surgical career interests were less comfortable performing Foley catheter insertion in males (7% vs 5%, p = 0.033) and in females (7% vs 5%, p = 0.008). Conclusions This study supports that medical students feel low levels of comfort with performing procedural skills despite high motivation for learning. Comfort was influenced by both career interest and elective experience. Programs aiming to increase students’ comfort levels in performing procedural skills should adapt curricula toward increasing early exposure to these skills.
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Ayandeh A, Zhang XC, Diamond JF, Michael SH, Rougas S. Development of a pilot procedural skills training course for preclerkship medical students. J Am Coll Emerg Physicians Open 2020; 1:1199-1204. [PMID: 33392523 PMCID: PMC7771806 DOI: 10.1002/emp2.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Despite procedural skills being recognized as an important component of medical school education, medical students are not confident in their ability to carry out a range of medical procedures. We conducted an institutional needs assessment and used the results to inform the creation of a procedure-based preclinical elective for first- and second-year students. METHODS We surveyed second-, third-, and fourth-year medical students at Alpert Medical School as well as select program directors to guide selection of a list of procedures to be taught in the elective. We then created an extracurricular 10-week procedural skills course for preclerkship medical students utilizing a hands-on, flipped classroom practice model. Volunteer preceptors were recruited from the Department of Emergency Medicine to participate with a student-to-faculty ratio not exceeding 5:1. Knowledge and skill acquisition were assessed using a multiple-choice knowledge exam and 4-station practical exam, respectively. Pre- and post-course online surveys were used to assess self-perceived confidence for all procedures. RESULTS We implemented our procedural skills training course for first- and second-year medical students in the fall of 2015. Forty-four students applied for the first iteration of the course and 15 students were selected to participate. Fourteen students ultimately completed the elective as well as the subsequent course surveys, multiple-choice exam, and practical exam. Students who participated in the elective had increased levels of self-reported confidence at the conclusion of the elective and performed better on a practical exam and multiple-choice exam compared to students who participated in only the standard curriculum. CONCLUSION A longitudinal preclerkship procedural course early during medical school is a feasible method of teaching procedural skills to a cohort of learners. A number of adjustments could be made to the course in order to scale up and include a larger cohort of students at our own or another institution.
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Affiliation(s)
- Armon Ayandeh
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Xiao C. Zhang
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jay F. Diamond
- Department of Emergency MedicineNew York University School of MedicineNew YorkNew YorkUSA
| | - Sarah H. Michael
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Steven Rougas
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Ong MN, Lew KM, Cheong YJ, Ting EWX, Bohari B, Yita T, Palayan K. Can We Use Peer-Assisted Learning to Teach Basic Surgical Skills? Malays J Med Sci 2020; 27:101-107. [PMID: 33154706 PMCID: PMC7605839 DOI: 10.21315/mjms2020.27.5.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background It is reported that medical students do not receive adequate opportunities to learn surgical skill and are at risk of being unable to perform simple surgical procedures safely. The usefulness of peer-assisted learning (PAL) as a tool to assist in delivering surgical skills training is worth exploring. Methods This is a randomised single blinded controlled trial. Fourth-year students from the university’s Surgical Society were asked to volunteer as peer tutors and those in 3rd-year were asked to undertake surgical skills training. A cohort of 35 students were selected and randomised to receive basic surgical skills training conducted either by faculty members or peers. The students’ performance of basic suturing skills was assessed using a checklist, through directly observed procedural skills (DOPS) technique. The assessment was conducted by faculty blinded to the training. Students’ perception to surgical skills training was assessed using a questionnaire survey. Results The suturing and knotting skills of students learned from their peers was comparable to that acquired from faculty. The students’ perceived that their peers could conduct surgical skills training similar to their faculty. Conclusion PAL approach for basic surgical skills training is as effective as faculty-led training. PAL has the potential to optimise the delivery of surgical skills training in undergraduate medical education.
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Affiliation(s)
- Mang Ning Ong
- International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Kar Min Lew
- International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Yih Jeng Cheong
- International Medical University, Seremban, Negeri Sembilan, Malaysia
| | | | - Bakri Bohari
- International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Tang Yita
- International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Kandasami Palayan
- International Medical University, Seremban, Negeri Sembilan, Malaysia
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van Boxel E, Mawson I, Dawkins S, Duncan S, van Boxel G. Predicting risk of underconfidence following maternity leave. Arch Dis Child 2020; 105:1108-1110. [PMID: 31201159 DOI: 10.1136/archdischild-2019-317376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine what factors affect paediatric trainee confidence on return to work after maternity leave. DESIGN Information was collected anonymously via an online survey from trainees who had taken maternity leave. SETTING The survey was distributed centrally to each UK deanery. MAIN OUTCOME MEASURES Trainee confidence was rated retrospectively using self-assessment. RESULTS 146 paediatric trainees from 12 out of 13 deaneries completed the survey. 96% of trainees experienced an initial lack of confidence, with 36% requiring 3 months or longer for their confidence to return. Prolonged lack of confidence was associated with longer time out of training, training stage, returning part-time, less frequent engagement with educational activities and lack of recognition by supervising consultant. CONCLUSION We propose a scoring system using the above risk factors, the MoTHER score (Months out, Training stage, Hours worked on return, Educational activities, Recognition by consultant), which can be used to identify trainees who are at higher probability of experiencing reduced confidence on return to work.
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Affiliation(s)
| | - Isabel Mawson
- Neonatology, Evelina Children's Hospital, London, UK
| | - Sarah Dawkins
- Community Children's Health Partnership, Bristol, UK
| | - Sandra Duncan
- Paediatric Critical Care Unit, John Radcliffe Hospital, Oxford, UK
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Boyajian MK, Lubner RJ, Roussel LO, Crozier JW, Ryder BA, Woo AS. A 3D printed suturing trainer for medical students. CLINICAL TEACHER 2020; 17:650-654. [PMID: 32592314 DOI: 10.1111/tct.13176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medical students must be able to suture competently upon graduation. To learn suturing technique, students must have access to practice materials. The purpose of this pilot study was to develop a novel suturing trainer and to evaluate its ability to provide realistic and accessible suturing practice. A cohort of senior students at one institution compared the device with standard suture-training media (porcine feet and sponges). METHODS Using 3D printing and silicone casting, a novel suturing trainer was developed and a cohort of senior medical students trialed the device in a standardised suturing workshop. Participants evaluated the novel suturing trainer, porcine feet and sponges for simulating human tissue with regard to: (i) tissue layers; (ii) tissue texture; (iii) ability to perform interrupted suturing; (iv) running subcuticular suturing; and (v) knot tying. RESULTS Compared with porcine feet and sponges, the suturing trainer had significantly higher mean scores (p < 0.001) for the simulation of human tissue layers and texture, as well as for the ability to facilitate the practice of interrupted suturing, running suturing and knot tying. All (n = 32) participants identified the silicone trainer as the best tool upon which to practice suturing, and 92% (n = 23) responded that their suturing skills would improve if the silicone trainer replaced porcine feet and sponges. DISCUSSION The silicone suturing device provides a more realistic and accessible suture learning experience than porcine feet and sponges. Further validation is required to assess its long-term effectiveness in medical education.
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Affiliation(s)
- Michael K Boyajian
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island, USA
| | - Rory J Lubner
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren O Roussel
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island, USA
| | - Joseph W Crozier
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island, USA
| | - Beth A Ryder
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of General Surgery, Brown University, Providence, Rhode Island, USA
| | - Albert S Woo
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island, USA
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Yunus M, Ghani Z, Ch. IM, Akram A. Evaluation of basic surgical skill workshop at undergraduate level in the discipline of surgery. Pak J Med Sci 2020; 36:609-614. [PMID: 32494242 PMCID: PMC7260932 DOI: 10.12669/pjms.36.4.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/03/2020] [Accepted: 03/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of basic surgical skill workshop at under graduate level. METHODS This was randomized controlled study (cross-over design) conducted at Al-Nafees Medical College and hospital from 1st January to November 30th 2017. Undergraduate medical students of Year-5 MBBS were randomized into two groups to undergo surgical skills training. One was workshop or interventional Group-A, other was traditional teaching or control Group-B. Online random sampling calculator was used for randomization. Both groups were given a pretest and post-test in the form of two OSATS station. RESULTS Total 49 students were enrolled in the study; Group-A had 25 whereas Group-B had 24 students. There was significant difference (p=0.000) in mean post-test scores of Group-A (36.28±6.75) and Group-B (24.17±5.09) out of 53 on OSATS station-1. Significant statistical difference (p=0.000) in the mean score of post-tests of Group-A (26.08±18.34) and Group-B (14.42±9.24) out of 37 was also noted on OSATS station-2. There was no significant difference in mean pretest scores on both stations in both groups. CONCLUSIONS This study has suggestions in development of curriculum as it provides a quantitative substantiation indicating that workshop teaching as a learning strategy can essentially augment traditional teaching of technical skills to undergraduate medical students.
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Affiliation(s)
- Maliha Yunus
- Prof. Dr. Maliha Yunus, MBBS, FCPS, MHPE. Professor of Surgery, Al-Nafees Medical College & Hospital, Isra University, Islamabad Campus, Pakistan
| | - Zeeshan Ghani
- Dr. Zeeshan Ghani, MBBS, FCPS, MCPS. Associate Professor of Paediatrics, Al-Nafees Medical College & Hospital, Isra University, Islamabad Campus, Pakistan
| | - Ihtasham Muhammad Ch.
- Dr. Ihtasham Muhammad Ch., MBBS, FCPS, FRCS. Associate Professor of Surgery, Al-Nafees Medical College & Hospital, Isra University, Islamabad Campus, Pakistan
| | - Ayesha Akram
- Dr. Ayesha Akram, MBBS, FCPS, MHPE. Assistant Professor of Gynaecology, HITEC Institute of Medical Sciences, Taxila, Pakistan
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Foote DC, Reddy RM, Matusko N, Sandhu G. Surgery clerkship offers greater entrustment of medical students with supervised procedures than other clerkships. Am J Surg 2020; 220:537-542. [PMID: 32139105 DOI: 10.1016/j.amjsurg.2020.02.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Medical student procedural participation is increasingly limited, creating concerns over poor preparation for internship. Inadequate experiences may also compromise patient safety. This study explores variances in procedural entrustment of medical students between core clerkships during the first clinical year. METHODS Students completing their first clinical year were surveyed on procedure participation. Holistic entrustment decisions are complex, thus participation was used as an objective proxy for entrustment. RESULTS 138 students responded (66% response rate); 89% (123/138) wished they had performed more procedures. Students had higher participation rates during procedural clerkships (surgery, obstetrics/gynecology). Entrustment was highest during surgery, and lowest during pediatrics. Surgery gave statistically significantly higher entrustment for subcuticular suturing (compared to obstetrics/gynecology) and nasogastric tube removal (compared to internal medicine). Entrustment was generally inversely proportional to procedure complexity within each specialty. CONCLUSIONS Students encounter higher entrustment during procedural clerkships, especially surgery. Targeted areas for increased procedural involvement can be identified in all specialties.
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Affiliation(s)
- Darci C Foote
- University of Michigan Medical School, 1305 Catherine St., Ann Arbor, MI, 48109, USA.
| | - Rishindra M Reddy
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Niki Matusko
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., 2120 Taubman Center, Ann Arbor, MI, 48109, USA.
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Germann CA, Strout TD, Park YS, Tekian A. Senior-Year Curriculum in U.S. Medical Schools: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2020; 32:34-44. [PMID: 31179752 DOI: 10.1080/10401334.2019.1618307] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Phenomenon: Many U.S. medical schools have responded to the adoption of competency-based medical education (CBME) frameworks by renewing their final-year curricula and including internship preparatory courses. The purpose of this scoping review was to map the published literature regarding the final year to discern how medical schools have responded to this paradigm change. Approach: A structured 5-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal, and 8 medical education journals were conducted to identify relevant articles published from 2006 to 2016. Four authors screened articles for inclusion using standardized eligibility criteria; interrater agreement was discussed and calculated. Authors extracted data elements, and a consensus-based approach was used to categorize, sort, and structure information gathered. Findings: Among 6,485 articles retrieved, 817 articles were included in the study. From 2007-2011 to 2012-2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. The majority of articles did not reference a CBME framework (572/817; 70%), the frequency of mentions increased 268% from 2007-2011 to 2012-2016. Nearly three fourths of preparatory course-related papers reference a CBME framework (37/50; 74%). Insights: Our findings may reflect a movement in U.S. medical schools toward using shared assessment metrics to support 4th-year medical students' preparation for their postgraduate medical education. Despite an increased reference to CBME, there is relatively little use of competency-based assessment frameworks to evaluate learning outcomes. This review also found a substantial increase in the frequency of articles referencing senior-year preparatory courses in U.S. medical schools. Articles tended to describe institution-specific research or experiences. Opportunities likely exist for multi-institutional and organizational collaboration in determining the structure of the final year of medical school.
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Affiliation(s)
- Carl A Germann
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Tania D Strout
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Luz LB, Grock CH, Oliveira VF, Bizarro L, Ardenghi TM, Ferreira MBC, Montagner F. Self-reported confidence and anxiety over endodontic procedures in undergraduate students-Quantitative and qualitative study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:482-490. [PMID: 31373094 DOI: 10.1111/eje.12456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The current literature shows a growing interest to assess the feelings and perceptions of students associated with the performance of elective endodontic procedures. This study aimed to evaluate the students' anxiety and self-perceptions related to performing such treatments. METHODS Forty-five students participated in the research (G1 = 22 beginners students; G2 = 23 senior students). Demographic data, STAI-State and Numerical Rating Scale (NRS) for pre-operative anxiety were completed before the appointment with patient. The STAI-Trait; NRS for post-operative anxiety; previous experiences in endodontics; and level of confidence in each stage of endodontic treatments were collected after appointment. Focal groups for qualitative data collection were performed on separate occasion. RESULTS Both groups showed higher scores in STAI-State than for STAI-Trait scale. G1 showed higher levels of anxiety in the pre-operative, compared with post-operative moment in the NRS scale. G2 reported feeling more confidence to insert intracanal medication and to restore teeth between appointments than G1. In both focus groups, participants reported insecurity in performing endodontic procedures due to difficulty in visualisation and to anatomic complexities. G1 reported that all the confidence they had was based in pre-clinical experience, and G2 mentioned concern about the end of graduation. CONCLUSION The participants' anxiety diminishes as they gain more experience in performing endodontic procedures. However, as they approach the end of the course anxiety levels increase. Greater availability of elective courses in endodontics could be a valuable alternative to provide students with more exposure to and experience with these procedures.
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Affiliation(s)
| | | | | | - Lisiane Bizarro
- Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maria Beatriz Cardoso Ferreira
- Full Professor of Pharmacology, Invited Professor, Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Francisco Montagner
- Endodontic Division, Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Yang A, Fernando S, Tighe J, O-Halloran M, Morphet J, Kumar A. Introduction of an interprofessional gynaecology surgical skills workshop for undergraduate medical and nursing students. Aust N Z J Obstet Gynaecol 2019; 60:238-243. [PMID: 31650525 DOI: 10.1111/ajo.13086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Medical and nursing students may feel under-prepared to perform basic surgical and gynaecology procedural skills. There also remains scope within undergraduate programs to integrate interprofessional education, and better prepare students for interprofessional collaboration to improve patient care. AIMS A simulation-based gynaecology surgical skills workshop program was introduced for undergraduate medical and nursing students. The aim of this study was to explore students' perceptions of a simulation-based interprofessional gynaecological skills program, using students' pre- and post-workshop confidence in taught skills reported in a post-workshop questionnaire as an outcome measure. MATERIALS AND METHODS One hundred and sixty undergraduate medical (n = 133) and nursing (n = 27) students attended the workshop program at a tertiary university in Melbourne, Australia. A survey was completed by all students immediately after the workshop, addressing students' perceptions of surgical education, the four skill-stations (gowning/gloving, suturing, intrauterine device insertion, and urethral catheterisation), and interprofessional education. A Wilcoxon signed-rank test was performed to compare students' pre- and post-workshop confidence scores. RESULTS Most medical and nursing students (86%) agreed their course should provide more structured surgical education. There was a statistically significant increase in post-workshop self-reported confidence scores for medical and nursing students in all four taught skills. Confidence in interprofessional behaviours also improved in both cohorts, but the improvement in nursing students did not reach statistical significance. CONCLUSIONS Simulation-based, interprofessional, gynaecological surgery skills workshops are practical and valuable additions to undergraduate medical and nursing curricula. Further research should explore long-term retention of procedural skills and changes in interprofessional attitudes in clinical practice.
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Affiliation(s)
- Amy Yang
- Austin Health, Melbourne, Australia
| | - Shavi Fernando
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Josie Tighe
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Monica O-Halloran
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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Luhoway JA, Ryan JF, Istl AC, Davidson J, Christakis N, Bütter A, Mele T. Perceived Barriers to the Development of Technical Skill Proficiency in Surgical Clerkship. JOURNAL OF SURGICAL EDUCATION 2019; 76:1267-1277. [PMID: 31003942 DOI: 10.1016/j.jsurg.2019.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/12/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Medical students are expected to achieve proficiency in a prescribed set of technical skills during surgical clerkship. However, available literature indicates students routinely report a lack of confidence and proficiency in these skills. Our study aims to identify barriers to technical skill development encountered by medical students during surgical clerkship with the goal of developing interventions to address these barriers. DESIGN Three hundred and forty two medical students were surveyed about their experience learning and performing technical skills during surgical clerkship. Students reported confidence in skill performance and subjective barriers to achieving competency using forced-choice and free-text responses. Multivariate regression models identified factors independently associated with specific barriers and more frequent technical skills performance. SETTING Main and satellite campuses of a Medical Council of Canada accredited Canadian academic medical center. PARTICIPANTS All third-year medical students. RESULTS A total of 253 students (74%) responded to the survey. Following surgical clerkship, the only technical skills participants felt confident performing independently were sterile technique (96%) and basic suturing (52%). Interest in a surgical career, observership experience, gender, and medical campus site were independently associated with the frequency of skill performance. With respect to developing technical proficiency, commonly cited barriers included lack of suitable cases for student participation (35.0%), time constraints (33.4%), and lack of opportunities provided by both consultants (29.1%) and residents (24.7%). Female gender was independently associated with decreased resident instruction, decreased confidence in skill performance, and fewer opportunities to perform requisite skills. Students at satellite campuses reported fewer barriers. CONCLUSIONS We identified (1) lack of suitable cases, (2) time constraints, and (3) failure to provide students opportunities as the most common barriers to technical skill proficiency. Female gender increased the perception of barriers, while there were fewer barriers perceived by students at satellite campuses. Skill-specific simulation training and other interventions may improve skill development in medical students given obstacles to developing proficiency in the clinical setting.
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Affiliation(s)
| | - Joanna F Ryan
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandra C Istl
- Division of General Surgery, London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jacob Davidson
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nicole Christakis
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Tina Mele
- Division of General Surgery, London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Miller KA, Monuteaux MC, Roussin C, Nagler J. Self-Confidence in Endotracheal Intubation Among Pediatric Interns: Associations With Gender, Experience, and Performance. Acad Pediatr 2019; 19:822-827. [PMID: 31229695 DOI: 10.1016/j.acap.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Supervisors' decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns' characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers). METHODS This was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns' performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale. RESULTS Forty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers. CONCLUSIONS Male pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.
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Affiliation(s)
- Kelsey A Miller
- Division of Emergency Medicine, Department of Medicine (KA Miller, MC Monuteaux, and J Nagler), Boston Children's Hospital, Boston, Mass.
| | - Michael C Monuteaux
- Division of Emergency Medicine, Department of Medicine (KA Miller, MC Monuteaux, and J Nagler), Boston Children's Hospital, Boston, Mass
| | - Christopher Roussin
- Boston Children's Hospital Simulator Program, Center for Life Sciences Building (C Roussin), Boston, Mass
| | - Joshua Nagler
- Division of Emergency Medicine, Department of Medicine (KA Miller, MC Monuteaux, and J Nagler), Boston Children's Hospital, Boston, Mass
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Henriksen MJV, Wienecke T, Kristiansen J, Park YS, Ringsted C, Konge L. Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety. Neurology 2019; 90:981-987. [PMID: 29784718 DOI: 10.1212/wnl.0000000000005556] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantify physician stress levels when performing lumbar puncture (LP) and explore operator stress effect on patient outcomes. METHODS This was a cross-sectional, multicenter study. Novices, intermediates, and experts in performing LP were recruited from 4 departments of neurology and emergency medicine. Stress was measured before and during performance of the LP using cognitive appraisal (CA), State-Trait Anxiety Inventory-Short (STAI-S) questionnaire, and the heart rate variability measure low frequency/high frequency index (LF/HF ratio). Patient-related outcomes were pain, confidence in the operator, and postdural puncture headache (PDPH). RESULTS Forty-six physicians were included in the study: 22 novices, 12 intermediates, and 12 experts. Novices had the highest stress level and experts the lowest measured by cognitive appraisal and STAI-S before and during LP performance (p < 0.001 for all comparisons). Novices had the highest sympathetic tonus indicated by the highest LF/HF ratio before (p = 0.004) and during (p = 0.056) LP performance. Physician stress level was not significantly related to patients' pain. However, there was a significant relationship between STAI-S during the procedure and patient confidence in the operator (regression coefficient = -0.034, p = 0.008). High physician heart rate during the procedure significantly increased the odds of PDPH (odds ratio = 1.17, p = 0.036). CONCLUSION Novice stress levels were high before and during performance of LP. Stress was significantly related to patient confidence in the operator and risk of PDPH. Simulation-based training should be considered to reduce novice residents' stress levels and increase patient safety.
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Affiliation(s)
- Mikael Johannes Vuokko Henriksen
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
| | - Troels Wienecke
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
| | - Jesper Kristiansen
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
| | - Yoon Soo Park
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
| | - Charlotte Ringsted
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
| | - Lars Konge
- From the Copenhagen Academy for Medical Education and Simulation (M.J.V.H., L.K.), the Capital Region of Denmark; Faculty of Health and Medical Sciences (M.J.V.H., L.K.), University of Copenhagen; Department of Neurology (T.W.), Zealand University Hospital; The National Research Centre for the Working Environment (J.K.), Copenhagen, Denmark; Department of Medical Education (Y.S.P.), University of Illinois Chicago; and Centre for Health Science Education (C.R.), Faculty of Health, Aarhus University, Denmark
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von Cranach M, Backhaus T, Brich J. Medical students' attitudes toward lumbar puncture-And how to change. Brain Behav 2019; 9:e01310. [PMID: 31058449 PMCID: PMC6576206 DOI: 10.1002/brb3.1310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/06/2019] [Accepted: 04/22/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To survey medical students on the lumbar puncture (LP) procedure in terms of their existing knowledge, practical experience and attitudes, and to determine whether the completion of a single standardized seminar that includes practical training on phantoms can alter these parameters. METHODS The survey was completed by medical students undertaking the curricular neurology course. Students were asked to describe their practical experience in different bedside procedures, and document how they perceive LP in terms of their own knowledge, confidence and attitude. Students then participated in a newly designed 90-min seminar that included practical training on phantoms and placed special emphasis both on the patients' point of view during the procedure and the benefits of an atraumatic approach. All students who completed the seminar were required to complete the survey for a second time. RESULTS Among the 153 participants, LP was associated with the lowest baseline levels of experience and confidence compared to other bedside procedures. Attitudes, knowledge, and confidence related to the various aspects of LP all showed significant improvement after the seminar. CONCLUSION A single standardized LP seminar with simulation training alters medical students' attitudes toward LP through improving their level of knowledge and confidence. This may have important implications in doctors-to-be on their stance toward LP and resultant advice to future patients regarding this important procedure.
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Affiliation(s)
- Moritz von Cranach
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tilo Backhaus
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jochen Brich
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Freiburg, Germany
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Wu V, Yeung C, Sykes EA, Zevin B. Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among notice medical students. Can J Surg 2019; 61:385-391. [PMID: 30265640 DOI: 10.1503/cjs.014217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Proficiency-based knot-tying curricula have been developed for square knots for medical students, but, to our knowledge, no such curriculum exists for the reverse half hitch alternating-post (RHAP) knot. We aimed to compare medical students' knot-tying proficiency, knot-tying self-confidence and final knot characteristics for RHAP and square knots in a simulated deep body cavity. METHODS We performed a within-subject prospective crossover study of novice medical students who received 30 minutes of training in tying both RHAP and square knots. Participant performance was assessed via a knot-tying checklist, and knot configuration, tensile strength, tightness (loop circumference) and mechanism of failure were also assessed. Participants' self-reported confidence in knot tying was captured. RESULTS Twenty-one students participated in the study. Mean scores on the knot-tying checklist were significantly higher for RHAP knots than for square knots (6.9 [standard deviation (SD) 2.1] v. 5.2 [SD 2.3], p < 0.01), and RHAP knots were significantly tighter than square knots (46.8 mm [SD 0.4 mm] v. 49.3 mm [SD 0.7 mm], p < 0.05). There were no differences between RHAP and square knots in correct knot configuration, breaking strength or mechanism of failure. Reverse half hitch alternating-post knots were easier to tie within a deep-body cavity, whereas square knots were easier to learn. CONCLUSION Novice medical students were more proficient in tying RHAP knots than square knots in a simulated deep body cavity. Students were able to construct RHAP knots more securely and reported increased confidence in tying RHAP knots at depth compared to square knots.
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Affiliation(s)
- Vincent Wu
- From the School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont. (Wu, Yeung, Sykes); and the Department of Surgery, Queen's University, Kingston, Ont. (Zevin)
| | - Cynthia Yeung
- From the School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont. (Wu, Yeung, Sykes); and the Department of Surgery, Queen's University, Kingston, Ont. (Zevin)
| | - Edward A Sykes
- From the School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont. (Wu, Yeung, Sykes); and the Department of Surgery, Queen's University, Kingston, Ont. (Zevin)
| | - Boris Zevin
- From the School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont. (Wu, Yeung, Sykes); and the Department of Surgery, Queen's University, Kingston, Ont. (Zevin)
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Development of a short and universal learning self-efficacy scale for clinical skills. PLoS One 2019; 14:e0209155. [PMID: 30615610 PMCID: PMC6322749 DOI: 10.1371/journal.pone.0209155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/02/2018] [Indexed: 11/23/2022] Open
Abstract
Background Learning self-efficacy, defined as learners’ confidence in their capability to learn specific subjects, is crucial for the enhancement of academic progress, because it is positively correlated with academic achievements and effective learning strategy use. In this study, we developed a universal scale called the Learning Self-Efficacy Scale (L-SES) for Clinical Skills for undergraduate medical students and validated it through item analysis and content validity index (CVI) calculation. Design The L-SES was developed based on the framework of Bloom’s taxonomy, and the questions were generated through expert consensus and CVI calculation. A pilot version of the L-SES was administered to 235 medical students attending a basic clinical skills course. The collected data were then examined through item analysis. Results The first draft of the L-SES comprised 15 questions. After expert consensus and CVI calculation, 3 questions were eliminated; hence, the pilot version comprised 12 questions. The CVI values of the 12 questions were between .88 and 1, indicating high content validity. Moreover, the item analysis indicated that the quality of L-SES reached the qualified threshold. The results showed that the L-SES scores were unaffected by gender (t = −0.049; 95% confidence interval [−.115, .109], p > .05). Conclusion The L-SES is a short, well-developed scale that can serve as a generic assessment tool for measuring medical students’ learning self-efficacy for clinical skills. Moreover, the L-SES is unaffected by gender differences. However, additional analyses in relevant educational settings are needed.
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Self-confidence and clinical skills: the case of students who study medicine in English in a non-English speaking setting. Ir J Med Sci 2018; 188:1057-1066. [PMID: 30569373 DOI: 10.1007/s11845-018-1947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND An increasing number of international students has been enrolling in medical studies in the English language offered by the countries of Eastern Europe. Development of practical skills is likely more challenging when students learn in the English language, while their patients are non-English speaking persons. AIMS To evaluate self-perception of practical skills of medical students in the English language program. METHODS From December 2016 to December 2017, a total of 52 students from the Studies in English program of two universities in Serbia were included in the study. Data were obtained by a previously validated questionnaire. RESULTS Participants were most confident when measuring blood pressure, checking the arterial pulse, and taking history. Students were the least confident when placing urinary catheters, performing rectal examinations, and suturing wounds. Male students reported higher confidence in "Major interventions" compared to females (p = 0.004), and no difference between male and female students was found in the total skill score of "knowledge of Serbian language" (p = 0.339). Adjusted analysis showed that a higher grade point average remains associated with a more confident perception of one's practical skills (B 26.48, 95% confidence interval 8.98-43.98). Rasch analysis showed that because the scores were distributed around the mean value between "not confident at all" and "quite confident," the majority of students had similar perceptions of their skills. CONCLUSION Active supervision by teaching staff is also recommended in an attempt to rectify the lack of confidence at performing a range of clinical procedures which is present among international students.
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Core versus specialty rotations do not affect students' surgical development. Surgery 2018; 164:1336-1340. [PMID: 30477674 DOI: 10.1016/j.surg.2018.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Research is scarce on how the diversity of surgical rotations affects students. We sought to assess the effect of core rotations compared to specialty rotations on students' development. METHODS Students were given a suturing workshop at the beginning of their surgical clerkship along with a questionnaire. They performed both a simple and a complex suturing task at the beginning and end of the 2-month clerkship. The students were divided into 2 groups based on their surgical rotations. Technical skill and exam scores were compared. RESULTS Thirty-eight students were included in the study. Objective scores increased for the simple task (14.2, standard deviation 4.5 vs 16.4, standard deviation 4.2, P = .04) and the complex task (12.9, standard deviation 5.3 vs 16.5, standard deviation 4.1, P < .01). Times decreased for the simple task (5.1, standard deviation 1.8 vs 4.1, standard deviation 1.3, min, P < .01) and the complex task (7.9, standard deviation 2.7 vs 6.3, standard deviation 1.5, min, P < .01). Using multivariate analysis, we found that reported hours in the operating room per week and previous hands-on experience affected proficiency of the simple suturing task only. Sixteen students had predominantly core surgical rotations. When compared to the 22 students with more specialty rotations, the only difference was gender (87.5% male vs 50.0% male, P = 0.02). There was no significant difference in the completion times (P = .96, .82), the objective scores (P = .06, .120), the written exam scores (P = .57), or the oral exam scores (P = .89). CONCLUSION In this small study, it was found that the type of students' rotations does not affect surgical skill or knowledge acquisition.
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Ramirez AG, Hu Y, Kim H, Rasmussen SK. Long-Term Skills Retention Following a Randomized Prospective Trial on Adaptive Procedural Training. JOURNAL OF SURGICAL EDUCATION 2018; 75:1589-1597. [PMID: 29803772 PMCID: PMC6252163 DOI: 10.1016/j.jsurg.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/16/2018] [Accepted: 03/25/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Cumulative sum (CuSum) is a real-time proficiency-monitoring tool adapted for simulation-based training. This study's objective was to investigate long-term outcomes of a double blinded, randomized control trial conducted with medical students assessing CuSum-guided curriculum against volume-based standards. The trial found a nearly 20% reduction in practice time to reach proficiency using the CuSum curriculum but long-term effects of decreased practice volume on proficiency is unknown. DESIGN Prior participants completed a survey assessing confidence, exposure, and feedback at 12 to 18 months following trial completion. They underwent retention testing of suturing, intubation, and central venous catheter placement (CVC), which was video-recorded and assessed by an expert evaluator. Baseline characteristics among repeat subjects were compared using chi-squared tests. Retention and initial trial outcome were compared using paired parametric statistical methods. SETTING The study was conducted at a major tertiary care center and training hospital. PARTICIPANTS Medical students, which completed the initial randomized control trial were eligible for enrollment. A total of 30/46(65%) responded to the survey, whereas 33/46(72%) completed retention testing. RESULTS Average scores and decay in procedural tasks over time for suturing, intubation and CVC were 91.6% (-4.7%), 86.1% (-4.1%), and 76.2% (-14.8%), respectively. Compared to the control group, the CuSum group mean difference in retention evaluation scores was -5.6% (p = 0.12). Confidence was not associated with initial or retention testing performance in any procedural task. Higher confidence was associated with additional exposure to the procedural task in suturing and intubation (p = 0.03 and p = 0.02, respectively). For intubation, higher confidence was reported by participants who received positive feedback (p = 0.01), and those assigned to the volume-based training arm (p = 0.03). CONCLUSION CuSum-guided training was equivalent to conventional training for suturing, intubation, and CVC. These findings importantly suggest medical students can retain competency in invasive surgical tasks with modest decay in proficiency over time regardless of initial training method.
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Affiliation(s)
- Adriana G Ramirez
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Yinin Hu
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Helen Kim
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Eastern Virginia Medical School, Norfolk, Virginia
| | - Sara K Rasmussen
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Manning EP, Mishall PL, Weidmann MD, Flax H, Lan S, Erlich M, Burton WB, Olson TR, Downie SA. Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection. ANATOMICAL SCIENCES EDUCATION 2018; 11:605-612. [PMID: 29603672 PMCID: PMC6165707 DOI: 10.1002/ase.1785] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 05/16/2023]
Abstract
Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.
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Affiliation(s)
- Edward P. Manning
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Priti L. Mishall
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
| | - Maxwell D. Weidmann
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Herschel Flax
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Sam Lan
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Mark Erlich
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
| | - William B. Burton
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Todd R. Olson
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Sherry A. Downie
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York
- Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, New York
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Ono Y, Tanigawa K, Kakamu T, Shinohara K, Iseki K. Out-of-hospital endotracheal intubation experience, confidence and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study. BMJ Open 2018; 8:e021858. [PMID: 30007929 PMCID: PMC6082470 DOI: 10.1136/bmjopen-2018-021858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/02/2018] [Accepted: 06/06/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Clinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among prehospital rescuers as well as their confidence in performing ETI and confidence-associated factors. DESIGN Population-based cross-sectional study conducted from January to September 2017. SETTING Northern Japan, including eight prefectures. PARTICIPANTS Emergency life-saving technicians (ELSTs) authorised to perform ETI. OUTCOME MEASURES Annual ETI exposure and confidence in performing ETI, according to a five-point Likert scale. To determine factors associated with ETI confidence, differences between confident ELSTs (those scoring 4 or 5 on the Likert scale) and non-confident ELSTs were evaluated. RESULTS Questionnaires were sent to 149 fire departments (FDs); 140 agreed to participate. Among the 2821 ELSTs working at responding FDs, 2620 returned the questionnaire (response rate, 92.9%); complete data sets were available for 2567 ELSTs (complete response rate, 91.0%). Of those 2567 respondents, 95.7% performed two or fewer ETI annually; 46.6% reported lack of confidence in performing ETI. Multivariable logistic regression analysis showed that years of clinical experience (adjusted OR (AOR) 1.09; 95% CI 1.05 to 1.13), annual ETI exposure (AOR 1.79; 95% CI 1.59 to 2.03) and the availability of ETI skill retention programmes including regular simulation training (AOR 1.31; 95% CI 1.02 to 1.68) and operating room training (AOR 1.44; 95% CI 1.14 to 1.83) were independently associated with confidence in performing ETI. CONCLUSIONS ETI is an uncommon event for most ELSTs, and nearly half of respondents did not have confidence in performing this procedure. Since confidence in ETI was independently associated with availability of regular simulation and operating room training, standardisation of ETI re-education that incorporates such methods may be useful for prehospital rescuers.
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Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University, Fukushima, Japan
- Department of Pharmacology, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Koichi Tanigawa
- Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Ken Iseki
- Emergency and Critical Care Medical Center, Fukushima Medical University, Fukushima, Japan
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Leraas HJ, Cox ML, Bendersky VA, Sprinkle SS, Gilmore BF, Gunasingha RM, Tracy ET, Sudan R. Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time. JOURNAL OF SURGICAL EDUCATION 2018; 75:644-649. [PMID: 28988956 PMCID: PMC9757025 DOI: 10.1016/j.jsurg.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/17/2017] [Accepted: 09/11/2017] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Surgical skills training varies greatly between institutions and is often left to students to approach independently. Although many studies have examined single interventions of skills training, no data currently exists about the implementation of surgical skills assessment as a component of the medical student surgical curriculum. We created a technical skills competition and evaluated its effect on student surgical skill development. METHODS Second-year medical students enrolled in the surgery clerkship voluntarily participated in a surgical skills competition consisting of knot tying, laparoscopic peg transfer, and laparoscopic pattern cut. Winning students were awarded dinner with the chair of surgery and a resident of their choice. Individual event times and combined times were recorded and compared for students who completed without disqualification. Disqualification included compromising cutting pattern, dropping a peg out of the field of vision, and incorrect knot tying technique. Timed performance was compared for 2 subsequent academic years using Mann-Whitney U test. RESULTS Overall, 175 students competed and 71 students met qualification criteria. When compared by academic year, 2015 to 2016 students (n = 34) performed better than 2014 to 2015 students (n = 37) in pattern cut (133s vs 167s, p = 0.040), peg transfer (66s vs 101s, p < 0.001), knot tying (28s vs 30s, p = 0.361), and combined time (232s vs 283s, p = 0.009). The best time for each academic year also improved (105s vs 110s). Fundamentals of Laparoscopic Surgery proficiency standards for examined tasks were achieved by 70% of winning students. CONCLUSIONS Implementation of an incentivized surgical skills competition improves student technical performance. Further research is needed regarding long-term benefits of surgical competitions for medical students.
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Affiliation(s)
| | - Morgan L Cox
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Shanna S Sprinkle
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian F Gilmore
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Sklar DP. "Don't Just Stand There, Do Something!" How Effective Procedural Training Can Help Physicians Find the Right Balance Between Doing No Harm and Doing Good. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:667-670. [PMID: 29688969 DOI: 10.1097/acm.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Cagiltay NE, Berker M. Technology-enhanced surgical education: attitudes and perceptions of the endoscopic surgery community in Turkey. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:32-38. [DOI: 10.1136/bmjstel-2017-000238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/03/2022]
Abstract
The education programme of surgery has unique problems. In this study, first, a literature review is conducted to cover the studies found in the literature reporting on the problems of surgical education. Additionally, a survey study is conducted with 31 participants, who are either currently enrolled in endoscopic surgery education programmes in Turkey or are experts in the field. Supportively semistructured individual interviews are also conducted with five participants. These data are collected to better understand the instructional methods being used, their problems and the participants’ preferred methods to be used. Additionally, the participants’ attitudes are also investigated regarding the use of new technologies to enhance the current education programmes. The results indicate that, in Turkey, surgical education programmes are still mostly offered in traditional ways while other educational methods are used in an extremely limited manner. In general, the authors emphasise that more research needs to be conducted to better understand the characteristics of the medical students and develop standards for surgical education programmes, educational tools specific for related surgical domains and guidelines for the curriculum integration. The results of this study aimed to guide the instructional system designers for the endoscopic surgery education programmes.
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Zieber M, Sedgewick M. Competence, confidence and knowledge retention in undergraduate nursing students - A mixed method study. NURSE EDUCATION TODAY 2018; 62:16-21. [PMID: 29275017 DOI: 10.1016/j.nedt.2017.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/02/2017] [Accepted: 12/03/2017] [Indexed: 06/07/2023]
Abstract
A primary goal of nursing programs is to ensure that graduates can successfully enter into professional practice. This paper examines the relationship between competence, confidence, and knowledge retention in undergraduate nursing students. The study involved a three test quantitative component as well as a qualitative component. The quantitative component comprised a pretest, posttest immediately following the intervention, posttest three month design. The intervention was comprised of an intensive one day advanced cardiac skills knowledge and simulation activity. The three tests measured competence, confidence, and knowledge retention. The results of the study demonstrated the intervention was effective in improving perceptions of competence and confidence both immediately and at a three month timeframe. Knowledge retention also was statistically significant at a three month timeframe. This study demonstrates the value of advanced knowledge and skill for undergraduate nursing students. Despite the policy enforced reality that participants were not able to use the knowledge and skill in clinical practice, the motivational benefit of the advanced knowledge had significant positive effects on participants.
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Affiliation(s)
- Mark Zieber
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
| | - Monique Sedgewick
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
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Ingrassia PL, Barozza LG, Franc JM. Prioritization in medical school simulation curriculum development using survey tools and desirability function: a pilot experiment. Adv Simul (Lond) 2018; 3:4. [PMID: 29497566 PMCID: PMC5828331 DOI: 10.1186/s41077-018-0061-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In Italy, there is no framework of procedural skills that all medical students should be able to perform autonomously at graduation. The study aims at identifying (1) a set of essential procedural skills and (2) which abilities could be potentially taught with simulation. Desirability score was calculated for each procedure to determine the most effective manner to proceed with simulation curriculum development. METHODS A web poll was conducted at the School of Medicine in Novara, looking at the level of expected and self-perceived competency for common medical procedures. Three groups were enrolled: (1) faculty, (2) junior doctors in their first years of practice, and (3) recently graduated medical students. Level of importance of procedural skills for independent practice expressed by teachers, level of mastery self-perceived by learners (students and junior doctors) and suitability of simulation training for the given technical skills were measured. Desirability function was used to set priorities for future learning. RESULTS The overall mean expected level of competency for the procedural skills was 7.9/9. Mean level of self reported competency was 4.7/9 for junior doctors and 4.4/9 for recently graduated students. The highest priority skills according to the desirability function were urinary catheter placement, nasogastric tube insertion, and incision and drainage of superficial abscesses. CONCLUSIONS This study identifies those technical competencies thought by faculty to be important and assessed the junior doctors and recent graduates level of self-perceived confidence in performing these skills. The study also identifies the perceived utility of teaching these skills by simulation. The study prioritizes those skills that have a gap between expected and observed competency and are also thought to be amenable to teaching by simulation. This allows immediate priorities for simulation curriculum development in the most effective manner. This methodology may be useful to researchers in other centers to prioritize simulation training.
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Affiliation(s)
- Pier Luigi Ingrassia
- Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie”–SIMNOVA, Università del Piemonte Orientale, via Lanino 1, 28100 Novara, Italy
| | - Ludovico Giovanni Barozza
- Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie”–SIMNOVA, Università del Piemonte Orientale, via Lanino 1, 28100 Novara, Italy
| | - Jeffrey Michael Franc
- Department of Emergency Medicine, 790 University Terrace Building, 8303-112 Street, Edmonton, AB T6G 2T4 Canada
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Are Graduating Pediatric Residents Prepared to Perform Infant Lumbar Punctures?: A Multi-Institutional Descriptive Study. Pediatr Emerg Care 2018; 34:116-120. [PMID: 27741067 DOI: 10.1097/pec.0000000000000914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few published studies describe graduating pediatric residents' procedural skills or success rates. This information would help guide supervisors' decisions about graduating residents' preparedness, training, and supervision needs. This study aimed to measure success rates for graduating pediatric residents performing infant lumbar puncture (LP) during the final months of their training and to describe their experiences performing and supervising infant LPs during the course of their training. METHODS This survey-based study was conducted at 10 academic medical institutions in 2013. The survey consisted of 4 domains: (1) demographics, (2) exposure to infant LP training as an intern, (3) number of LPs performed and supervised during residency, and (4) specific information on the most recent clinical infant LP. RESULTS One hundred ninety-eight (82%) of 242 eligible graduating residents responded to the survey. A 54% success rate was noted for graduating residents when they were the first provider performing the infant LPs. Success rates were 24% if they were not the first provider to attempt the LP. Overall, graduating residents were supervised on 29% of their LPs, used anesthesia for 29%, and used the early stylet removal technique for 63%. The graduating residents performed a median of 12 infant LPs and supervised others on a median of 5 infant LPs throughout their residency. The vast majority reported feeling confident and prepared to perform this procedure. CONCLUSIONS At the end of residency, graduating pediatric residents were rarely supervised and had low infant LP success rates despite confidence in their skills. However, graduating residents frequently supervised others performing this procedure.
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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J Grad Med Educ 2018; 10:43-50. [PMID: 29467972 PMCID: PMC5821016 DOI: 10.4300/jgme-d-17-00318.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/10/2017] [Accepted: 09/24/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. OBJECTIVE We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. METHODS We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. RESULTS Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. CONCLUSIONS A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
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Henriksen MJV, Wienecke T, Thagesen H, Jacobsen RBV, Subhi Y, Brydges R, Ringsted C, Konge L. Optimizing Residents' Performance of Lumbar Puncture: An RCT Comparing the Effect of Preparatory Interventions on Performance and Self-Confidence. J Gen Intern Med 2018; 33:148-154. [PMID: 29134571 PMCID: PMC5789103 DOI: 10.1007/s11606-017-4207-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/30/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lumbar puncture is often associated with uncertainty and limited experience on the part of residents; therefore, preparatory interventions can be essential. There is growing interest in the potential benefit of videos over written text. However, little attention has been given to whether the design of the videos impacts on subsequent performance. OBJECTIVE To investigate the effect of different preparatory interventions on learner performance and self-confidence regarding lumbar puncture (LP). DESIGN Randomized controlled trial in which participants were randomly assigned to one of three interventions as preparation for performing lumbar puncture: 1) goal- and learner-centered video (GLV) presenting procedure-specific process goals and learner-centered information; 2) traditional video (TV) providing expert-driven content, but no process goals; and 3) written text (WT) with illustrations. PARTICIPANTS AND MAIN MEASURES Participants were PGY-1 doctors without LP experience. After the preparatory intervention, participants performed an LP in a simulated setting with a standardized patient and an assistant. Two content experts, blinded to participant group allocation, assessed video recordings of the performance using the Lumbar Puncture Assessment Tool (LumPAT) and an overall global rating. Participants rated their self-confidence immediately prior to performing the procedure. The primary outcome was the difference in LumPAT scores among groups. KEY RESULTS A total of 110 PGY-1 doctors were included. Results demonstrated significant differences in LumPAT mean scores among the three groups: GLV, 42.8; TV, 40.6; WT, 38.1 (p = 0.01). The global rating scores were highest in the GLV group (p = 0.026). Self-confidence scores differed significantly among the three groups (p = 0.003), with the TV group scoring the highest. There were no significant correlations between self-confidence scores and performance scores in any of the groups. CONCLUSION A video designed with procedure-specific process goals and learner-centered information resulted in better subsequent LP performance than a traditionally designed video or written text. Participants' self-confidence was not predictive of their actual performance.
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Affiliation(s)
- Mikael Johannes Vuokko Henriksen
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, The Capital Region of Denmark, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Troels Wienecke
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Helle Thagesen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Rikke Borre Vita Jacobsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Head and Orthopedic/UFU 4231 Anesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Yousif Subhi
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Ryan Brydges
- The Wilson Center, University Health Network, Toronto, Canada
- Allan Waters Family Simulation Centre & Professorship in Technology-Enabled Education, St. Michael's Hospital, Toronto, Canada
- Deptarment of Medicine, University of Toronto, Toronto, Canada
| | - Charlotte Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, The Capital Region of Denmark, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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