The acquisition and retention of urinary catheterisation skills using surgical simulator devices: teaching method or student traits

Simulation of gastroscopy and endoscopic retrograde cholangiopancreatography for medical student education

BACKGROUND

Simulation training has become part of medical student education, however endoscopy simulators have mostly been reserved for speciality training. Evidence suggests that simulation training has the potential to educate future doctors about endoscopy procedures and improve their communication with patients. Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that is technically challenging and poorly understood by medical students. This study aimed to investigate whether simulating gastroscopy and ERCP using an anatomical model of the upper gastrointestinal tract improves procedural knowledge, confidence, and performance in medical students.

METHODS

Students completed three attempts at gastroscopy and one attempt at ERCP using the model. Participants rated knowledge and confidence relating to endoscopic procedures before and after completing the simulation. Students also reported their attitudes towards endoscopic simulation training after their participation.

RESULTS

There was a significant increase in self-perceived knowledge of the purpose of and steps involved in endoscopy (P < 0.001), gastrointestinal anatomy (P = 0.003), and biliary system anatomy (P = 0.002) after using the simulator. Participants also reported significantly increased skills confidence in performing gastroscopy and duodenoscopy (P < 0.001), including in their ability to explain endoscopic procedures to a patient (P < 0.001). All participants agreed (5%) or strongly agreed (95%) that simulation training is a useful addition to their learning, and that they would like more simulation training in the medical curriculum.

CONCLUSION

Simulation training is an effective and engaging method of promoting procedural awareness and understanding of basic endoscopic procedures in medical students, with the potential to improve doctor-patient interactions in early clinical practice.

Improving Foundation Year doctors’ confidence with routine suprapubic catheter change using an easily reproducible simulation model

Objective:

Previous studies report low confidence levels amongst junior doctors in changing suprapubic catheters (SPC). We aimed to assess and improve foundation doctors’ confidence in changing an SPC, and to identify factors contributing to a lack in confidence. A teaching session using an easily reproducible simulation model was delivered to improve confidence.

Method:

A teaching session on routine SPC changes was delivered to a cohort of 30 Foundation Year 2 doctors within a single hospital. The teaching session comprised a short presentation followed by a practical session with the teaching models. Trainees completed a questionnaire on self-reported confidence levels in catheterisation prior to, and directly after, the session.

Results:

The self-reported confidence level with SPC changes was measured using a 5-point scale (1 = not very confident, 5= very confident), and following the session, the median score increased from 1 to 4. 100% ( N = 28) of trainees felt the teaching session increased their confidence with routine SPC changes and that the simulation model was a useful tool.

Conclusion:

Some junior doctors report low confidence levels with SPC changes. A teaching session on routine SPC changes using a simulation model may improve confidence

Level of evidence:

2c

Twelve tips for efficient procedural simulation

Procedural simulation (PS) is increasingly being used worldwide in healthcare for training caregivers in psychomotor competencies. It has been demonstrated to improve learners' confidence and competence in technical procedures, with consequent positive impacts on patient outcomes and safety. Several frameworks can guide healthcare educators in using PS as an educational tool. However, no theory-informed practical framework exists to guide them in including PS in their training programs. We present 12 practical tips for efficient PS training that translates educational concepts from theory to practice, based on the existing literature. In doing this, we aim to help healthcare educators to adequately incorporate and use PS both for optimal learning and for transfer into professional practice.

A prospective audit on the effect of training and educational workshops on the incidence of urethral catheterization injuries

INTRODUCTION

The incidence of iatrogenic urethral catheterization (UC) injuries is approximately 0.3%. Resultant complications are associated with patient morbidity and unnecessary healthcare costs. Our aim was to investigate whether educational training workshops decreased the incidence of UC-related injuries.

METHODS

A prospective audit was performed to calculate incidence, morbidity, and costs associated with iatrogenic UC injury from January to July 2015. Educational workshops were then conducted with healthcare staff and training modules for junior doctors. UC-related incidence, morbidity, and costs in the subsequent six-month period were recorded prospectively and compared with the previous data.

RESULTS

The incidence of iatrogenic UC injuries was reduced from 4.3/1000 catheters inserted to 3.8/1000 catheters after the intervention (p=0.59). Morbidity from UC increased in the second half in the form of increase in cumulative additional inpatient hospital stay (22 to 79 days; p=0.25), incidence of urosepsis (n=2 to n=4), and need for operative intervention (n=1 to n=2). The cost of managing UC injuries almost doubled in the period after the training intervention (€50 449 to €90 100).

CONCLUSIONS

Current forms of educational and training interventions for UC did not significantly change morbidity or cost of iatrogenic UC injuries despite a decrease in incidence. Improved and intensive training protocols are necessary for UC to prevent avoidable iatrogenic complications, as well as a safer urethral catheter design.

Skill Acquisition and Retention Following Simulation-Based Training in Pavlik Harness Application

BACKGROUND

Simulation-based learning is increasingly prevalent in many surgical training programs, as medical education moves toward competency-based curricula. In orthopaedic surgery, developmental dysplasia of the hip is a commonly treated condition, where the standard of care for patients less than six months of age is an orthotic device such as the Pavlik harness. However, despite widespread use of the Pavlik harness and the potential complications that may arise from inappropriate application, we know of no previously described formal training curriculum for Pavlik harness application.

METHODS

We developed a video and model-based simulation learning module for Pavlik harness application. Two novice groups (residents and allied health professionals) were exposed to the module and, at pre-intervention, post-intervention, and retention testing, were evaluated on their ability to apply a Pavlik harness to the model. Evaluations were completed using a previously validated Objective Structured Assessment of Technical Skills (OSATS) and a global rating scale (GRS) specific to Pavlik harness application. A control group that did not undergo the module was also evaluated at two time points to determine if exposure to the Pavlik harness alone would affect skill acquisition. All groups were compared with a group of clinical experts, whose scores were used as a competency benchmark. Statistical analysis of skill acquisition and retention was conducted using t tests and analysis of variance (ANOVA).

RESULTS

Exposure to the learning module improved resident and allied health professionals' competency in applying a Pavlik harness (p < 0.05) to the level of the expert clinicians, and this level of competency was retained one month after exposure to the module. Control subjects who were not exposed to the module did not improve, nor did they achieve competency.

CONCLUSIONS

The simulation-based learning module was shown to be an effective tool for teaching the application of a Pavlik harness, and learners demonstrated retainable skills post-intervention. This learning module can form the cornerstone of formal teaching of Pavlik harness application for developmental dysplasia of the hip.

Selection of nursing teaching strategies in mainland China: A questionnaire survey

BACKGROUND

In nursing education, the traditional lecture and direct demonstration teaching method cannot cultivate the various skills that nursing students need. How to choose a more scientific and rational teaching method is a common concern for nursing educators worldwide.

OBJECTIVE

To investigate the basis for selecting teaching methods among nursing teachers in mainland China, the factors affecting the selection of different teaching methods, and the application of different teaching methods in theoretical and skill-based nursing courses.

DESIGN

Questionnaire survey.

SETTINGS

Seventy one nursing colleges from 28 provincial-level administrative regions in mainland China.

PARTICIPANTS

Following the principle of voluntary informed consent, 262 nursing teachers were randomly selected through a nursing education network platform and a conference platform.

METHODS

The questionnaire contents included the basis for and the factors influencing the selection of nursing teaching methods, the participants' common teaching methods, and the teaching experience of the surveyed nursing teachers. The questionnaires were distributed through the network or conference platform, and the data were analyzed by SPSS 17.0 software.

RESULTS

The surveyed nursing teachers selected teaching methods mainly based on the characteristics of the teaching content, the characteristics of the students, and their previous teaching experiences. The factors affecting the selection of teaching methods mainly included large class sizes, limited class time, and limited examination formats. The surveyed nursing teachers primarily used lectures to teach theory courses and the direct demonstration method to teach skills courses, and the application frequencies of these two teaching methods were significantly higher than those of other teaching methods (P=0.000).

CONCLUSION

More attention should be paid to the selection of nursing teaching methods. Every teacher should strategically choose teaching methods before each lesson, and nursing education training focused on selecting effective teaching methods should be more extensive.