Core procedural skills competencies and the maintenance of procedural skills for medical students: a Delphi study

Student access patterns for an online clinical skills procedural video library

CLINICAL RELEVANCE

Clinical skills training is essential in optometry curricula to develop core graduate entry competencies, including self-directed learning to facilitate life-long learning. Efficient and efficacious approaches are required to optimise student and educator time and resources.

BACKGROUND

A video library of optometric clinical skills was created in 2012 to support self-directed student learning and face-to-face training. Use of videos in higher education generally increased during the COVID-19 pandemic and has remained above pre-pandemic levels. This study aimed to capture and evaluate student access patterns in the library to determine which videos were accessed most, and if this changed with training stage and following the pandemic.

METHODS

Data on student viewing and critique submission were extracted for 71 videos from a clinical skills video library from 2018 to 2023. The number of videos viewed by students was analysed by year, cohort, video type (gold standard, scripted errors, summary, and student generated) and video category (history, screening, refraction, anterior segment, posterior segment and tonometry).

RESULTS

First-year students viewed the most videos, and this decreased significantly during and following the pandemic. Overall, the number of videos viewed decreased with increasing course stage. Video access, by category, aligned with the curriculum. Views were highest for gold standard and student videos. Viewing of scripted error videos and submission of critiques of procedural videos was low for all course stages and years.

CONCLUSION

A web-based video library of optometric clinical skills was used for self-directed learning, mostly by students early in their training. Similar resources developed in the future should align with curriculum and include exemplar and student-based videos. Exploration of student and educator perspectives regarding factors that impact engagement with the online library warrants investigation to facilitate optimal integration in post-pandemic times.

Identifying Essential Procedural Skills for Medical Students: A Modified Delphi Technique

BACKGROUND

Although Sri Lankan medical students need to acquire specific procedural skills during their undergraduate training, agreement on what skills they should obtain is inconclusive. This study aimed to generate consensus of the expert panel on essential procedural skills and level of expertise to be attained for Sri Lankan medical students and need for developing and implementing a pre-clerkship procedural training curriculum to improve procedural expertise.

METHODS

A three-round online modified Delphi study was conducted between August 2022 and January 2023. The initial questionnaire was developed from existing student logbooks and published literature. Round one invited the expert panel to rate their agreement on the inclusion of essential procedures for undergraduate medical training. In Round two, the panel rated their expectation of procedural expertise for a medical graduate on the first day of internship (ie, Observer to Proficient). Round three established the consensus on the need for a pre-clerkship procedural curriculum.

RESULTS

The expert panel included 17 clinicians involved in undergraduate medical education and supervision of intern medical doctors. In Round 1, they rated their agreement on including teaching of 64 procedures and suggested four additional procedures. In Round 2, experts re-appraised 33 items and rated the level of procedural expertise. In Round 3, experts re-appraised the ratings of 14 essential procedures and rated the support for a pre-clerkship procedural curriculum for medical students. Consensus defined as > 75% agreement was established with 35 essential procedural skills. Most of the experts expressed the need for a pre-clerkship procedural curriculum for medical students.

CONCLUSIONS

Through three rounds of modified Delphi, the current study established 35 procedural skills essential for a Sri Lankan medical graduate. The results also support the need for developing and implementing a pre-clerkship procedural training curriculum to improve procedural expertise of graduating doctors which demonstrate the importance of aligning existing medical curricula with competency-based medical education.

Are interns prepared? A summary of current transition to residency preparation courses content

Background

The transition from medical student to emergency medicine resident is a critical point in training. Medical students start residency with different levels of understanding and some are not meeting the emergency medicine (EM) Level 1 milestones. Residency preparation courses (RPCs) were created to fill this gap and prepare medical students for residency.

Objectives

The objective was to review content from current RPC curricula to determine the content that should be included in an EM-specific transition to residency preparation course.

Methods

We collected curricula from RPC course directors at different institutions and reviewed and coded the topics into categories: (1) didactics, (2) procedures, and (3) unique topics (defined as nontraditional topics that did not fit squarely into didactics or procedures).

Results

We obtained content from 13 different RPC curricula. Length of the courses ranged from one to 8 weeks with the mean being three weeks. Most courses were taught within a larger medical school course and were not specific to EM (62%). The most frequently taught didactic topics were airway interventions (85%), critical care (69%), and chest pain/shortness of breath (62%). Most programs included a simulation component (92%) and the most common procedures included airway interventions (69%); lines-central, arterial, and Cordis (69%); lumbar puncture (62%); and ultrasound (62%). Many of the courses had unique or special features taught within the curriculum. The most frequently taught unique content were sessions on self-awareness and self-regulation (85%) and advanced communication (69%).

Conclusions

After multiple RPC curricula content was reviewed, a set of basic curriculum has been determined and supported by the content analysis. By including a standardized curriculum within RPC's, this will help better prepare medical students and create a standard for medical students entering EM residency and may allow intern orientations to focus on higher level skills.

A do it yourself (DIY) point-of-care wrist ultrasound phantom for joint access training

BACKGROUND

Joint access is essential for arthrocentesis, or joint aspiration of fluids. Joint treatments that are not performed properly can result in avoidable patient issues such as damage to the muscles, tendons, and blood vessels surrounding the joint. The use of ultrasound has become the gold standard for this procedure and proven to be a support in the skill learning process. However, success with this equipment, particularly in small joints like the wrist, depends on a clinician's capacity to recognize the crucial landmarks that guide these procedures. Prior to executing on a real patient, task trainers have proven to be an effective way for doctors to practice and prepare for procedures. However, shortcomings of current solutions include high purchase costs, incompatibility with ultrasound imaging, and low reusability. In addition, since this is a procedure that is not performed frequently, there may not be space or resources available in healthcare facilities to accommodate one at the point of care. This study aimed to close the existing gap by developing a DIY ultrasound compatible task trainer for wrist joint access training.

RESULTS

We developed a novel ultrasound compatible wrist joint model that can be made from sustainable materials and reusable parts, thus reducing the costs for acquisition and environmental impact. Our model, which was produced utilizing small-batch production methods, is made up of 3D-printed bones enclosed in an ultrasound-compatible gelatin mixture. It can be easily remade after each practice session, removing needle tracks that are visible under ultrasound for conventional phantoms. The ultrasonic properties of this model were tested through pixel brightness analysis and visual inspection of simulated anatomical structures.

CONCLUSION

Our results report the advantages and limitations of the proposed model regarding production, practice, and ultrasound compatibility. While future work entails the transfer to patients of the same skill, this reusable and replicable model has proven, when presented to experts, to be successful in representing the physical characteristics and ultrasound profile of significant anatomical structures. This novel DIY product could be an effective alternative to teach procedures in the context of resource-restrained clinical simulation centers.

Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study

Background

Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit.

Methods

A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant.

Results

The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction.

Conclusion and recommendation

The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.

Core Procedural Skills to be Taught for III-Year Undergraduate Medical Students: A Modified Delphi Study

Introduction

While medical students are expected to learn procedural skills during their training, there is no consensus on their level of learning. Further, the most essential procedural skills across medical curricula which need to be taught during their III-year clinical posting are often not considered. The purpose of this study was to identify the core procedural skills needed to be taught during the III-year undergraduate medical students clinical posting.

Methods

A three-round, online Modified Delphi method was used to identify consensus on selecting the most essential procedural skills prescribed in National Medical Commission (NMC) curriculum 2019. In Round 1, a list of 54 procedural skills from the National Medical Commission's (NMC) Graduate Medical Education Regulations (GMER) 2019 curriculum was distributed to 22 experts in pre-clinical medical education and multidisciplinary clinicians.They rated the skills in terms of importance. In Round 2, the skills that received consensus in Round 1 were presented, resulting in 13 skills for evaluation. Round 3 further narrowed down the skills to a final consensus of 6. An interclass correlation coefficient of 0.767 among experts indicates a substantial level of reliability.

Results

Consensus was achieved for six procedural skills, each demonstrating over 80% agreement among the experts. These skills include basic life support, intravenous cannulation, urinary catheterization for both male and female patients, nasogastric tube insertion, oxygen administration, and basic suturing. Notably, all these skills received the highest level of agreement, surpassing 90% consensus.

Conclusions

The results of the modified Delphi study offer crucial insights into the procedural skills that should be included in the curriculum for third-year undergraduate medical students during their clinical rotations in a tertiary care teaching hospital. Faculty members at these institutions differ in their opinions regarding the importance of teaching specific procedural skills, influenced by their teaching background and the student cohorts they instruct. From a comprehensive list, six skills have been pinpointed as the most vital through the modified Delphi technique. Moreover, the Delphi technique is acknowledged as a valuable method for achieving a consensus on prioritizing the training of certifiable skills.

Exploring training needs of newly graduated medical doctors to inform the undergraduate simulation-based curriculum: a national Delphi consensus study

PURPOSE

Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors.

METHODS

We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures.

RESULTS

In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture.

CONCLUSION

Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education.