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Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers. ATS Sch 2023; 4:48-60. [PMID: 37089675 PMCID: PMC10117416 DOI: 10.34197/ats-scholar.2022-0065oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background Advanced practice providers (APPs) are essential members of intensive care unit (ICU) interprofessional teams and are expected to be competent in performing procedures. There are no published criteria for establishing when APPs can independently perform procedures. Simulation-based mastery learning (SBML) is an effective strategy for improving critical care skills but has not been applied to practicing ICU APPs. Objective The purpose of this study was to evaluate if an SBML curriculum could improve the critical care skills and procedural self-confidence of ICU APPs. Methods We performed a pretest-posttest study of central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management skills among ICU APPs who participated in an SBML course at an academic hospital. For each skill, APPs underwent baseline skills assessments (pretests) on a simulator using previously published checklists, followed by didactic sessions and deliberate practice with individualized feedback. Within 2 weeks, participants were required to meet or exceed previously established minimum passing standards (MPS) on simulated skills assessments (posttests) using the same checklists. Further deliberate practice was provided for those unable to meet the MPS until they retested and met this standard. We compared pretest to posttest skills checklist scores and procedural confidence. Results All 12 eligible ICU APPs participated in internal jugular CVC, subclavian CVC, and MV training. Five APPs participated in thoracentesis training. At baseline, no APPs met the MPS on all skills. At training completion, all APPs achieved the mastery standard. Internal jugular CVC pretest performance improved from a mean of 67.2% (standard deviation [SD], 28.8%) items correct to 97.1% (SD, 3.8%) at posttest (P = 0.005). Subclavian CVC pretest performance improved from 29.2% (SD, 32.7%) items correct to 93.1% (SD 3.9%) at posttest (P < 0.001). Thoracentesis pretest skill improved from 63.9% (SD, 30.6%) items correct to 99.2% (SD, 1.7%) at posttest (P = 0.054). Pretest MV skills improved from 54.8% (SD, 19.7%) items correct to 92.3% (SD, 5.0%) at posttest (P < 0.001). APP procedural confidence improved for each skill from pre to posttest. Conclusion SBML is effective for training APPs to perform ICU skills. Relying on traditional educational methods does not reliably ensure that APPs are adequately prepared to perform skills such as CVC insertion, thoracentesis, and MV management.
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Abstract
Research in cognitive psychology shows that expert clinicians make a medical diagnosis through a two step process of hypothesis generation and hypothesis testing. Experts generate a list of possible diagnoses quickly and intuitively, drawing on previous experience. Experts remember specific examples of various disease categories as exemplars, which enables rapid access to diagnostic possibilities and gives them an intuitive sense of the base rates of various diagnoses. After generating diagnostic hypotheses, clinicians then test the hypotheses and subjectively estimate the probability of each diagnostic possibility by using a heuristic called anchoring and adjusting. Although both novices and experts use this two step diagnostic process, experts distinguish themselves as better diagnosticians through their ability to mobilize experiential knowledge in a manner that is content specific. Experience is clearly the best teacher, but some educational strategies have been shown to modestly improve diagnostic accuracy. Increased knowledge about the cognitive psychology of the diagnostic process and the pitfalls inherent in the process may inform clinical teachers and help learners and clinicians to improve the accuracy of diagnostic reasoning. This article reviews the literature on the cognitive psychology of diagnostic reasoning in the context of cardiovascular disease.
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Affiliation(s)
- John E Brush
- Sentara Health Research Center, Norfolk, VA, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jonathan Sherbino
- McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Geoffrey R Norman
- McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, ON, Canada
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Strowd LC, Kelly K, Peters TR, Jackson JM. Student, Faculty, and Coach Perspectives on Why Athletes Excel in Medical School: A Qualitative Analysis. TEACHING AND LEARNING IN MEDICINE 2022; 34:43-59. [PMID: 35100913 DOI: 10.1080/10401334.2021.1921584] [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: 01/17/2020] [Revised: 04/15/2021] [Accepted: 04/08/2021] [Indexed: 06/14/2023]
Abstract
Phenomenon Medical schools are tasked with selecting applicants who will excel in a rigorous curriculum and successfully perform as future physicians. While many studies have assessed quantitative prematriculation data for predicting success in medical school, fewer studies have assessed for qualitative prematriculation factors influencing medical school performance. A recent study revealed that medical students with at least one year of varsity level college athletics participation outperformed their peers on United States Medical Licensing board exams and clinical clerkships. The current study sought to explore medical student, medical school faculty, and college coach perspectives about factors explaining why medical students with collegiate athletic experience succeed in medical school. Approach: In 2019, the authors conducted semi-structured interviews with medical students with collegiate athletic experience, medical school faculty with experience educating student athletes, and college coaches with experience training student athletes who matriculated into medical school. The interview transcripts were systematically coded and analyzed for themes using a grounded theory approach. Participants were recruited and interviewed until saturation of data was reached. Findings: Fifteen medical students with collegiate athletic experience, five medical school faculty, and three collegiate coaches participated in the study. Six themes were identified as important factors explaining the academic success of these students in medical school and each of these themes appeared in student, faculty, and coach interviews: goal setting, goal pursuit, and performance appraisal; development of time management, planning, and organizational skills; development of team values and teamwork skills; development of communication and interpersonal skills; acceptance of, coping strategies for, and resilient response to stress and adversity; and prioritization of personal wellness. Participants described meaningful connections between these attributes and skills, suggesting the students' development, transfer, and application of them is interrelated. Insights: In this study, academic success of medical students with collegiate athletic experience was attributed to specific skills and attributes developed during college. The grounded theory life skills transfer model can explain transfer of these attributes and skills from college to the medical school setting. Theoretical frameworks and empirical study findings from the sociology, educational psychology, sports psychology, and medical education literature provide helpful lenses for understanding why these skills and attributes confer success among student athletes in medical school. These findings offer important insights on skill development that may support the academic success of all medical students.
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Affiliation(s)
- Lindsay Chaney Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine Kelly
- Medical Student, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Timothy R Peters
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Marie Jackson
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Holland JR, Latuska RF, MacKeil-White K, Ciener DA, Vukovic AA. "Sim One, Do One, Teach One": A Simulation-Based Trauma Orientation for Pediatric Residents in the Emergency Department. Pediatr Emerg Care 2021; 37:e1285-e1289. [PMID: 31977766 DOI: 10.1097/pec.0000000000002003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine the effectiveness of a simulation-based curriculum in improving confidence in trauma resuscitation skills and increasing attendance during trauma resuscitations for pediatric residents during their emergency medicine rotation. METHODS A simulation-based orientation curriculum was implemented for the 2017-2018 academic year. Participants completed a qualitative survey before and after each session to assess their comfort level with skills required in a trauma resuscitation. Responses were compared using the Wilcoxon ranked sum test. Nursing documentation was reviewed for the 2016-2017 and 2017-2018 academic years to determine the frequency of resident attendance at trauma resuscitations. Pediatric resident attendance before and after intervention were compared via χ2 analysis. RESULTS Survey responses showed a significant increase in confidence in all skills assessed, including primary and secondary survey performance, knowledge of pediatric resident role, knowledge of necessary equipment, ability to determine acuity of patient illness or injury, and ability to differentiate between modes of oxygen delivery (P < 0.01). There was no statistically significant change in the frequency of pediatric resident attendance at trauma bay resuscitations before and after curriculum implementation (21.2% vs 25.7%, P = 0.09). CONCLUSIONS Through the implementation of a simulation-based trauma orientation for pediatric residents, we were able to improve self-reported confidence in trauma resuscitation skills. This improvement did not result in an increased attendance at trauma resuscitations. Next steps include identifying additional barriers to pediatric resident attendance at trauma bay resuscitations.
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Affiliation(s)
- Jaycelyn R Holland
- From the Division of Pediatric Emergency Medicine-Department of Pediatrics
| | - Richard F Latuska
- From the Division of Pediatric Emergency Medicine-Department of Pediatrics
| | - Kimberly MacKeil-White
- Department of Nursing Education-Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Daisy A Ciener
- From the Division of Pediatric Emergency Medicine-Department of Pediatrics
| | - Adam A Vukovic
- From the Division of Pediatric Emergency Medicine-Department of Pediatrics
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Koshmaganbetova G, Kurmangalieva S, Bazargaliyev Y, Zhexenova A, Urekeshov B, Azhmuratova M. The Effectiveness of Training on Auscultation of Heart with a Simulator of Cardiology in Medical Students. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
The purpose of this study was to determine whether the training module with a simulator of cardiology improves auscultation skills in medical students.
Methods. Medical students of the third year after completing the module of the cardiovascular system of the discipline “Propaedeutics of internal diseases, passed a two-hour or four-hour training module in clinical auscultation with retesting immediately after the intervention and in the fourth year. The control group consisted of fourth-year medical students who had no intervention.
Results. The diagnostic accuracy in two-hour training was 45.9% vs 35.3% in four-hour training p <.001. The use of a cardio simulator significantly increased the accurate detection of mitral regurgitation immediately after training on a simulator (more than 73%) p <.001. The next academic year, regression was observed in the diagnostic accuracy of mitral insufficiency in the intervention group after six months of observation by 4%. The auscultation skills of students at the bedside of real patients did not increase after training on a simulator: the accuracy of diagnosis of the auscultatory picture of the defect was equally low in the intervention group and the control group (35.0% vs 30.8%, p = 0.651).
Conclusions. Two-hour training was more effective than four-hour training. After training on cardiac auscultation using a patient’s cardiological simulator, the accuracy rate was low in a situation close to the clinical conditions and a clinic on a real patient.
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Mnouskin Y, Assaf D, Barkon-Steinberg G, Rachmuth J, Carmeli I, Keidar A, Rayman S. Proctored preceptorship model for learning eTEP repair for inguinal hernia for general surgery residents. Hernia 2021; 26:1053-1062. [PMID: 34591214 DOI: 10.1007/s10029-021-02507-4] [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: 06/06/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. AIM Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. METHODS Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups-Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. RESULTS Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). CONCLUSION Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.
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Affiliation(s)
- Y Mnouskin
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - D Assaf
- Department of Surgery C, Chaim Sheba Medical Center, (Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 2 Sheba Rd., 52610, Ramat Gan, Israel
| | - G Barkon-Steinberg
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - J Rachmuth
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - I Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - A Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - S Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel.
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McNutt R, Tews M, Kleinheksel AJ. Student Performance During a Simulated Patient Encounter Has No Impact on Debriefer Adherence to PEARLS Debriefing Model. MEDICAL SCIENCE EDUCATOR 2021; 31:1141-1148. [PMID: 34457957 PMCID: PMC8368893 DOI: 10.1007/s40670-021-01290-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Debriefing is necessary for effective simulation education. The PEARLS (Promoting Excellence and Reflective Learning in Simulations) is a scripted debriefing model that incorporates debriefing best practices. It was hypothesized that student simulation performance might impact facilitator adherence to the PEARLS debriefing model. There are no published findings on the effect of student performance on debriefer behavior. METHODS Third-year medical students participated in a video-recorded, formative simulation to treat a high-fidelity mannequin for an asthma exacerbation. A faculty debriefer trained in the PEARLS model evaluated student performance with a standardized rubric and conducted a recorded debriefing. Debriefing recordings were analyzed for debriefer adherence to the PEARLS model. Debriefers were assigned a debriefing score (DS) from 0 to 13; 13 was perfect adherence to the model. Definitive intervention (DI) for asthma exacerbation was defined as bronchodilator therapy. Critical actions were as follows: a focused history, heart/lung exam, giving oxygen, and giving a bronchodilator. RESULTS Mean DS for the debriefers of students who provided DI was 8.57; 9.14 for those students who did not (P = 0.25). Mean DS for debriefers of students who completed all critical actions was 8.68; 8.52 for those students who did not (P = 0.62). Analysis of elapsed time to DI showed no relationship between the time DI was provided and DS. CONCLUSIONS Student performance had no impact on debriefer performance, suggesting the PEARLS model is an effective aid for debriefers, regardless of learner performance. These findings suggest student performance may not bias facilitators' ability to conduct quality debriefings.
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Affiliation(s)
- Richard McNutt
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, AF 1018, 30912 Augusta, Georgia
| | - Matthew Tews
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, AF 1018, 30912 Augusta, Georgia
| | - A. J. Kleinheksel
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
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Kaminsky J, Bianchi R, Eisner S, Ovitsh R, Lopez AM, Smith L, Talukder N, Quinn A. Respiratory Auscultation Lab Using a Cardiopulmonary Auscultation Simulation Manikin. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11107. [PMID: 33768144 PMCID: PMC7970645 DOI: 10.15766/mep_2374-8265.11107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/24/2020] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Mastery of respiratory auscultation skills is fundamental for clinicians to develop. We created a case-based educational session utilizing a high-fidelity simulator to teach lung sound auscultation to medical students at our institution. We employed a hypothesis-driven approach and deliberate practice to enhance students' learning experience and retention of acquired skills. METHODS We developed the session to teach second-year medical students how to discriminate between normal and pathological respiratory sounds within the context of clinical vignettes. Faculty facilitators, in conjunction with near-peer educators, made use of a high-fidelity auscultation manikin to guide students through case-based problem sets. Students were given the opportunity to auscultate the manikin while being observed and receiving feedback from the faculty. RESULTS We introduced the manikin in 2016, with a total of 759 second-year medical students from four class years having participated in the session since then. Students evaluated the session through an end-of-the-week and end-of-unit survey. The survey showed an overall improvement in learner satisfaction over previous years. Survey results and feedback were used to make adjustments to the session. DISCUSSION Our respiratory auscultation session was well received overall. Proper faculty development is crucial for implementing the session. Because of the focus on deliberate practice, adequate time must be allotted to hold the session. This program is reproducible with similar high-fidelity simulators.
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Affiliation(s)
- Jennifer Kaminsky
- Resident Physician, Department of Emergency Medicine, Staten Island University Hospital
- Corresponding author:
| | - Riccardo Bianchi
- Associate Professor, Department of Physiology and Pharmacology, State University of New York Downstate Health Sciences University; Associate Dean for Foundations of Medicine, College of Medicine, State University of New York Downstate Health Sciences University
| | - Shirley Eisner
- Associate Professor and Co-Director of Gross Anatomy, Department of Cell Biology, State University of New York Downstate Health Sciences University
| | - Robin Ovitsh
- Associate Clinical Professor, Department of Pediatrics, State University of New York Downstate Health Sciences University; Associate Dean for Clinical Competencies, College of Medicine, State University of New York Downstate Health Sciences University
| | - Ana Maria Lopez
- Fourth-Year Medical Student, College of Medicine, State University of New York Downstate Health Sciences University
| | - Leanna Smith
- Fourth-Year Medical Student, College of Medicine, State University of New York Downstate Health Sciences University
| | - Nawar Talukder
- Resident Physician, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix
| | - Antonia Quinn
- Associate Clinical Professor, Department of Emergency Medicine, State University of New York Downstate Health Sciences University; Associate Director of Clinical Competencies, College of Medicine, State University of New York Downstate Health Sciences University College of Medicine
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Martinelli SM, Chen F, Isaak RS, Huffmyer JL, Neves SE, Mitchell JD. Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond. Anesth Analg 2021; 132:585-593. [PMID: 33201006 DOI: 10.1213/ane.0000000000005333] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision article discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19, and evidence for these modifications, and suggests future directions for anesthesiology education. Learning management systems provide structure to online learning. They have been increasingly utilized to improve access to didactic materials asynchronously. Despite some historic reservations, the pandemic has necessitated a rapid uptake across programs. Commercially available systems offer a wide range of peer-reviewed curricular options. The flipped classroom promotes learning foundational knowledge before teaching sessions with a focus on application during structured didactics. There is growing evidence that this approach is preferred by learners and may increase knowledge gain. The flipped classroom works well with learning management systems to disseminate focused preclass work. Care must be taken to keep virtual sessions interactive. Simulation, already used in anesthesiology, has been critical in preparation for the care of COVID-19 patients. Multidisciplinary, in situ simulations allow for rapid dissemination of new team workflows. Physical distancing and reduced availability of providers have required more sessions. Early pandemic decreases in operating volumes have allowed for this; future planning will have to incorporate smaller groups, sanitizing of equipment, and attention to use of personal protective equipment. Effective technical skills training requires instruction to mastery levels, use of deliberate practice, and high-quality feedback. Reduced sizes of skill-training workshops and approaches for feedback that are not in-person will be required. Mock oral and objective structured clinical examination (OSCE) allow for training and assessment of competencies often not addressed otherwise. They provide formative and summative data and objective measurements of Accreditation Council for Graduate Medical Education (ACGME) milestones. They also allow for preparation for the American Board of Anesthesiology (ABA) APPLIED examination. Adaptations to teleconferencing or videoconferencing can allow for continued use. Benefits of teaching in this new era include enhanced availability of asynchronous learning and opportunities to apply universal, expert-driven curricula. Burdens include decreased social interactions and potential need for an increased amount of smaller, live sessions. Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.
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Affiliation(s)
- Susan M Martinelli
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Fei Chen
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Robert S Isaak
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Sara E Neves
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - John D Mitchell
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Schroedl CJ, Frogameni A, Barsuk JH, Cohen ER, Sivarajan L, Wayne DB. Impact of Simulation-based Mastery Learning on Resident Skill Managing Mechanical Ventilators. ATS Sch 2020; 2:34-48. [PMID: 33870322 PMCID: PMC8043263 DOI: 10.34197/ats-scholar.2020-0023oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Caring for patients requiring mechanical ventilation is complex, and residents may lack adequate skill for managing these patients. Simulation-based mastery learning (SBML) is an educational model that trains clinicians to a high standard and can reduce complications. The mastery learning model has not been applied to ventilator management. Objective: The purpose of this study was to determine whether SBML, as compared with traditional training, is an effective strategy for teaching residents the skills necessary to manage patients requiring mechanical ventilation. Methods: We developed an SBML curriculum and a 47-item skills checklist to test ventilator management for patients with normal, restricted, and obstructed lung physiology. A minimum passing standard (MPS) on the checklist was set using the Mastery Angoff method. Residents rotating through the medical intensive care unit in Academic Year 2017-2018 were assigned to SBML or traditional training based on their medical intensive care unit team. The SBML group was pretested on a ventilator simulator using the skills checklist. They then received a 1.5-hour session (45 min didactic and 45 min deliberate practice on the simulator with feedback). At rotation completion, they were posttested on the simulator using the checklist until the MPS was met. Both SBML-trained and traditionally trained groups received teaching during daily bedside rounds and twice weekly didactic lectures. At rotation completion, traditionally trained residents were tested using the same skills checklist on the simulator. We compared pretest and posttest performance among SBML-trained residents and end of the rotation test performances between the SBML-trained and traditionally trained residents. Results: The MPS was set at 87% on the checklist. Fifty-seven residents were assigned to the SBML-trained group and 49 were assigned to the traditionally trained group. Mean checklist scores for SBML-trained residents improved from 51.4% (standard deviation [SD] = 17.5%) at pretest to 86.1% (SD = 7.6%) at initial posttest and 92.5% (SD = 3.7%) at final (mastery) posttest (both P < 0.001). Forty-two percent of residents required more than one attempt at the posttest to meet or exceed the MPS. At rotation completion, the traditionally trained residents had a mean test score of 60.9% (SD = 13.3%). Conclusion: SBML is an effective strategy to train residents on mechanical ventilator management. An SBML curriculum may augment traditional training methods to further equip residents to safely manage ventilated patients.
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Affiliation(s)
- Clara J. Schroedl
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Frogameni
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R. Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lakshmi Sivarajan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B. Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Patel D, Hawkins J, Chehab LZ, Martin-Tuite P, Feler J, Tan A, Alpers BS, Pink S, Wang J, Freise J, Kim P, Peabody C, Bowditch J, Williams ER, Sammann A. Developing Virtual Reality Trauma Training Experiences Using 360-Degree Video: Tutorial. J Med Internet Res 2020; 22:e22420. [PMID: 33325836 PMCID: PMC7773512 DOI: 10.2196/22420] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/05/2022] Open
Abstract
Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there has been a shift to practicing skills through simulations with mannequins or patient actors. Virtual reality (VR), and in particular, the use of 360-degree video and audio (cineVR), is the next-generation advancement in medical simulation that has novel applications to augment clinical skill practice, empathy building, and team training. In this paper, we describe methods to design and develop a cineVR medical education curriculum for trauma care training using real patient care scenarios at an urban, safety-net hospital and Level 1 trauma center. The purpose of this publication is to detail the process of finding a cineVR production partner; choosing the camera perspectives; maintaining patient, provider, and staff privacy; ensuring data security; executing the cineVR production process; and building the curriculum.
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Affiliation(s)
- Devika Patel
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica Hawkins
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Lara Zena Chehab
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Patrick Martin-Tuite
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Joshua Feler
- Department of Neurosurgery, Brown University, Providence, RI, United States
| | - Amy Tan
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Benjamin S Alpers
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Sophia Pink
- School of Engineering, Stanford University, Stanford, CA, United States
| | - Jerome Wang
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Jonathan Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Phillip Kim
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher Peabody
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - John Bowditch
- J. Warren McClure School of Emerging Communication Technologies, Scripps College of Communication, Ohio University, Athens, OH, United States
| | - Eric R Williams
- J. Warren McClure School of Emerging Communication Technologies, Scripps College of Communication, Ohio University, Athens, OH, United States
| | - Amanda Sammann
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Abstract
This article explores high-fidelity simulation in anesthesiology education and provides strategies for its use to improve management of critical events. Educational theories that underlie the use of simulation are described. High-fidelity simulation is useful in teaching technical (diagnostic and procedural) and nontechnical (communication and professionalism) skills, including crisis resource management (CRM) skills. The practice of CRM is fundamental to ensuring patient safety during critical events and to the safe practice of anesthesiology, and its critical elements are presented. A discussion of the use of high-fidelity simulation to learn to combine highly complex procedural skills and CRM is also provided.
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Green W, Shahzad MW, Wood S, Martinez Martinez M, Baines A, Navid A, Jay R, Whysall Z, Sandars J, Patel R. Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice. Br J Clin Pharmacol 2020; 86:2234-2246. [PMID: 32343422 PMCID: PMC7576627 DOI: 10.1111/bcp.14325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. METHODS Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness. RESULTS There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention. CONCLUSION Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.
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Affiliation(s)
- William Green
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | | | - Stephen Wood
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Maria Martinez Martinez
- Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, UK
| | - Andrew Baines
- Pilgrim Hospital Boston, United Lincolnshire Hospitals (ULH) NHS Trust, Boston, Lincolnshire, UK
| | - Ahmad Navid
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Robert Jay
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Zara Whysall
- Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
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14
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Performance improvement to address anesthesia hazards. Int Anesthesiol Clin 2020; 58:38-44. [DOI: 10.1097/aia.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Benthem Y, van de Pol EMR, Draaisma JMT, Donders R, van Goor H, Tan ECTH. Professionalizing peer instructor skills in basic life support training for medical students: A randomized controlled trial. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918806644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Radboud university medical center designed an obligatory basic life support and first-aid course for first-year medical students. Objectives: We evaluated the value of an additional train-the-trainer course following European Resuscitation Council guidelines, which focuses on practical basic life support training and providing feedback, in comparison with standard in-service instructor training. Methods: This study was a prospective randomized controlled trial. A total of 10 intervention instructors, 14 control instructors, and 337 first-year medical students participated in the study. Students, blinded for the type of instructor, completed questionnaires evaluating the quality of the basic life support training (theoretical and practical) and provided feedback. The secondary endpoint was the basic life support examination to assess whether the instructors’ training influenced the quality of the participants’ basic life support. Results: The response rate of the questionnaire was 82% on average. No differences were found between intervention and control group concerning theoretical basic life support training. The intervention instructors scored significantly higher on practical basic life support training according to student evaluations ( p < 0.001). The pass rate on basic life support examinations did not differ significantly ( p = 0.669). Appreciation of given feedback was independent of instructors’ educational training. Conclusion: This study is the first to establish that the 12-h train-the-trainer course following European Resuscitation Council guidelines improves students’ appreciation of practical basic life support training. The additional course did not influence appreciation of theoretical basic life support training or perceived feedback.
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Affiliation(s)
- Yvet Benthem
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Eva MR van de Pol
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Jos MTh Draaisma
- Department of Paediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Edward CTH Tan
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
- Department of Emergency Medicine, Radboud university medical center, Nijmegen, The Netherlands
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16
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Deliberate practice using validated metrics improves skill acquisition in performance of ultrasound-guided peripheral nerve block in a simulated setting. J Clin Anesth 2018; 48:22-27. [DOI: 10.1016/j.jclinane.2018.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/13/2018] [Accepted: 04/27/2018] [Indexed: 01/22/2023]
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17
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Abstract
Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement.
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Affiliation(s)
- Amanda Burden
- Cooper Medical School of Rowan University, 401 South Broadway Camden, NJ 08103, USA.
| | - Erin White Pukenas
- Cooper Medical School of Rowan University, 401 South Broadway Camden, NJ 08103, USA
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Coggins A, Desai M, Nguyen K, Moore N. Early acquisition of non-technical skills using a blended approach to simulation-based medical education. Adv Simul (Lond) 2017; 2:12. [PMID: 29450013 PMCID: PMC5806380 DOI: 10.1186/s41077-017-0045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022] Open
Abstract
Background Non-technical skills are emerging as an important component of postgraduate medical education. Between 2013 and 2016, a new blended training program incorporating non-technical skills was introduced at an Australian university affiliated hospital. Program participants were medical officers in years 1 and 2 of postgraduate training. Methods An interdisciplinary faculty trained in simulation-based education led the program. The blended approach combined open access online resources with multiple opportunities to participate in simulation-based learning. The aim of the study was to examine the value of the program to the participants and the effects on the wider hospital system. The mixed methods evaluation included data from simulation centre records, hospital quality improvement data, and a post-hoc reflective survey of the enrolled participants (n = 68). Results Over 30 months, 283 junior doctors were invited to participate in the program. Enrolment in a designated simulation-based course was completed by 169 doctors (59.7%). Supplementary revision sessions were made available to the cohort with a median weekly attendance of five participants. 56/68 (82.4%) of survey respondents reported increased confidence in managing deteriorating patients. During the period of implementation, the overall rate of hospital cardiac arrests declined by 42.3%. Future objectives requested by participants included training in graded assertiveness and neurological emergencies. Conclusions Implementation of a non-technical skills program was achieved with limited simulation resources and was associated with observable improvements in clinical performance. The participants surveyed reported increased confidence in managing deteriorating patients, and the program introduction coincided with a significant reduction in the rate of in-hospital cardiac arrests.
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Affiliation(s)
- Andrew Coggins
- 1Emergency Department, Westmead Hospital, Hawkesbury Road, Sydney, NSW 2145 Australia.,Simulated Environment for Clinical Training (SiLECT), Sydney, Australia.,3The University of Sydney, Western Clinical School, Sydney, Australia
| | - Mihir Desai
- Simulated Environment for Clinical Training (SiLECT), Sydney, Australia
| | - Khanh Nguyen
- 1Emergency Department, Westmead Hospital, Hawkesbury Road, Sydney, NSW 2145 Australia.,Simulated Environment for Clinical Training (SiLECT), Sydney, Australia
| | - Nathan Moore
- Simulated Environment for Clinical Training (SiLECT), Sydney, Australia.,3The University of Sydney, Western Clinical School, Sydney, Australia
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Abstract
Rapid Cycle Deliberate Practice (RCDP) is a novel simulation-based education model that is currently attracting interest, implementation, exploration and research in medical education. In RCDP, learners rapidly cycle between deliberate practice and directed feedback within the simulation scenario until mastery is achieved. The objective of this systematic review is to examine the literature and summarize the existing knowledge on RCDP in simulation-based medical education. Fifteen resources met inclusion criteria; they were diverse and heterogeneous, such that we did not perform a quantitative synthesis or meta-analysis but rather a narrative review on RCDP. All resources described RCDP in a similar manner. Common RCDP implementation strategies included: splitting simulation cases into segments, micro debriefing in the form of 'pause, debrief, rewind and try again' and providing progressively more challenging scenarios. Variable outcome measures were used by the studies including qualitative assessments, scoring tools, procedural assessment using checklists or video review, time to active skills and clinical reports. Results were limited and inconsistent. There is an absence of data on retention after RCDP teaching, on RCDP, with learners from specialties other than pediatrics, on RCDP for adult resuscitation scenarios and if RCDP teaching translates into practice change in the clinical realm. We have identified important avenues for future research on RCDP.
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Affiliation(s)
- Jillian Taras
- Anesthesiology Resident, University of Toronto, Canada
| | - Tobias Everett
- Department of Anesthesia, The Hospital for Sick Children, University of Toronto
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20
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Banerjee A, Slagle JM, Mercaldo ND, Booker R, Miller A, France DJ, Rawn L, Weinger MB. A simulation-based curriculum to introduce key teamwork principles to entering medical students. BMC MEDICAL EDUCATION 2016; 16:295. [PMID: 27852293 PMCID: PMC5112730 DOI: 10.1186/s12909-016-0808-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/27/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Failures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams. METHODS As part of a new "Foundations" core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students' anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students' course evaluations, faculty reflection, and debriefing, the course changed and matured. RESULTS Four hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their "Decision Making Abilities" (OR 1.69, 95% CI 1.07-2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28-3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises. CONCLUSIONS This curriculum could be valuable to other medical schools seeking to inculcate teamwork foundations in their medical school's preclinical curricula. Moreover, this curriculum can be used to facilitate teamwork principles important to inter-disciplinary, as well as uni-disciplinary, collaboration.
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Affiliation(s)
- Arna Banerjee
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue S, 526 MAB, Nashville, TN 37212 USA
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jason M. Slagle
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Nathaniel D. Mercaldo
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Ray Booker
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
| | - Anne Miller
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN USA
- Present Address: Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Daniel J. France
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Lisa Rawn
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
- Present Address: Baptist Health Neurosurgery Arkansas, Little Rock, AR USA
| | - Matthew B. Weinger
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
- Health Services Research Division and the Geriatrics Research Education and Clinical Center, Veterans Affairs (VA) Tennessee Valley Healthcare System – Nashville Campus, Nashville, TN USA
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Kim S, Willett LR, Noveck H, Patel MS, Walker JA, Terregino CA. Implementation of a Mini-CEX Requirement Across All Third-Year Clerkships. TEACHING AND LEARNING IN MEDICINE 2016; 28:424-431. [PMID: 27141826 DOI: 10.1080/10401334.2016.1165682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PROBLEM Direct observation of medical students performing clinical tasks, such as eliciting a patient history or examining a patient, and the provision of feedback, are foundational to student improvement but have been reported to occur infrequently. The mini clinical evaluation exercise (mini-CEX) is a tool that can facilitate direct observation and feedback. This study assessed the impact of a mini-CEX requirement across all 3rd-year clerkships on student report of direct observation by faculty and objectively measured clinical skills. INTERVENTION A mini-CEX requirement across all 3rd-year clerkships was implemented in the 2012-2013 academic year. The impact of the mini-CEX requirement on student report of direct observation was assessed by end-of-clerkship surveys and Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) items on direct observation. The impact on students' clinical skills was assessed by a summative Objective Structured Clinical Examination (OSCE). Pre/post comparisons were assessed with chi-square and Fisher's exact tests. CONTEXT A mini-CEX requirement had been in place for the internal medicine clerkship, and student reports of direct observation were historically higher for the internal medicine clerkship than for other clerkships. Faculty, residents, and students at each of the clinical sites across all 6 clerkships were oriented to the use of the mini-CEX; the feasibility of its use during usual patient interaction settings and the importance of direct observation and feedback for student improvement were emphasized during these sessions. OUTCOME Adherence to the mini-CEX requirement was high: 92% of required forms were completed, and 78% of completed forms indicated that specific feedback was given. The proportion of students reporting direct observation of physical examination significantly increased in all clerkships, with the largest relative increase occurring in surgery (from 49% to 87%), χ2(1, N = 225) = 37.70, p < .0001. Significant increases were seen in faculty observation of history taking in pediatrics, surgery, and psychiatry. Direct observation rates also increased on the AAMC GQ items for history taking and physical exam for all clerkships. Failures on the summative OSCE decreased from 12% preintervention to 2% postintervention (p = .0046). LESSONS LEARNED Institution of a mini-CEX requirement was feasible across all 3rd-year clerkships and was associated with a significant increase in student report of direct observation by faculty and a decrease in summative OSCE failure rates.
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Affiliation(s)
- Sarang Kim
- a Department of Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Laura R Willett
- a Department of Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Helaine Noveck
- a Department of Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Manish S Patel
- a Department of Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - John A Walker
- a Department of Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Carol A Terregino
- b Department of Medicine and Office of Education , Rutgers Robert Wood Johnson Medical School , Piscataway , New Jersey , USA
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Meischke H, Painter I, Turner AM, Weaver MR, Fahrenbruch CE, Ike BR, Stangenes S. Protocol: simulation training to improve 9-1-1 dispatcher identification of cardiac arrest. BMC Emerg Med 2016; 16:9. [PMID: 26830676 PMCID: PMC4736553 DOI: 10.1186/s12873-016-0073-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/25/2016] [Indexed: 11/29/2022] Open
Abstract
Background 9-1-1 dispatchers are often the first contact for bystanders witnessing an out-of-hospital cardiac arrest. In the time before Emergency Medical Services arrives, dispatcher identification of the need for, and provision of Telephone-CPR (T-CPR) can improve survival. Our study aims to evaluate the use of phone-based standardized patient simulation training to improve identification of the need for T-CPR and shorten time to start of T-CPR instructions. Methods/Design The STAT-911 study is a randomized controlled trial. We will recruit 160 dispatchers from 9-1-1 call-centers in the Pacific Northwest; they are randomized to an intervention or control group. Intervention participants complete four telephone simulation training sessions over 6–8 months. Training sessions consist of three mock 9-1-1 calls, with a standardized patient playing a caller witnessing a medical emergency. After the mock calls, an instructor who has been listening in and scoring the dispatcher’s call management, connects to the dispatcher and provides feedback on select call processing skills. After the last training session, all participants complete the simulation test: a call session that includes two mock 9-1-1 calls of medium complexity. During the study, audio from all actual cardiac arrest calls handled by the dispatchers will be collected. All dispatchers complete a baseline survey, and after the intervention, a follow-up survey to measure confidence. Primary outcomes are proportion of calls where dispatchers identify the need for T-CPR, and time to start of T-CPR, assessed by comparing performance on two calls in the simulation test. Secondary outcomes are proportion of actual cardiac arrest calls in which dispatchers identify the need for T-CPR and time to start of T-CPR; performance on call-taking skills during the simulation test; self-reported confidence in the baseline and follow-up surveys; and calculated costs of the intervention training sessions and projected costs for field implementation of training sessions. Discussion The STAT-911 study will evaluate if over-the-phone simulation training with standardized patients can improve 9-1-1 dispatchers’ ability identify the need for, and promptly begin T-CPR. Furthermore, it will advance knowledge on the effectiveness of simulation training for health services phone-operators interacting with clients, patients, or bystanders in diagnosis, triage, and treatment decisions. Trial registration ClinicalTrials.gov Registration Number: NCT01972087. Registered 23 October 2013.
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Affiliation(s)
- Hendrika Meischke
- University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA.
| | - Ian Painter
- University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA.
| | - Anne M Turner
- University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA.
| | - Marcia R Weaver
- University of Washington, Institute for Health Metrics and Evaluation, 2301 Fifth Ave, Room 436, Seattle, WA, 98121, USA.
| | - Carol E Fahrenbruch
- Public Health- Seattle and King County, Division of Emergency Medical Services, 401 5th Ave Suite 1200, Seattle, WA, 98104, USA.
| | - Brooke R Ike
- Department of Family Medicine, University of Washington, 4225 Roosevelt Way NE, Suite 308, Seattle, WA, 98105, USA.
| | - Scott Stangenes
- University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA.
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An evaluation of the use of deliberate practice and simulation to train interns in requesting blood products. Simul Healthc 2016; 10:92-7. [PMID: 25710316 DOI: 10.1097/sih.0000000000000070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Technical or practical skills deficits upon graduation from medical school are prevalent and contribute to increasing medical error. The current study sought to evaluate the efficacy of a simulation- and deliberate practice-based learning program for requesting blood products, delivered to newly graduated interns. METHODS The requesting of blood products by a group of 27 "trained" interns was prospectively compared with that of a group of 30 "untrained" interns throughout the first 13 weeks of internship at an Irish teaching hospital. RESULTS Our analysis showed that the training intervention reduced the risk of a rejected sample by 65% as compared with interns who did not receive the training. Moreover, the risk of a rejected sample for trained interns was 45% lower than for much more experienced doctors. The untrained interns required more than 2 months of clinical experience to reach an error rate that was not significantly different from that of the trained interns. CONCLUSIONS These findings indicate that skills acquired through deliberate practice generalized to the clinical setting led to a significant reduction in blood product prescribing errors.
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Groener JB, Bugaj TJ, Scarpone R, Koechel A, Stiepak J, Branchereau S, Krautter M, Herzog W, Nikendei C. Video-based on-ward supervision for final year medical students. BMC MEDICAL EDUCATION 2015; 15:163. [PMID: 26419731 PMCID: PMC4588264 DOI: 10.1186/s12909-015-0430-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 09/02/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Constructive feedback is an essential element of the educational process, helping trainees reach their maximum potential and increasing their skill level. Video-based feedback has been described as highly effective in various educational contexts. The present study aimed to evaluate the feasibility and acceptability of video-based, on-ward supervision for final year students in a clinical context with real patients. METHODS Nine final year medical students (three male, six female; aged 25.1 ± 0.7 years) and eight patients (five male, three female; aged 59.3 ± 16.8 years) participated in the pilot study. Final year students performed routine medical procedures at bedside on internal medicine wards at the University of Heidelberg Medical Hospital. Students were filmed and were under supervision. After performing the procedures, an oral feedback loop was established including student, patient and supervisor feedback on communicative and procedural aspects of skills performed. Finally, students watched their video, focusing on specific teachable moments mentioned by the supervisor. Written evaluations and semi-structured interviews were conducted that focused on the benefits of video-based, on-ward supervision. Interviews were analysed qualitatively, using open coding to establish recurring themes and overarching categories to describe patients' and students' impressions. Descriptive, quantitative analysis was used for questionnaire data. RESULTS Supervised, self-chosen skills included history taking (n = 6), physical examination (n = 1), IV cannulation (n = 1), and ECG recording (n = 1). The video-based, on-ward supervision was well accepted by patients and students. Supervisor feedback was rated as highly beneficial, with the video material providing an additional opportunity to focus on crucial aspects and to further validate the supervisor's feedback. Students felt the video material would be less beneficial without the supervisor's feedback. The setting was rated as realistic, with filming not influencing behaviour. CONCLUSION Video-based, on-ward supervision may be a powerful tool for improving clinical medical education. However, it should be regarded as an additional tool in combination with supervisors' oral feedback. Acceptance was high in both students and patients. Further research should address possibilities of efficiently combining and routinely establishing these forms of feedback in medical education.
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Affiliation(s)
- J B Groener
- Department of Endocrinology and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany.
| | - T J Bugaj
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
| | - R Scarpone
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany
| | - A Koechel
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
| | - J Stiepak
- Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Heidelberg, Germany.
| | - S Branchereau
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
| | - M Krautter
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
| | - W Herzog
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
| | - C Nikendei
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
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Chalouhi GE, Bernardi V, Ville Y. Ultrasound simulators in obstetrics and gynecology: state of the art. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:255-63. [PMID: 25346451 DOI: 10.1002/uog.14707] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 05/09/2023]
Affiliation(s)
- G E Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Bernardi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Women and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Y Ville
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Joseph N, Nelliyanil M, Jindal S, Utkarsha, Abraham AE, Alok Y, Srivastava N, Lankeshwar S. Perception of Simulation-based Learning among Medical Students in South India. Ann Med Health Sci Res 2015; 5:247-52. [PMID: 26229712 PMCID: PMC4512116 DOI: 10.4103/2141-9248.160186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Traditional methods of educating medical students are no longer sufficient in the current era largely influenced by multimedia. Simulation-based techniques may play a pivotal role in bridging this educational gap. Aim: This study was conducted to explore the perception of medical students towards simulation based learning (SBL). Subjects and Methods: This cross-sectional study was conducted in May 2013 in a private medical college in Mangalore, Karnataka, India. A total of 247 participants from fourth, sixth, eighth semester and internship were chosen by convenience sampling method. Attitudinal data on perception towards SBL were collected using a self-administered questionnaire with responses in a 5-point Likert's scale. Results: The mean age of students was 21.3 (standard deviation 1.9) years, and males constituted 55.5% (137/247). Most participants 72.5% (179/247) had favorable perceptions of SBL, with scores of92–118 out of a possible 118 points. Favorable perception towards SBL was seen significantly more among female students (P = 0.04) and senior MBBS students of sixth and eighth semesters (P = 0.05). Nearly, all students (90.7%; 224/247) agreed that simulation supports the development of clinical skills. As many as 29.6% (73/247) agreed that real patients might be replaced with simulated patients in practical examinations. Conclusion: SBL was perceived as favorable by a large number of participants in this study indicating a bright prospect for its implementation in the medical curriculum.
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Affiliation(s)
- N Joseph
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - M Nelliyanil
- Department of Community Medicine, A J Institute of Medical Sciences and Research Centre, Mangalore, India
| | - S Jindal
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - Utkarsha
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - A E Abraham
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - Y Alok
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - N Srivastava
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - S Lankeshwar
- Department of Community Medicine, AIMS, Bellur, Karnataka, India
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Sawyer T, White M, Zaveri P, Chang T, Ades A, French H, Anderson J, Auerbach M, Johnston L, Kessler D. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1025-33. [PMID: 25881645 DOI: 10.1097/acm.0000000000000734] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.
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Affiliation(s)
- Taylor Sawyer
- T. Sawyer is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington. M. White is assistant professor, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. P. Zaveri is assistant professor, Division of Emergency Medicine, Children's National Health System, Washington, DC. T. Chang is assistant professor, Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Los Angeles, California. A. Ades is associate professor, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. H. French is assistant professor, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. J. Anderson is associate professor, Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon. M. Auerbach is assistant professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut. L. Johnston is assistant professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut. D. Kessler is assistant professor, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
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Multak N, Newell K, Spear S, Scalese RJ, Issenberg SB. A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students. J Physician Assist Educ 2015; 26:70-76. [PMID: 25933013 DOI: 10.1097/jpa.0000000000000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. METHODS This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. RESULTS Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. CONCLUSIONS This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.
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Affiliation(s)
- Nina Multak
- Nina Multak, MPAS, PA-C, is an associate clinical professor at the Drexel University Physician Assistant Program, Philadelphia, Pennsylvania. Karen Newell, MMSc, PA-C, is an assistant professor at the Emory University Physician Assistant Program, Atlanta, Georgia. Sherrie Spear, MHS, PA-C, is an assistant professor at the Duke University Physician Assistant Program, Durham, North Carolina. Ross J. Scalese, MD, is an associate professor of Medicine and director of Educational Technology Development at the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida. S. Barry Issenberg, MD, is the associate dean for Research in Medical Education, professor of Medicine, and director of the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida
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Pukenas EW, Dodson G, Deal ER, Gratz I, Allen E, Burden AR. Simulation-based education with deliberate practice may improve intraoperative handoff skills: a pilot study. J Clin Anesth 2014; 26:530-8. [DOI: 10.1016/j.jclinane.2014.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/22/2023]
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Kelly M, Bennett D, Bruce-Brand R, O'Flynn S, Fleming P. One week with the experts: a short course improves musculoskeletal undergraduate medical education. J Bone Joint Surg Am 2014; 96:e39. [PMID: 24599211 DOI: 10.2106/jbjs.m.00325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Musculoskeletal problems constitute a considerable workload across all medical and surgical disciplines. There is a mismatch between the burden of musculoskeletal medicine seen by non-orthopaedists clinically and the amount of time afforded it in undergraduate training. Recent initiatives to address this include the United States Bone and Joint Decade and curricular innovations that demonstrate a benefit from improved instruction. Such curricular interventions are usually situated within a wider program reform and last a short time. Gaining institutional support and securing curricular time are challenging. This article shows the positive evaluation of a brief, intense course on musculoskeletal medicine. METHODS A one-week course was offered to 154 medical students. The study took place in Ireland, where the student body comprises a mix of graduate students and undergraduate students, who enter medical school directly from second-level education. This course comprised brief didactic talks, case-based small group work, and physical examination skills demonstration. Attitudes toward musculoskeletal medicine prior to the course were elicited. The course was evaluated using pre-course and post-course standardized cognitive tests. Long-term retention was evaluated by end-of-year extended matching questions and an objective standardized clinical examination station. The test results between undergraduate and graduate students and student rating of musculoskeletal medicine as important or less important were compared. RESULTS Complete data were available for 125 students (81%). Seventy-four percent of students rated musculoskeletal medicine to be of major or critical importance to their career. There was a significant difference (p < 0.001, r = 0.678) in the mean score of the standardized cognitive test between the pre-course test and the post-course test; the mean performance score (and standard deviation) was 48.2% ± 14.2% (range, 17% to 79%), with a pass rate of 3.3%, for the pre-course test and 75.3% ± 15.02% (range, 32% to 100%), with a pass rate of 61%, for the post-course test. At the end of the year, 69.9% of students passed the extended matching questions and 96.7% passed an objective standardized clinical examination station. Graduate students performed better on the post-course standardized cognitive test score (p < 0.001) and objective standardized clinical examination (p < 0.05). Students who rated musculoskeletal medicine as important did not perform better than those who rated it as less important (p = 0.334). CONCLUSIONS We report a favorable evaluation of a short, intense course on musculoskeletal medicine and suggest that the introduction of basic concepts of musculoskeletal medicine is feasible within established curricula.
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Affiliation(s)
- Martina Kelly
- Department of Family Medicine, University of Calgary, 3330 Hospital Drive, Calgary, T2N 2N1, Alberta, Canada. E-mail address:
| | - Deirdre Bennett
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. E-mail address for D. Bennett: . E-mail address for S. O'Flynn:
| | - Robert Bruce-Brand
- Department of Trauma and Orthopedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. E-mail address for R. Bruce-Brand: . E-mail address for P. Fleming:
| | - Siun O'Flynn
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. E-mail address for D. Bennett: . E-mail address for S. O'Flynn:
| | - Pat Fleming
- Department of Trauma and Orthopedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. E-mail address for R. Bruce-Brand: . E-mail address for P. Fleming:
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Cioffi JM. Perceptual learning and the development of expertise: a discussion paper. NURSE EDUCATION TODAY 2013; 33:83-86. [PMID: 22939770 DOI: 10.1016/j.nedt.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/09/2012] [Accepted: 08/04/2012] [Indexed: 06/01/2023]
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McKinney J, Cook DA, Wood D, Hatala R. Simulation-based training for cardiac auscultation skills: systematic review and meta-analysis. J Gen Intern Med 2013; 28:283-91. [PMID: 22968795 PMCID: PMC3614132 DOI: 10.1007/s11606-012-2198-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/19/2012] [Accepted: 07/18/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The current review examines the effectiveness of simulation-based medical education (SBME) for training health professionals in cardiac physical examination and examines the relative effectiveness of key instructional design features. METHODS Data sources included a comprehensive, systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, ERIC, Web of Science, and Scopus through May 2011. Included studies investigated SBME to teach health profession learners cardiac physical examination skills using outcomes of knowledge or skill. We carried out duplicate assessment of study quality and data abstraction and pooled effect sizes using random effects. RESULTS We identified 18 articles for inclusion. Thirteen compared SBME to no-intervention (either single group pre-post comparisons or SBME added to other instruction common to all learners, such as traditional bedside teaching), three compared SBME to other educational interventions, and two compared two SBME interventions. Meta-analysis of the 13 no-intervention comparison studies demonstrated that simulation-based instruction in cardiac auscultation was effective, with pooled effect sizes of 1.10 (95 % CI 0.49-1.72; p < 0.001; I(2) = 92.4 %) for knowledge outcomes and 0.87 (95 % CI 0.52-1.22; p < 0.001; I(2) = 91.5 %) for skills. In sub-group analysis, hands-on practice with the simulator appeared to be an important teaching technique. Narrative review of the comparative effectiveness studies suggests that SBME may be of similar effectiveness to other active educational interventions, but more studies are required. LIMITATIONS The quantity of published evidence and the relative lack of comparative effectiveness studies limit this review. CONCLUSIONS SBME is an effective educational strategy for teaching cardiac auscultation. Future studies should focus on comparing key instructional design features and establishing SBME's relative effectiveness compared to other educational interventions.
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Affiliation(s)
- James McKinney
- />Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - David A. Cook
- />Office of Education Research, Mayo Medical School, Rochester, MN USA
- />Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
| | - David Wood
- />Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Rose Hatala
- />Department of Medicine, University of British Columbia, Vancouver, BC Canada
- />St. Paul’s Hospital, Suite 5907 Burrard Bldg, 1081 Burrard St., Vancouver, BC Canada V6Z 1Y6
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Teteris E, Fraser K, Wright B, McLaughlin K. Does training learners on simulators benefit real patients? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:137-44. [PMID: 21630128 DOI: 10.1007/s10459-011-9304-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/06/2011] [Indexed: 05/19/2023]
Abstract
Despite limited data on patient outcomes, simulation training has already been adopted and embraced by a large number of medical schools. Yet widespread acceptance of simulation should not relieve us of the duty to demonstrate if, and under which circumstances, training learners on simulation benefits real patients. Here we review the data on performance of healthcare providers or trainees following simulation training, and discuss ways of enhancing transfer of learning from simulated to real patients. While there is tremendous potential for simulation in medical education and healthcare, further studies are needed to identify if and when simulation training improves the quality of care delivered to patients, and to compare the cost-effectiveness of simulated learning experiences to lower fidelity and less expensive interventions.
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Affiliation(s)
- Elise Teteris
- Office of Undergraduate Medical Education, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Comparing three pedagogical approaches to psychomotor skills acquisition. Am J Surg 2012; 203:8-13. [DOI: 10.1016/j.amjsurg.2011.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 11/19/2022]
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Jeffries PR, Beach M, Decker SI, Dlugasch L, Groom J, Settles J, O'Donnell JM. Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses. Nurs Educ Perspect 2011; 32:316-22. [PMID: 22029244 DOI: 10.5480/1536-5026-32.5.316] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one-group pre-to-post-intervention design. Educational interventions included faculty-led, simulation-based case presentations using the Harvey cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer-based CD-ROM program. Outcome measures included a 31-item cognitive written exam, a 13-item skills checklist used in each of a three-station objective structured clinical exam, learner self-efficacy and satisfaction survey, instructor satisfaction and self-efficacy survey, and a participant logbook to record practice time using the self-learning materials. Thirty-six students who received the simulation-based training showed statistically significant pre-to-post-test improvement in cognitive knowledge and cardiovascular assessment skills.
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Affiliation(s)
- Pamela R Jeffries
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
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Duvivier RJ, van Dalen J, Muijtjens AM, Moulaert VRMP, van der Vleuten CPM, Scherpbier AJJA. The role of deliberate practice in the acquisition of clinical skills. BMC MEDICAL EDUCATION 2011; 11:101. [PMID: 22141427 PMCID: PMC3293754 DOI: 10.1186/1472-6920-11-101] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 12/06/2011] [Indexed: 05/12/2023]
Abstract
BACKGROUND The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training. METHODS Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results. RESULTS 875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1. CONCLUSIONS The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.
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Affiliation(s)
- Robbert J Duvivier
- Skillslab, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jan van Dalen
- Skillslab, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Arno M Muijtjens
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Véronique RMP Moulaert
- Rehabilitation Foundation Limburg, Adelante Rehabiliation Centre, Hoensbroek, the Netherlands
| | - Cees PM van der Vleuten
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Albert JJA Scherpbier
- Institute for Medical Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Abstract
One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation of a real world process to achieve educational goals through experiential learning. Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. Although medical simulation is relatively new, simulation has been used for a long time in other high risk professions such as aviation. Medical simulation allows the acquisition of clinical skills through deliberate practice rather than an apprentice style of learning. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. There are different types and classification of simulators and their cost vary according to the degree of their resemblance to the reality, or 'fidelity'. Simulation- based learning is expensive. However, it is cost-effective if utilized properly. Medical simulation has been found to enhance clinical competence at the undergraduate and postgraduate levels. It has also been found to have many advantages that can improve patient safety and reduce health care costs through the improvement of the medical provider's competencies. The objective of this narrative review article is to highlight the importance of simulation as a new teaching method in undergraduate and postgraduate education.
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Affiliation(s)
- Abdulmohsen H Al-Elq
- Department of Internal Medicine, College of Medicine, University of Dammam, Kingdom of Saudi Arabia
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Instruction Using a High-Fidelity Cardiopulmonary Simulator Improves Examination Skills and Resource Allocation in Family Medicine Trainees. Simul Healthc 2011; 6:278-83. [DOI: 10.1097/sih.0b013e3182207d1c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meguerdichian DA, Heiner JD, Younggren BN. Emergency medicine simulation: a resident's perspective. Ann Emerg Med 2011; 60:121-6. [PMID: 21944898 DOI: 10.1016/j.annemergmed.2011.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
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Reising DL, Carr DE, Shea RA, King JM. Comparison of communication outcomes in traditional versus simulation strategies in nursing and medical students. Nurs Educ Perspect 2011; 32:323-327. [PMID: 22029245 DOI: 10.5480/1536-5026-32.5.323] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Institute of Medicine has called for more interprofessional collaboration between physicians and nurses. The purpose of this research was to compare the outcomes in affective and communication domains using a traditional (roundtable) model versus simulation in nursing and medical students. A prospective, descriptive survey design was used to collect data on 41 senior bachelor of science in nursing students, and 19 second-year medical students. The simulation strategy resulted in statistically higher levels of stress as identified by participants. In addition, nearly all participants reported having a better sense of the clinical role, and with 55 percent of participants stating that the experience changed their view of the role of the clinical team. This initial study indicates that interprofessional communication may be enhanced using simulation.
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McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:706-11. [PMID: 21512370 PMCID: PMC3102783 DOI: 10.1097/acm.0b013e318217e119] [Citation(s) in RCA: 947] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). METHOD This is a quantitative meta-analysis that spans 20 years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes. RESULTS Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared with traditional clinical medical education was 0.71 (95% confidence interval, 0.65-0.76; P < .001). CONCLUSIONS Although the number of reports analyzed in this meta-analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.
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Affiliation(s)
- William C McGaghie
- Northwestern University Clinical and Translational Sciences Institute, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
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Anderson JM, Warren JB. Using simulation to enhance the acquisition and retention of clinical skills in neonatology. Semin Perinatol 2011; 35:59-67. [PMID: 21440812 DOI: 10.1053/j.semperi.2011.01.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Neonatal care occurs in extremely complex and dynamic environments and requires providers to operate under intense time pressure in coordination with multiple disciplines. Teaching the clinical skills requisite to effective practice requires the meticulous application of curricular design principles. Simulation can be used as an effective instructional strategy in achieving learner acquisition and retention of the cognitive, technical, and behavioral skills essential to optimal delivery of care in neonatology.
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Affiliation(s)
- JoDee M Anderson
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
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Goodman WM, Lamers A. Said another way: asking the right questions regarding the effectiveness of simulations. Nurs Forum 2011; 45:246-52. [PMID: 21077893 DOI: 10.1111/j.1744-6198.2010.00199.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Applying simulations in healthcare practice and education is increasingly accepted, yet a number of recent authors have questioned the effectiveness of these technologies. The contention is that while high-fidelity simulators may contribute to educational gains, their gains compared to low-tech alternatives are often "not significant." That assessment, however, and the evidence it is based on, may be a consequence of asking the wrong questions. Typical studies often compare a measure for "average success" for one group's members versus another's on some criteria, but this can mask important information about the "tails" of the distribution for how trainees are performing. An alternative approach, adapted from quality control, compares error rates for each group in the experiment, in aggregate. The statistical results of evaluations can change if this method is used, as illustrated by a recent study showing that simulation training can significantly reduce the frequency of medication administration errors among student nurses on placement. The paper includes a case study to tangibly demonstrate how the way we frame our evaluation test question can reverse the apparent statistical finding of the significance test.
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Fraser K, Wright B, Girard L, Tworek J, Paget M, Welikovich L, McLaughlin K. Simulation Training Improves Diagnostic Performance on a Real Patient With Similar Clinical Findings. Chest 2011; 139:376-381. [DOI: 10.1378/chest.10-1107] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Verma A, Bhatt H, Booton P, Kneebone R. The Ventriloscope® as an innovative tool for assessing clinical examination skills: appraisal of a novel method of simulating auscultatory findings. MEDICAL TEACHER 2011; 33:e388-e396. [PMID: 21696273 DOI: 10.3109/0142159x.2011.579200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Simulation is increasingly used as a teaching tool and in assessment. The Ventriloscope® (VS) is a new auscultation simulator. This modified stethoscope allows pre-recorded sounds (activated wirelessly) to be integrated with a simulated patient (SP, professional actor). AIMS This study explores the instrument's potential for overcoming limitations of current objective structured clinical examination (OSCE) assessment by increasing validity while retaining reliability. METHODS After training SPs to synchronise the device with their breathing (recreating abnormal signs), we evaluated the VS during a third year undergraduate medical student OSCE. Students (n = 385), examiners (n = 19) and SPs (n = 10) completed post-exam questionnaires which were analysed using a coding framework. OSCE performance data were analysed using Stata 10. RESULTS When 'compared to their usual stethoscope' 40% of students found no difference in using the VS; 69% found it easier to identify sounds; 68% found examination with the VS very or fairly realistic when 'compared to examining a real patient'. Examination scores were comparable with other OSCE stations. CONCLUSIONS The VS reliably provided consistent 'abnormal' auscultatory signs within an OSCE framework. Using a VS may increase OSCE validity, allowing examiners to assess students' application of knowledge in a realistically simulated setting. The VS can help bridge the gap between simulation and real patients.
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Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulation-based mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med 2010; 25:780-5. [PMID: 20339952 PMCID: PMC2896602 DOI: 10.1007/s11606-010-1309-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac auscultation is a core clinical skill. However, prior studies show that trainee skills are often deficient and that clinical experience is not a proxy for competence. OBJECTIVE To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills. DESIGN Untreated control group design with pretest and posttest. PARTICIPANTS Third-year students who received a cardiac auscultation curriculum and fourth year students who did not. INTERVENTION A cardiac auscultation curriculum consisting of a computer tutorial and a cardiac patient simulator. All third-year students were required to meet or exceed a minimum passing score (MPS) set by an expert panel at posttest. MEASUREMENTS Diagnostic accuracy with simulated heart sounds and actual patients. RESULTS Trained third-year students (n = 77) demonstrated significantly higher cardiac auscultation accuracy compared to untrained fourth year students (n = 31) in assessment of simulated heart sounds (93.8% vs. 73.9%, p < 0.001) and with real patients (81.8% vs. 75.1%, p = 0.003). USMLE scores correlated modestly with a computer-based multiple choice assessment using simulated heart sounds but not with bedside skills on real patients. CONCLUSIONS A cardiac auscultation curriculum consisting of deliberate practice with a computer-based tutorial and a cardiac patient simulator resulted in improved assessment of simulated heart sounds and more accurate examination of actual patients.
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Affiliation(s)
- John Butter
- Augusta Webster, MD Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Ten Eyck RP, Tews M, Ballester JM, Hamilton GC. Improved Fourth-Year Medical Student Clinical Decision-Making Performance as a Resuscitation Team Leader After a Simulation-Based Curriculum. Simul Healthc 2010; 5:139-45. [DOI: 10.1097/sih.0b013e3181cca544] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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