An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents

Virtual simulations for neonatal education

Virtual simulation (VS) education involves the use of virtual reality, augmented reality, mixed reality and screen-based platforms, collectively referred to as extended reality, to provide education and assessment. This novel simulation modality supports experiential learning and increases access to practice opportunities, supplementing manikin-based simulation. VS has been used successfully for neonatal resuscitation training in high and low resource settings. Virtual simulators can be used to objectively assess learner performance in neonatal resuscitation knowledge and skills. When implementing VS for neonatal resuscitation training, key considerations include matching learning objectives with suitable technology, pre-session preparation, supporting learners, and debriefing. Additional research is needed to evaluate the impact of VS applications on clinical practice and patient outcomes.

PICU Passport: Pilot study of a handheld resident curriculum

BACKGROUND

To explore the impact of an educational tool designed to streamline resident learning during their pediatric intensive care (PICU) rotations.

METHODS

Topics and procedures were chosen for inclusion based on national requirements for pediatric residents. Residents received a PICU Passport at the beginning of their rotations. PICU faculty were provided learning objectives for each topic. Residents and faculty were surveyed before and after starting use of the Passport.

RESULTS

Twenty-two residents pre-Passport and 38 residents post-Passport were compared. Residents were more satisfied with their educational experiences (27 % vs. 79 %; P < 0.001), more likely to report faculty targeted teaching towards knowledge gaps (5 % vs. 63 %; P < 0.001) and felt more empowered to ask faculty to discuss specific topics (27 % vs. 76 %; P = 0.002). The median number of teaching sessions increased from 3 to 10 (Z = 4.2; P < 0.001). Most residents (73 %) felt the Passport helped them keep track of their learning and identify gaps in their knowledge.

CONCLUSIONS

The PICU Passport helps residents keep track of their learning and identify gaps in their knowledge. Passport use increases resident satisfaction with education during their PICU rotation and empowers residents to ask PICU faculty to address specific knowledge gaps.

End-of-Life Care: A Multimodal and Comprehensive Curriculum for Graduating Medical Students Utilizing Experiential Learning Opportunities

INTRODUCTION

End-of-life (EOL) care is an essential skill for most physicians and health care providers, yet there continues to be an educational gap in medical education literature for these skills. The Johns Hopkins School of Medicine developed the Transition to Residency, Internship, and Preparation for Life Events (TRIPLE) curriculum with the primary goal of preparing graduating medical students for life after medical school.

METHODS

The EOL module was one of many within the TRIPLE curriculum and consisted of two half-day sessions that targeted EOL care, death, dying, and communication skills. The first half-day session focused on a standardized patient encounter where learners initiated and completed an EOL care goals conversation around a living will. The second half-day session focused on death and dying. It included didactic sessions on organ donation, autopsy/death certificates, a simulation-based learning session on ending a resuscitation, and a standardized patient encounter where learners disclosed the death of a loved one. End-of-day and end-of-course evaluations were collected via anonymous online surveys.

RESULTS

In 2019, 120 students and 26 instructors participated in TRIPLE. Students rated the EOL module overall as 4.6 of 5 (SD = 0.6) and rated instructors overall as 4.6 of 5 (SD = 0.6).

DISCUSSION

By implementing a thorough and diverse curriculum with a variety of modalities and targeted skills, learners may be better prepared to care for patients dealing with EOL care issues. Further, the generalization of these skills may assist learners in a variety of other aspects of patient and family care.

Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study

Background

The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students.

Objective

The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement.

Methods

We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary.

Results

Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided.

Conclusions

Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies.

The development and implementation of a 12-month simulation-based learning curriculum for pediatric emergency medicine fellows utilizing debriefing with good judgment and rapid cycle deliberate practice

BACKGROUND

There are currently training gaps, primarily procedural and teamwork skills, for pediatric emergency medicine (PEM) fellows. Simulation-based learning (SBL) has been suggested as an educational modality to help fill those gaps. However, there is little evidence suggesting how to do so. The objective of this project is to develop and implement an SBL curriculum for PEM fellows with established curriculum development processes and instructional design strategies to improve PEM fellowship training.

METHODS

We developed a 12-month longitudinal SBL curriculum focused on needs assessment, instructional strategies, and evaluation. The curriculum development process led us to combine the instructional strategies of debriefing with good judgment, rapid cycle deliberate practice, and task-training to improve core PEM skills such as procedural competence, crisis resource management, and managing complex medical and traumatic emergencies. Using multiple approaches, we measured outcomes related to learners (attendance, performance, critical procedure opportunities), instructor performance, and program structure.

RESULTS

Eight/Eight (100%) PEM fellows participated in this curriculum from July 2015 to June 2017 with an overall attendance rate of 68%. Learners self-reported high satisfaction (4.4/5, SD = 0.5) and perceived educational value (4.9/5, SD = 0.38) with the curriculum and overall program structure. Learners had numerous opportunities to practice critical procedures such as airway management (20 opportunities), defibrillator use (ten opportunities), and others (ten opportunities). Learner Debriefing Assessment for Simulation in Healthcare (short version) scores had mean scores greater than 5.8/7 (SD = 0.89) across all six elements.

CONCLUSIONS

This longitudinal SBL curriculum combining debriefing with good judgment and rapid cycle deliberate practice can be a feasible method of reducing current training gaps (specifically with critical procedure opportunities) in PEM fellowship training. More work is needed to quantify the training gap reduction and to refine the curriculum.

An Innovative Evaluation in Fundamental Nursing Curriculum for Novice Nursing Students: An Observational Research

BACKGROUND

<Fundamental Nursing> is the first specialized curriculum for nursing students, laying a foundation for nursing education. <Fundamental Nursing> includes many important basic nursing skills, which suggests the traditional examination could not evaluate how well students learn. Since the OSCE (objective structured clinical examination) developed, it has been used among newly graduated nurses, postgraduate nursing students and achieved some success. OSCE might be a better way to evaluate and reflect students' fundamental nursing skills and comprehensive abilities, although few studies have put it into practice.

OBJECTIVES

To build an examination model relating to <Fundamental Nursing> based on OSCE, and put this examination model into practice, and then evaluate the reliability and validity of this examination model.

DESIGN

This study is to design an examination model based on literature and teaching purposes of <Fundamental Nursing>. A quantitative descriptive survey methodology was used to obtain the students' outcome and the views of the students on the process and outcome.

SETTINGS

This study was conducted in the nursing school of one comprehensive university in Beijing, China.

PARTICIPANTS

99 undergraduate nursing students in second year participated in this study.

METHODS

The OSCE consisted of 4 interactive simulated patient stations, 2 operating stations without standard patients, 2 theoretical stations. We designed 4 standardized process-based case scenarios and corresponding scripts pertinent to each station. 4 standard patients and 8 teachers of <Fundamental Nursing> were recruited, trained and evaluated before the implementation of objective structured clinical examination.

RESULTS

The average score of overall fundamental nursing skills was 90.51 ± 4.00. The Cronbach alpha was 0.665, demonstrating the OSCE is reliable. The content validity of each station varies from 0.90-1, and the criterion validity was promising (R = 0.661, p = 0.000). Also, most students were in favor of OSCE to evaluate in <Fundamental Nursing>.

CONCLUSIONS

The OSCE is a reliable and valid assessment tool in <Fundamental Nursing>. Meanwhile, it could inspire students' critical thinking and promote students' communication skills. Through successive application of OSCE in nursing education from the very beginning, it might also have some potential effect on the clinical performance.