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Cold KM, Vamadevan A, Vilmann AS, Svendsen MBS, Konge L, Bjerrum F. Computer-aided quality assessment of endoscopist competence during colonoscopy: A systematic review. Gastrointest Endosc 2024:S0016-5107(24)00219-0. [PMID: 38580134 DOI: 10.1016/j.gie.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND AIMS Endoscopists' competence can vary widely, as shown in the variation in adenoma detection rate (ADR). Computer-aided quality assessment (CAQ) can automatically assess performance during individual procedures. This review aims to identify and describe different CAQ systems for colonoscopy. METHODS A systematic review of the literature was done using MEDLINE, EMBASE, and SCOPUS based on three blocks of terms according to the inclusion criteria: Colonoscopy, Competence assessment, and Automatic evaluation. Articles were systematically reviewed by two reviewers, first by abstract and then in full text. The methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS 12,575 studies were identified, 6,831 remained after removal of duplicates, and 6,806 did not pass the eligibility criteria and were excluded, leaving thirteen studies for final analysis. Five categories of CAQ systems were identified: Withdrawal speedometer (seven studies), Scope movement analysis (three studies), Effective withdrawal time (one study), Fold examination quality (one study), and Visual gaze pattern (one study). The withdrawal speedometer was the only CAQ system that tested its feedback by examining changes in ADR. Three studies observed an improvement in ADR, and two studies did not. The methodological quality of the studies was high (mean MERSQI 15.2 points, maximum 18 points). CONCLUSIONS Thirteen studies developed or tested CAQ systems, most frequently by correlating it to ADR. Only five studies tested feedback by implementing the CAQ system. A meta-analysis was impossible due to the heterogeneous study designs, and more studies are warranted.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark
| | - Andreas Slot Vilmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Gastrounit, Surgical section, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark; Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Gastrounit, Surgical section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Vamadevan A, Konge L, Bjerrum F. Variable practice is superior to self-directed training for laparoscopic simulator training: a randomized trial. Surg Endosc 2024; 38:1902-1911. [PMID: 38321334 PMCID: PMC10978673 DOI: 10.1007/s00464-024-10688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Mastering laparoscopy is challenging-it requires specific psychomotor skills which are difficult to obtain in the operating room without potentially compromising patient safety. Proficiency-based training programs using virtual reality simulators allow novices to practice and develop their skills in a patient-safe learning environment. Variable practice leads to stronger retention and skills transfer in a non-surgical setting. The objective of this trial was to investigate if variable practice was superior to self-directed training. METHODS A randomized trial where participants (n = 36) were randomized to proficiency-based laparoscopic simulator training of basic skills using either variable practice or self-directed training, followed by a transfer test with proficiency-based training on a procedural task (a salpingectomy). All participants returned after a period of 3-5 weeks to perform a retention test. RESULTS The mean time to proficiency for the basic skills tasks were 119 min (SD: 93) for the variable practice group versus 182 min (SD: 46) for the self-directed training group (p = 0.015). The time to reach proficiency during the transfer test was 103 min (SD: 57) versus 183 min (SD: 64) for the variable practice group versus the self-directed training group, respectively (p < 0.001). The mean time to proficiency for the retention test was 51 min (SD: 26) and 109 min (SD: 53) for the variable practice group and self-directed training group, respectively (p < 0.001). CONCLUSION Variable practice is superior to self-directed training for proficiency-based laparoscopic training. With variable time to practice proficiency is reduced, there is higher transfer to a procedural task, and retention is improved.
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Affiliation(s)
- Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Surgical Section, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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Tang DHY, Østdal TB, Vamadevan A, Konge L, Houlind K, Stadeager M, Bjerrum F. No difference between using short and long intervals for distributed proficiency-based laparoscopy simulator training: a randomized trial. Surg Endosc 2024; 38:300-305. [PMID: 37993677 PMCID: PMC10776690 DOI: 10.1007/s00464-023-10522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Simulation-based training is increasingly used to acquire basic laparoscopic skills. Multiple factors can influence training, e.g., distributed practice is superior to massed practice in terms of efficiency. However, the optimal interval between training sessions is unclear. The objective of this trial was to investigate if shorter intervals between sessions are more efficient than longer intervals during proficiency-based laparoscopy simulator training. METHODS A randomized simulation-based trial where medical students (n = 39) were randomized to proficiency-based training with either 1-2 days (intervention group) or 6-8 days (control group) between training sessions. Both groups practiced a series of basic tasks and a procedural module until proficiency level on the LapSim® simulator. Both groups were given instructor feedback upon request. After reaching proficiency, participants were invited back for a retention test 3-5 weeks later and practiced the same tasks to proficiency again. RESULTS The mean time to reach proficiency during training was 291 (SD 89) and 299 (SD 89) min in the intervention and control group, respectively (p = 0.81). During the retention test, the mean time to reach proficiency was 94 (SD 53) and 96 (SD 39) minutes in the intervention and control groups, respectively (p = 0.91). CONCLUSION We found no difference whether practicing with shorter intervals or longer intervals between training sessions when examining time to proficiency or retention.
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Affiliation(s)
- Diana Hai Yen Tang
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark.
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Theresa Bruun Østdal
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Houlind
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Odense, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Surgery, Hvidovre Hospital, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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Nielsen AO, Cold KM, Vamadevan A, Konge L, Clementsen PF. Systematic Endobronchial Ultrasound - The Six Landmarks Approach. J Vis Exp 2023. [PMID: 37590526 DOI: 10.3791/65551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Lung cancer is the leading cause of cancer mortality globally. To ensure the correct diagnosis and staging in relation to treatment options, it is crucial to obtain valid biopsies from suspected tumors and mediastinal lymph nodes and accurate identification of the mediastinal lymph nodes regarding the Tumor-Node-Metastasis (TNM)-classification. Flexible bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is essential in the workup and diagnosis of patients suspected of lung cancer. EBUS-TBNA from mediastinal lymph nodes is a technically difficult procedure and has been identified as one of the most important procedures that should be integrated into a simulation-based training program for invasive pulmonologists. More specific guidelines that govern training in EBUS-TBNA are needed to meet this demand. We hereby propose a systematic, stepwise approach with specific attention to six landmarks that support the endoscopist when navigating through the bronchial maze. The stepwise approach relying on the six landmarks is used in the EBUS-certified training program offered by the European Respiratory Society (ERS).
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Affiliation(s)
- Anne Orholm Nielsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen;
| | - Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
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Cold KM, Vamadevan A, Nielsen AO, Konge L, Clementsen PF. Systematic Bronchoscopy: the Four Landmarks Approach. J Vis Exp 2023. [PMID: 37427954 DOI: 10.3791/65358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a simulation-based training program for pulmonologists. However, more specific guidelines that govern bronchoscopy training are needed to meet this demand. To ensure patients a competent examination, we propose a systematic, stepwise approach, splitting the procedure into four "landmarks" to support novice endoscopists navigating the bronchial maze. The procedure can be evaluated based on three established outcome measures to ensure a thorough and effective inspection of the bronchial tree: diagnostic completeness, structured progress, and procedure time. The stepwise approach relying on the four landmarks is used at all simulation centers in Denmark and is being implemented in the Netherlands. To provide instant feedback to novice bronchoscopists when training and to relieve time constraints from consultants, we suggest that future studies should implement artificial intelligence as a feedback and certification tool when training new bronchoscopists.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark;
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
| | - Anne Orholm Nielsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark; Department of Pulmonary Medicine, Bispebjerg Hospital
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
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Vamadevan A, Konge L, Stadeager M, Bjerrum F. Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial. Surg Endosc 2023; 37:200-208. [PMID: 35918547 DOI: 10.1007/s00464-022-09422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Laparoscopy requires specific psychomotor skills and can be challenging to learn. Most proficiency-based laparoscopic training programs have used non-haptic virtual reality simulators; however, haptic simulators can provide the tactile sensations that the surgeon would experience in the operating room. The objective was to investigate the effect of adding haptic simulators to a proficiency-based laparoscopy training program. METHODS A randomized controlled trial was designed where residents (n = 36) were randomized to proficiency-based laparoscopic simulator training using haptic or non-haptic simulators. Subsequently, participants from the haptic group completed a follow-up test, where they had to reach proficiency again using the non-haptic simulator. Participants from the non-haptic group returned to train until reaching proficiency again using the non-haptic simulator. RESULTS Mean completion times during the intervention were 120 min (SD 38.7 min) and 183 min (SD 66.3 min) for the haptic group and the non-haptic group, respectively (p = 0.001). The mean times to proficiency during the follow-up test were 107 min (SD 41.0 min) and 58 min (SD 23.7 min) for the haptic and the non-haptic group, respectively (p < 0.001). The haptic group was not faster to reach proficiency in the follow-up test than during the intervention (p = 0.22). In contrast, the non-haptic group reached the required proficiency level significantly faster in the follow-up test (p < 0.001). CONCLUSION Haptic virtual reality simulators reduce the time to reach proficiency compared to non-haptic simulators. However, the acquired skills are not transferable to the conventional non-haptic setting.
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Affiliation(s)
- Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Department of Surgery, Zealand University Hospital, Køge, Denmark
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Noerholk LM, Bader‐Larsen KS, Morcke AM, Vamadevan A, Andreasen LA, Svendsen JH, Jørsboe H, Tolsgaard MG. Business as (un)usual: A qualitative study of clerkship experiences during a health crisis. Med Educ 2022; 56:805-814. [PMID: 35199378 PMCID: PMC9543617 DOI: 10.1111/medu.14787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION During a health crisis, hospitals must prioritise activities and resources, which can compromise clerkship-based learning. We explored how health crises affect clinical clerkships using the COVID-19 pandemic as an example. METHODS In a constructivist qualitative study, we conducted 22 semi-structured interviews with key stakeholders (i.e. medical students and doctors) from two teaching hospitals and 10 different departments. We used thematic analysis to investigate our data and used stakeholder theory as a sensitising concept. RESULTS We identified three themes: (1) emotional triggers and reactions; (2) negotiation of legitimacy; and (3) building resilience. Our results suggest that the health crisis accentuated already existing problems in clerkships, such as students' feelings of low legitimacy, constant negotiation of roles, inconsistencies navigating rules and regulations and low levels of active participation. Medical students and doctors adapted to the new organisational demands by developing increased resilience. Students responded by reaching out for guidance and acceptance to remain relevant in the clinical clerkships. Doctors developed a behaviour of closing in and focused on managing themselves and their patients. This created tension between these two stakeholder groups. CONCLUSION A health crisis can critically disrupt the hierarchical structure within the clinical clerkships and exacerbate existing conflicts between stakeholder groups. When medical students are not perceived as legitimate stakeholders in clinical clerkships during a health crisis, their attendance is perceived as unnecessary or even a nuisance. Despite increased student proactiveness and resilience, their roles inevitably shift from being doctors-to-be to students-to-be-managed.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Karlen S. Bader‐Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | | | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Hanne Jørsboe
- Nykøbing Falster Sygehus, Region ZealandNykøbing FalsterDenmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Centre for Fetal Medicine, Juliane Marie CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
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Noerholk LM, Morcke AM, Kulasegaram K, Nørgaard LN, Harmsen L, Andreasen LA, Pedersen NG, Johnsson V, Vamadevan A, Tolsgaard MG. Does group size matter during collaborative skills learning? A randomised study. Med Educ 2022; 56:680-689. [PMID: 35262226 PMCID: PMC9313549 DOI: 10.1111/medu.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Collaborative skills learning in the form of dyad learning compared with individual learning has been shown to lead to non-inferior skills retention and transfer. However, we have limited knowledge on which learning activities improve collaborative skills training and how the number of collaborators may impact skills transfer. We explored the effects of skills training individually, in dyads, triads or tetrads on learning activities during training and on subsequent skills transfer. METHODS In a randomised, controlled study, participants completed a pre-post-transfer-test set-up in groups of one to four. Participants completed 2 hours of obstetric ultrasound training. In the dyad, triad and tetrad group participants took turns actively handling the ultrasound probe. All performances were rated by two blinded experts using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale and a Global Rating Scale (GRS). All training was video recorded, and learning activities were analysed using the Interactive-Constructive-Active-Passive (ICAP) framework. RESULTS One hundred one participants completed the simulation-based training, and ninety-seven completed the transfer test. Performance scores improved significantly from pre- to post-test for all groups (p < 0.001, ηp2 = 0.55). However, group size did not affect transfer test performance on OSAUS scores (p = 0.13, ηp2 = 0.06) or GRS scores (p = 0.23, ηp2 = 0.05). ICAP analyses of training activities showed that time spent on non-learning and passive learning activities increased with group size (p < 0.001, ηp2 = 0.31), whereas time spent on constructive and interactive learning activities was constant between groups compared with singles (p < 0.001, ηp2 = 0.72). CONCLUSION Collaborative skills learning in groups of up to four did not impair skills transfer despite less hands-on time. This may be explained by a compensatory shift towards constructive and interactive learning activities that outweigh the effect of shorter hands-on time.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | | | | | - Lone N. Nørgaard
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Lotte Harmsen
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Department of Gynecology and ObstetricsCopenhagen University Hospital ‐ HvidovreCopenhagenDenmark
| | - Nina Gros Pedersen
- Fetal Medicine Unit, Department of Obstetrics and GynaecologyCopenhagen University Hospital ‐ HerlevCopenhagenDenmark
| | - Vilma Johnsson
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Soni D, Chandrasekaran A, Singh K, Singh K, Mohan B, Negi P, Chattopadhyay K, Vamadevan A, Prabhakaran D, Kinra S. PO137 Gender Differences In Physiological and Behavioral Risk Factors Among Patients With Acute Myocardial Infarction: Findings From the Yoga-Care Trial. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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