By Tate Skinner and Dr. Adam Dubrowski
1. Acta Paediatr. 2017 Feb 28. doi:
10.1111/apa.13792. [Epub ahead of print]
Student peer teaching in paediatric
simulation training is a feasible low-cost alternative for education.
Wagner
M1, Mileder LP2, Goeral K1, Klebermass-Schrehof K1, Cardona FS1, Berger A1,
Schmölzer GM3,4, Olischar M1.
Author
information:
1Division
of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of
Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna,
Austria.
2Division
of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical
University of Graz, Graz, Austria.
3Department
of Paediatrics, University of Alberta, Edmonton, Canada.
4Centre
for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital,
Alberta Health Services, Edmonton, Canada.
Abstract
AIM:
The
World Health Organization recommends regular simulation training to prevent
adverse healthcare events. We used specially trained medical students to
provide paediatric simulation training to their peers and assessed feasibility,
cost and confidence of students who attended the courses.
METHODS:
Students
at the Medical University of Vienna, Austria were eligible to participate. Students
attended two high-fidelity simulation training sessions, delivered by peers,
which were video recorded for evaluation. The attendees then completed
questionnaires before and after the training. Associated costs and potential
benefits were analysed.
RESULTS:
From
May 2013 to June 2015, 152 students attended the sessions and 57 (37.5%)
completed both questionnaires. Satisfaction was high, with 95% stating their
peer tutor was competent and 90% saying that peer tutors were well prepared.
The attendees' confidence in treating critically ill children significantly
improved after training (p<0.001). The average costs for a peer tutor were
six Euros per working hour, compared to 35 Euros for a physician.
CONCLUSION:
Using
peer tutors for paediatric simulation training was a feasible and low-cost
option that increased the number of medical students who could be trained and
increased the self-confidence of the attendees. Satisfaction with the peer
tutors was high. This article is protected by copyright. All rights reserved.
This
article is protected by copyright. All rights reserved.
PMID:
28244140 [PubMed - as supplied by publisher]
2. BMC Med
Educ. 2017 Mar 2;17(1):50. doi: 10.1186/s12909-017-0882-7.
Intraosseous
access can be taught to medical students using the four-step approach.
Afzali M1,2, Kvisselgaard AD3, Lyngeraa TS4,
Viggers S5.
Author information:
1Department of Anaesthesiology, University
Hospital of Copenhagen, Herlev, Denmark. monika.afzali@regionh.dk.
2Cochrane Anaesthesia, Critical and Emergency
Care, The Cochrane Collaboration, Herlev, Denmark. monika.afzali@regionh.dk.
3Students' Society of Anaesthesiology &
Traumatology, Faculty of Health and Medical Sciences, University of Copenhagen,
Herlev, Denmark.
4Department of Anaesthesiology, Nordsjælland
Hospital, Herlev, Denmark.
5Copenhagen Academy for Medical Education and
Simulation, Capital Region of Denmark, Herlev, Denmark.
Abstract
BACKGROUND:
The intraosseous (IO) access is an alternative
route for vascular access when peripheral intravascular catheterization cannot
be obtained. In Denmark the IO access is reported as infrequently trained and
used. The aim of this pilot study was to investigate if medical students can
obtain competencies in IO access when taught by a modified Walker and Peyton's
four-step approach.
METHODS:
Nineteen students attended a human cadaver
course in emergency procedures. A lecture was followed by a workshop. Fifteen
students were presented with a case where IO access was indicated and their
performance was evaluated by an objective structured clinical examination
(OSCE) and rated using a weighted checklist. To evaluate the validity of the
checklist, three raters rated performance and Cohen's kappa was performed to
assess inter-rater reliability (IRR). To examine the strength of the overall
IRR, Randolph's free-marginal multi rater kappa was used.
RESULTS:
A maximum score of 15 points was obtained by
nine (60%) of the participants and two participants (13%) scored 13 points with
all three raters. Only one participant failed more than one item on the
checklist. The expert rater rated lower with a mean score of 14.2 versus the
non-expert raters with mean 14.6 and 14.3. The overall IRR calculated with
Randolph's free-marginal multi rater kappa was 0.71.
CONCLUSION:
The essentials of the IO access procedure can
be taught to medical students using a modified version of the Walker and
Peyton's four-step approach and the checklist used was found reliable.
3.
Eur J Vasc Endovasc Surg. 2017 Mar 1. pii:
S1078-5884(17)30059-X. doi: 10.1016/j.ejvs.2017.01.011. [Epub ahead of print]
A National
Needs Assessment to Identify Technical Procedures in Vascular Surgery for
Simulation Based Training.
Nayahangan LJ1, Konge L2, Schroeder TV2,
Paltved C3, Lindorff-Larsen KG4, Nielsen BU5, Eiberg JP6.
Author information:
1Copenhagen Academy for Medical Education and
Simulation, The Capital Region of Denmark, Copenhagen, Denmark. Electronic
address: leizl.joy.nayahangan@regionh.dk.
2Copenhagen Academy for Medical Education and
Simulation, The Capital Region of Denmark, Copenhagen, Denmark; Faculty of
Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
3MidtSim - Centre for Human Resources, Central
Region of Denmark and Aarhus University, Aarhus, Denmark.
4NordSim - Centre for Skills Training and
Simulation, Aalborg University Hospital, Aalborg, Denmark.
5Sim-C - the Simulation Centre of Odense
University Hospital, Odense, Denmark.
6Copenhagen Academy for Medical Education and
Simulation, The Capital Region of Denmark, Copenhagen, Denmark; Faculty of Health
and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department
of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
Abstract
OBJECTIVES AND BACKGROUND:
Practical skills training in vascular surgery
is facing challenges because of an increased number of endovascular procedures
and fewer open procedures, as well as a move away from the traditional
principle of "learning by doing." This change has established
simulation as a cornerstone in providing trainees with the necessary skills and
competences. However, the development of simulation based programs often
evolves based on available resources and equipment, reflecting convenience
rather than a systematic educational plan. The objective of the present study
was to perform a national needs assessment to identify the technical procedures
that should be integrated in a simulation based curriculum.
DESIGN AND METHODS:
A national needs assessment using a Delphi
process was initiated by engaging 33 predefined key persons in vascular surgery.
Round 1 was a brainstorming phase to identify technical procedures that
vascular surgeons should learn. Round 2 was a survey that used a needs
assessment formula to explore the frequency of procedures, the number of
surgeons performing each procedure, risk and/or discomfort, and feasibility for
simulation based training. Round 3 involved elimination and ranking of
procedures.
RESULTS:
The response rate for round 1 was 70%, with 36
procedures identified. Round 2 had a 76% response rate and resulted in a
preliminary prioritised list after exploring the need for simulation based
training. Round 3 had an 85% response rate; 17 procedures were eliminated,
resulting in a final prioritised list of 19 technical procedures.
CONCLUSION:
A national needs assessment using a
standardised Delphi method identified a list of procedures that are highly
suitable and may provide the basis for future simulation based training
programs for vascular surgeons in training.
Copyright © 2017 European Society for Vascular
Surgery. Published by Elsevier Ltd. All rights reserved.
PMID: 28258884 [PubMed - as supplied by
publisher]
4.
BMC Med Educ. 2017 Mar 4;17(1):52. doi:
10.1186/s12909-017-0880-9.
Improving
disclosure of medical error through educational program as a first step toward
patient safety.
Kim CW1, Myung SJ2, Eo EK3, Chang Y4.
Author information:
1Department of Emergency Medicine, Choong Ang
University College of Medicine, Seoul, Republic of Korea.
2Seoul National University College of
Medicine, Office of Medical Education, 103 Daehak-ro, Jongno-gu, Seoul,
110-799, Republic of Korea. issac73@snu.ac.kr.
3Soonchunhyang University Bucheon Hospital,
Bucheon, Republic of Korea.
4Department of Surgery, Dankook University
Hospital, Cheonan, Chungcheongnam-do, Republic of Korea.
Abstract
BACKGROUND:
Although physicians believe that medical
errors should be disclosed to patients and their families, they often hesitate
to do so. In this study, we assessed the effectiveness of an education program
for medical error disclosure.
METHODS:
In 2015, six medical interns and 79
fourth-year medical students participated in this study. The education program
included practice of error disclosure using a standardized patient scenario,
feedback, and short didactic sessions. Participant performance was evaluated
with a previously developed rating scale that measures error disclosure
performance on five specific component skills. Following education program, we
surveyed participant perceptions of medical error disclosure with varying
severity of error outcome and their satisfaction with the education program
using a 5-point Likert scale. We also surveyed the change of attitude or
confidence of participants after education program.
RESULTS:
The performance score was not significantly
different between medical interns and medical students (p = 0.840). Following
the education program, 65% of participants said that they had become more
confident in coping with medical errors, and most participants (79.7%) were
satisfied with the education program. They also indicated that they felt a
greater duty to disclose medical errors and deliver an apology when the medical
error outcome is more severe.
CONCLUSIONS:
An education program for disclosing medical
errors was helpful in improving confidence in medical error disclosure.
Extending the program to more diverse scenarios and a more diverse group of
physicians is needed.
PMID: 28259161 [PubMed - in process]
5.
J Thorac Cardiovasc Surg. 2017 Feb 9. pii:
S0022-5223(17)30184-8. doi: 10.1016/j.jtcvs.2016.12.054. [Epub ahead of print]
Hands-on
surgical training of congenital heart surgery using 3-dimensional print models.
Yoo SJ1, Spray T2, Austin EH 3rd3, Yun TJ4,
van Arsdell GS5.
Author information:
1Department of Diagnostic Imaging, Hospital
for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of
Cardiology, Department of Paediatrics, Hospital for Sick Children, University
of Toronto, Toronto, Ontario, Canada. Electronic address:
shi-joon.yoo@sickkids.ca.
2Division of Cardiothoracic Surgery,
Department of Surgery, The Children's Hospital of Philadelphia, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, Penn.
3Department of Cardiovascular and Thoracic
Surgery, University of Louisville, Norton Children's Hospital, Louisville, Ky.
4Division of Pediatric Cardiac Surgery, Asan
Medical Center, Seoul, South Korea.
5Division of Cardiovascular Surgery,
Department of Surgery, Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada.
Abstract
OBJECTIVE:
Patient-based congenital heart surgery (CHS)
training is opportunity-based and difficult. Three-dimensional (3D) print
models of the heart were used for hands-on surgical training (HOST) at the 2015
AATS and subsequently in 2 local institutions. We aim to introduce the process
of 3D printing for surgical simulation and to present the attendee's responses.
METHODS:
Using CT or MR angiograms, the models of
congenital heart disease were created and printed with flexible rubberlike
material. Altogether, 81 established surgeons or trainees performed simulated
surgical procedures with the expert surgeons' guidance and supervision. At the
completion of the session, 50 of 81 attendees participated in the questionnaire
assessment of the program.
RESULTS:
All responders found the course helpful in
improving their surgical skills. All would consider including HOST sessions in
the training programs. All found that the models showed the necessary
pathologic findings. Most found that the consistency and elasticity of the
model material were different from those of the human myocardium. However, the
responders thought that the quality of the models was acceptable (88%) or
manageable (12%) for surgical practice. The major weaknesses listed were
related to the print material and poor representation of the cardiac valves.
CONCLUSIONS:
HOST using 3D print heart models is achievable
and allows surgical practice on pathological hearts without patients' risk.
HOST is a highly applicable surgical simulation format for CHS. Incorporation
of HOST in training programs could change the traditional opportunity-based
education to the requirement-based standardized education.
Copyright © 2017 The American Association for
Thoracic Surgery. All rights reserved.
PMID: 28268011 [PubMed - as supplied by
publisher]
6.
Surg Endosc. 2017 Mar 9. doi:
10.1007/s00464-017-5452-x. [Epub ahead of print]
Validation
of the mobile serious game application Touch Surgery™ for cognitive training
and assessment of laparoscopic cholecystectomy.
Kowalewski KF1, Hendrie JD1, Schmidt MW1,
Proctor T2, Paul S1, Garrow CR1, Kenngott HG1, Müller-Stich BP1, Nickel F3.
Author information:
1-Department of General, Visceral, and
Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110,
69120, Heidelberg, Germany.
2-Department of Medical Biometry and
Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120,
Heidelberg, Germany.
3-Department of General, Visceral, and
Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110,
69120, Heidelberg, Germany. felix.nickel@med.uni-heidelberg.de.
Abstract
BACKGROUND:
Touch Surgery™ (TS) is a serious gaming
application for cognitive task simulation and rehearsal of key steps in surgical
procedures. The aim was to establish face, content, and construct validity of
TS for laparoscopic cholecystectomy (LC). Furthermore, learning curves with TS
and a virtual reality (VR) trainer were compared in a randomized trial.
METHODS:
The performance of medical students and
general surgeons was compared for all three modules of LC in TS to establish
construct validity. Questionnaires assessed face and content validity. For
analysis of learning curves, students were randomized to train on VR or TS first,
and then switched to the other training modality. Performance data were
recorded.
RESULTS:
54 Surgeons and 51 medical students completed
the validation study. Surgeons outperformed students with TS: patient
preparation (students = 45.0 ± 19.1%; surgeons = 57.3 ± 15.2%; p < 0.001),
access and laparoscopy (students = 70.2 ± 10.9%; surgeons = 75.9 ± 9.7%;
p = 0.008) and LC (students = 69.8 ± 12.4%; surgeons = 77.7 ± 9.6%;
p < 0.001). Both groups agreed that TS was a highly useful and realistic
application. 46 students were randomized for learning curve analysis. It took
them 2-4 attempts to reach a 100% score with TS. Training with TS first did not
improve students' performance on the VR trainer; however, students who trained
with VR first scored significantly higher in module 3 of TS.
CONCLUSION:
TS is an accepted serious gaming application
for learning cognitive aspects of LC with established construct, face, and
content validity. There appeared to be a synergy between TS and the VR trainer.
Therefore, the two training modalities should accompany one another in a
multimodal training approach to laparoscopy.
PMID: 28281111
7.
Clin Teach. 2017 Mar 16. doi:
10.1111/tct.12623. [Epub ahead of print]
Trainees
at a resuscitation: a dual liability.
Stewart NH1, Tanksley A2, Edelson DP3, Arora
VM2.
Author information:
1-Department of Pulmonary, Critical Care and
Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
2-Department of General Medicine, University
of Chicago, Illinois, USA.
3-Department of Hospital Medicine, University
of Chicago, Illinois, USA.
Abstract
BACKGROUND:
During basic life support (BLS) training,
medical students receive little instruction on their role during a
resuscitation attempt. Research is sparse regarding trainee perceptions of the
resuscitation team. This study sought to describe trainee experiences and
perceptions of resuscitation teams.
METHODS:
Clinical third-year medical students (MS3s)
and incoming interns (PGY1s) reported on survey items addressing prior BLS
education, knowledge of BLS, and the student's perceptions and experiences
during a resuscitation attempt.
RESULTS:
Of the 61 third-year medical students
surveyed, 72 per cent responded. Over half (51%) of third-year medical students
reported feeling confident with their compressions, yet few knew the correct
rate of compressions (16%). Nearly three-quarters of the third-year medical
students participated in a resuscitation (74%), but only 16 per cent considered
themselves an essential member of the resuscitation team. Moreover, almost half
(45%) felt awkward during a resuscitation attempt, and nearly one-third (29%) felt
marginalised. To contextualise our data, incoming interns were surveyed during
their orientation week and 81 per cent responded: one-third (35%) considered
themselves essential to the team, over half (64%) felt awkward and nearly
one-third (32%) felt marginalised. In addition, many do not understand their
role on the resuscitation team: 37 per cent of third-year students versus 57
per cent of incoming interns.
DISCUSSION:
Although most students participated in a
resuscitation attempt, many students do not understand their role, few felt
included on the team and numerous students felt awkward or marginalised.
Explicit role training and expanding resuscitation simulation to include the
student may increase confidence levels, improving patient care. Medical
students receive little instruction on their role during a resuscitation
attempt.
© 2017 John Wiley & Sons Ltd and The
Association for the Study of Medical Education.
PMID: 28300340
8.
Am J Surg. 2017 Mar 9. pii:
S0002-9610(17)30458-0. doi: 10.1016/j.amjsurg.2017.03.001. [Epub ahead of
print]
3D vision
accelerates laparoscopic proficiency and skills are transferable to 2D
conditions: A randomized trial.
Sørensen SM1, Konge L2, Bjerrum F3.
Author information:
1-Copenhagen Academy for Medical Education and
Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen,
Copenhagen, Denmark. Electronic address: stine.d.soerensen@gmail.com.
2-Copenhagen Academy for Medical Education and
Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen,
Copenhagen, Denmark. Electronic address: lars.konge@regionh.dk.
3University of Copenhagen, Copenhagen,
Denmark; Department of Gynecology, The Juliane Marie Center for Children, Women
and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark. Electronic address: fbjerrum@gmail.com.
Abstract
BACKGROUND:
Laparoscopy is difficult to master, in part
because surgeons operate in a three-dimensional (3D) space guided by
two-dimensional (2D) images. This trial explores the effect of 3D vision during
a laparoscopic training program, and examine whether it is possible to transfer
skills acquired with 3D conditions to 2D conditions.
METHODS:
We designed a randomized controlled trial
where residents (n = 34) were randomized to proficiency-based laparoscopic
simulator training under either 3D or 2D conditions. Subsequently, participants
completed a retention test under 2D conditions.
RESULTS:
Mean training time were reduced in the
intervention group; 231 min versus 323 min; P = 0.012. There was no significant
difference in the mean times to completion of the retention test; 92 min versus
95 min; P = 0.85.
CONCLUSION:
3D vision reduced time to proficiency on a
virtual-reality laparoscopy simulator. Furthermore, skills learned with 3D
vision can be transferred to 2D vision conditions. Clinicaltrials.gov
(NCT02361463).
SUMMERY FOR THE TABLE OF CONTENTS:
Three-dimensional (3D) vision accelerates time
to proficiency in a virtual-reality laparoscopic training program and the
psychomotor skills learned with 3D vision can be transferred to 2D vision
conditions.
Copyright © 2017 Elsevier Inc. All rights
reserved.
PMID: 28302275
9.
J Hand Surg Am. 2017 Mar 16. pii:
S0363-5023(17)30291-5. doi: 10.1016/j.jhsa.2017.02.008. [Epub ahead of print]
A
Mobile-Based Surgical Simulation Application: A Comparative Analysis of
Efficacy Using a Carpal Tunnel Release Module.
Amer KM1, Mur T2, Amer K3, Ilyas AM4 .
Author information:
1-Temple University Lewis Katz School of
Medicine, Philadelphia, PA. Electronic address: Kamil.amer@temple.edu.
2-Temple University Lewis Katz School of
Medicine, Philadelphia, PA.
3-Rutgers UMDNJ, New Jersey Medical School,
Newark, NJ.
4-Rothman Institute at the Thomas Jefferson
University, Philadelphia, PA.
Abstract
PURPOSE:
The utilization of surgical simulation
continues to grow in medical training. The TouchSurgery application (app) is a
new interactive virtual reality smartphone- or tablet-based app that offers a
step-by-step tutorial and simulation for the execution of various operations. The
purpose of this study was to compare the efficacy of the app versus traditional
teaching modalities utilizing the "Carpal Tunnel Surgery" module. We
hypothesized that users of the app would score higher than those using the
traditional education medium indicating higher understanding of the steps of
surgery.
METHODS:
A total of 100 medical students were recruited
to participate. The control group (n = 50) consisted of students learning about
carpal tunnel release surgery using a video lecture utilizing slides. The study
group (n = 50) consisted of students learning the procedure through the app.
The content covered was identical in both groups but delivered through the
different mediums. Outcome measures included comparison of test scores and
overall app satisfaction.
RESULTS:
Test scores in the study group (89.3%) using
the app were significantly higher than those in the control group (75.6%).
Students in the study group rated the overall content validity, quality of
graphics, ease of use, and usefulness to surgery preparation as very high (4.8
of 5).
CONCLUSIONS:
Students utilizing the app performed better on
a standardized test examining the steps of a carpal tunnel release than those
using a traditional teaching modality. The study findings lend support for the
use of the app for medical students to prepare for and learn the steps for
various surgical procedures.
CLINICAL RELEVANCE:
This study provides useful information on
surgical simulation, which can be utilized to educate trainees for new
procedures.
Copyright © 2017 American Society for Surgery
of the Hand. Published by Elsevier Inc. All rights reserved.
PMID: 28318742
10.
Tissue Eng Part A. 2017 Mar 27. doi:
10.1089/ten.TEA.2016.0528. [Epub ahead of print]
3D liver
surgery simulation: computer-assisted surgical planning with 3D simulation
software and 3D printing.
Oshiro Y1, Ohkohchi N2.
Author information:
1-Tsukuba Daigaku Igaku Bumon, 38515,
Department of Surgery , 1-1-1 Tennodai, Tsukuba, 305-8575 , Tsukuba,
Ibarakiken, Japan , 305-0006 ; oshiro@md.tsukuba.ac.jp.
2-Tsukuba Daigaku Igaku Bumon, 38515,
Department of Surgery, Tsukuba, Ibaraki, Japan ; nokochi3@md.tsukuba.ac.jp.
Abstract
To perform accurate hepatectomy without
injury, it is necessary to understand the anatomical relationship among the
branches of Glisson's sheath, hepatic veins, and tumor. In Japan,
three-dimensional (3D) preoperative simulation for liver surgery is becoming
increasingly common, and liver 3D modeling and 3D hepatectomy simulation by 3D
analysis software for liver surgery have been covered by universal healthcare
insurance since 2012. Herein, we review the history of virtual hepatectomy
using computer-aided surgery (CAS) and our research to date, and we discuss the
future prospects of CAS. We have used the SYNAPSE VINCENT medical imaging
system (Fujifilm Medical, Tokyo, Japan) for 3D visualization and virtual
resection of the liver since 2010. We developed a novel fusion imaging
technique combining 3D computed tomography (CT) with magnetic resonance imaging
(MRI). The fusion image enables us to easily visualize anatomic relationships
among the hepatic arteries, portal veins, bile duct, and tumor in the hepatic
hilum. In 2013, we developed an original software, called Liversim, that
enables real-time deformation of the liver using physical simulation, and a
randomized control trial has recently been conducted to evaluate the use of Liversim
and SYNAPSE VINCENT for preoperative simulation and planning. Furthermore, we
developed a novel hollow 3D-printed liver model whose surface is covered with
frames. This model is useful for safe liver resection, has better visibility,
and the production cost is reduced to one-third of a previous model.
Preoperative simulation and navigation with CAS in liver resection are expected
to help planning and conducting a surgery and surgical education. Thus, a novel
CAS system will contribute to not only the performance of reliable hepatectomy
but also to surgical education.
PMID: 28343411
11.
BMC Med Educ. 2017 Mar 28;17(1):65. doi:
10.1186/s12909-017-0892-5.
Conveying
practical clinical skills with the help of teaching associates-a randomised
trial with focus on the long term learning retention.
Hoefer SH1, Sterz J2, Bender B2, Stefanescu
MC2, Theis M3, Walcher F4, Sader R3, Ruesseler M2.
Author information:
1-Department of Oral, Cranio-Maxillofacial,
and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University,
Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. shoefer@em.uni-frankfurt.de.
2-Department of Trauma, Hand, and
Reconstructive Surgery, University Hospital Frankfurt, Goethe University,
Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
3-Department of Oral, Cranio-Maxillofacial,
and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University,
Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
4-Department of Trauma Surgery, Medical
Faculty University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg,
Germany.
Abstract
BACKGROUND:
Ensuring that all medical students achieve
adequate clinical skills remains a challenge, yet the correct performance of
clinical skills is critical for all fields of medicine. This study analyzes the
influence of receiving feedback by teaching associates in the context of
achieving and maintaining a level of expertise in complex head and skull
examination.
METHODS:
All third year students at a German university
who completed the obligatory surgical skills lab training and surgical
clerkship participated in this study. The students were randomized into two
groups.
CONTROL GROUP:
lessons by an instructor and peer-based
practical skills training. Intervention group: training by teaching associates who
are examined as simulation patients and provided direct feedback on student
performance. Their competency in short- and long-term competence (directly
after intervention and at 4 months after the training) of head and skull
examination was measured. Statistical analyses were performed using SPSS
Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test
methods were applied. As a measurement of correlation, Pearson correlations and
correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was
calculated.
RESULTS:
A total of 181 students were included (90
intervention, 91 control). Out of those 181 students 81 agreed to be videotaped
(32 in the control group and 49 in the TA group) and examined at time point 1.
At both time points, the intervention group performed the examination
significantly better (time point 1, p = <.001; time point 2 (rater 1
p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d)
was up to 1.422.
CONCLUSIONS:
The use of teaching associates for teaching
complex practical skills is effective for short- and long-term retention. We
anticipate the method could be easily translated to nearly every patient-based
clinical skill, particularly with regards to a competence-based education of
future doctors.
PMID: 28351359
12.
Med Teach. 2017 Mar 30:1-8. doi:
10.1080/0142159X.2017.1303135. [Epub ahead of print]
Simulation-based
trauma education for medical students: A review of literature.
Borggreve AS1,2, Meijer JM2, Schreuder HW3,
Ten Cate O1.
Author information:
1-a Center for Research and Development of
Education, University Medical Center Utrecht , t he Netherlands.
2-b Department of Surgery , University Medical
Center Utrecht , Utrecht , the Netherlands.
3-c Department of Gynaecology and Reproductive
Medicine, UMC Utrecht Cancer Center , University Medical Center Utrecht ,
Utrecht , the Netherlands.
Abstract
BACKGROUND:
Medical students often do not feel prepared to
manage emergency situations after graduation. They experience a lack of
practical skills and show significant deficits in cognitive performance to
assess and stabilize trauma patients. Most reports in the literature about
simulation-based education pertain to postgraduate training. Simulation-based
trauma education (SBTE) in undergraduate medical education could improve
confidence and performance of recently graduated doctors in trauma
resuscitation. We reviewed the literature in search of SBTE effectiveness for
medical students.
METHODS:
A PubMed, Embase and CINAHL literature search
was performed to identify all studies that reported on the effectiveness of
SBTE for medical students, on student perception on SBTE or on the
effectiveness of different simulation modalities.
RESULTS:
Eight studies were included. Three out of four
studies reporting on the effectiveness of SBTE demonstrated an increase in
performance of students after SBTE. SBTE is generally highly appreciated by
medical students. Only one study directly compared two modalities of SBTE and
reported favorable results for the mechanical model rather than the
standardized live patient model.
CONCLUSION:
SBTE appears to be an effective method to
prepare medical students for trauma resuscitation. Furthermore, students enjoy
SBTE and they perceive SBTE as a very useful learning method.
PMID: 28355934
13.
Ann Am Thorac Soc. 2017 Apr;14(4):529-535.
doi: 10.1513/AnnalsATS.201612-950OC.
Comparison
between Simulation-based Training and Lecture-based Education in Teaching
Situation Awareness. A Randomized Controlled Study.
Lee Chang A1, Dym AA2, Venegas-Borsellino C1,
Bangar M1, Kazzi M1, Lisenenkov D1, Qadir N1, Keene A1, Eisen LA1.
Author information:
1-1 Division of Critical Care Medicine,
Department of Medicine, Montefiore Medical Center of Albert Einstein College of
Medicine, Bronx, New York.
2-2 Albert Einstein College of Medicine,
Bronx, New York.
Abstract
RATIONALE:
Situation awareness has been defined as the
perception of the elements in the environment within volumes of time and space,
the comprehension of their meaning, and the projection of their status in the
near future. Intensivists often make time-sensitive critical decisions, and
loss of situation awareness can lead to errors. It has been shown that
simulation-based training is superior to lecture-based training for some
critical scenarios. Because the methods of training to improve situation
awareness have not been well studied in the medical field, we compared the
impact of simulation vs. lecture training using the Situation Awareness Global
Assessment Technique (SAGAT) score.
OBJECTIVES:
To identify an effective method for teaching
situation awareness.
METHODS:
We randomly assigned 17 critical care fellows
to simulation vs. lecture training. Training consisted of eight cases on airway
management, including topics such as elevated intracranial pressure, difficult
airway, arrhythmia, and shock. During the testing scenario, at random times
between 4 and 6 minutes into the simulation, the scenario was frozen, and the
screens were blanked. Respondents then completed the 28 questions on the SAGAT
scale. Sample items were categorized as Perception, Projection, and
Comprehension of the situation. Results were analyzed using SPSS Version 21.
RESULTS:
Eight fellows from the simulation group and
nine from the lecture group underwent simulation testing. Sixty-four SAGAT
scores were recorded for the simulation group and 48 scores were recorded for
the lecture group. The mean simulation vs. lecture group SAGAT score was
64.3 ± 10.1 (SD) vs. 59.7 ± 10.8 (SD) (P = 0.02). There was also a difference
in the median Perception ability between the simulation vs. lecture groups
(61.1 vs. 55.5, P = 0.01). There was no difference in the median Projection and
Comprehension scores between the two groups (50.0 vs. 50.0, P = 0.92, and
83.3 vs. 83.3, P = 0.27).
CONCLUSIONS:
We found a significant, albeit modest,
difference between simulation training and lecture training on the total SAGAT
score of situation awareness mainly because of the improvement in perception
ability. Simulation may be a superior method of teaching situation awareness.
PMID: 28362531
14.
Arch Pediatr. 2017 Mar 29. pii:
S0929-693X(17)30083-0. doi: 10.1016/j.arcped.2017.02.020. [Epub ahead of print]
Implementation
and assessment of a training course for residents in neonatology and pediatric
emergency medicine.
Brossier D1, Bellot A2, Villedieu F3,
Fazilleau L2, Brouard J4, Guillois B2.
Author information:
1-Pediatric intensive care unit, CHU de Caen,
3(e) étage bâtiment FEH, avenue de la Côte-de-Nacre, 14003 Caen, France.
Electronic address: brossier-d@chu-caen.fr.
2-Neonatal department, CHU de Caen, avenue de
la Côte-de-Nacre, 14003 Caen, France.
3-Pediatric intensive care unit, CHU de Caen,
3(e) étage bâtiment FEH, avenue de la Côte-de-Nacre, 14003 Caen, France.
4-Pediatric department, CHU de Caen, avenue de
la Côte-de-Nacre, 14003 Caen, France.
Abstract
BACKGROUND AND AIMS:
Residents must balance patient care and the
ongoing acquisition of medical knowledge. With increasing clinical
responsibilities and patient overload, medical training is often left aside. In
2010, we designed and implemented a training course in neonatology and
pediatric emergency medicine for residents in pediatrics, in order to improve
their medical education. The course was made of didactic sessions and several
simulation-based seminars for each year of residency. We conducted this study
to assess the impact of our program on residents' satisfaction and
self-assessed clinical skills.
METHODS:
A survey was conducted at the end of each
seminar. The students were asked to complete a form on a five-point rating
scale to evaluate the courses and their impact on their satisfaction and
self-assessed clinical skills, following the French National Health Institute's
adapted Kirkpatrick model.
RESULTS:
Sixty-four (84%) of the 76 residents who
attended the courses completed the form. The mean satisfaction score for the
entire course was 4.78±0.42. Over 80% of the students felt that their clinical
skills had improved.
CONCLUSION:
Medical education is an important part of
residency training. Our training course responded to the perceived needs of the
students with consistently satisfactory evaluations. Before the evaluation of
the impact of the course on patient care, further studies are needed to assess
the acquisition of knowledge and skills through objective evaluations.
Copyright © 2017 Elsevier Masson SAS. All
rights reserved.
PMID: 28365188
15.
Clin Orthop Relat Res. 2017 Apr 3. doi:
10.1007/s11999-017-5336-3. [Epub ahead of print]
Teaching
the Basics: Development and Validation of a Distal Radius Reduction and Casting
Model.
Seeley MA1, Fabricant PD2, Lawrence JT3.
Author information:
1-Geisinger Medical Center, 100 N Academy
Avenue, Danville, PA, 17821, USA. mseeley1@geisinger.edu.
2-Hospital for Special Surgery, New York, NY,
USA.
3-Children's Hospital of Philadelphia,
Philadelphia, PA, USA.
Abstract
BACKGROUND:
Approximately one-third of reduced pediatric
distal radius fractures redisplace, resulting in further treatment. Two major
modifiable risk factors for loss of reduction are reduction adequacy and cast
quality. Closed reduction and immobilization of distal radius fractures is an
Accreditation Council for Graduate Medical Education residency milestone.
Teaching and assessing competency could be improved with a life-like simulation
training tool.
QUESTIONS/PURPOSES:
Our goal was to develop and validate a
realistic distal radius fracture reduction and casting simulator as determined
by (1) a questionnaire regarding the "realism" of the model and (2)
the quantitative assessments of reduction time, residual angulation, and
displacement.
METHODS:
A distal radius fracture model was created
with radiopaque bony segments and articulating elbows and shoulders. Simulated
periosteum and internal deforming forces required proper reduction and casting
techniques to achieve and maintain reduction. The forces required were
estimated through an iterative process through feedback from experienced
clinicians. Embedded monofilaments allowed for quantitative assessment of
residual displacement and angulation through the use of fluoroscopy. Subjects
were asked to perform closed reduction and apply a long arm fiberglass cast.
Primary performance variables assessed included reduction time, residual
angulation, and displacement. Secondary performance variables consisted of
number of fluoroscopic images, casting time, and cast index (defined as the
ratio of the internal width of the forearm cast in the sagittal plane to the
internal width in the coronal plane at the fracture site). Subject grading was
performed by two blinded reviewers. Interrater reliability was nearly perfect
across all measurements (intraclass correlation coefficient range, 0.94-0.99),
thus disagreements in measurements were handled by averaging the assessed
values. After completion the participants answered a Likert-based questionnaire
regarding the realism of simulation. Eighteen participants consented to
participate in the study (eight attending pediatric orthopaedic surgeons, six
junior residents, four senior residents). The performances of junior residents
(Postgraduate Year [PGY] 1-2), senior residents (PGY 3-5), and attending surgeons
were compared using one-way ANOVA with Tukey's-adjusted pairwise comparisons.
RESULTS:
The majority of participants (15 of 18) felt
that the model looked, felt, and moved like a human forearm. All participants
strongly agreed that the model taught the basic steps of fracture reduction and
should be implemented in orthopaedic training. Attending surgeons reduced
fractures in less time than junior residents (60 ± 27 seconds versus 460 ± 62
seconds; mean difference, 400 seconds; 95% CI, 335-465 seconds; p < 0.001).
Residual angulation was greater for junior residents when compared with
attending surgeons on AP (7° ± 5° versus 0.7° ± 0.9°; mean difference, 6.3°;
95% CI, 3°-11°; p = 0.003) and lateral (27° ± 7° versus 7° ± 5°; mean
difference, 20°; 95% CI, 13°-27°; p = 0.001) radiographs. Similarly, residual
displacement was greater for junior residents than either senior residents
(mean difference, 16 mm; 95% CI, 2-34 mm; p = 0.05) or attending surgeons (mean
difference, 15 mm; 95% CI, 3-27 mm; p = 0.02) on lateral images. There were no
differences identified in secondary performance variables (number of
fluoroscopic images, casting time, and cast index) between groups.
CONCLUSIONS:
This is the first distal radius fracture
reduction model to incorporate an elbow and shoulder and allow quantitative
assessment of the fracture reduction. This simulator may be useful in an
orthopaedic resident training program to help them reach a defined minimum
level of competency. This simulator also could easily be integrated in other
accreditation and training programs, including emergency medicine.
LEVEL OF EVIDENCE:
Level II, therapeutic study.
PMID: 28374350
16.
J Educ Perioper Med. 2017 Jul 1;19(1):E503.
Expert
Evaluation of a Chicken Tissue-based Model for Teaching Ultrasound-guided
Central Venous Catheter Insertion.
Nachshon A1, Mitchell JD1, Mueller A1,
Banner-Goodspeed VM1, McSparron JI2.
Author information:
1-Department of Anesthesiology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA.
2-Division of Pulmonary, Critical Care, and
Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA.
Abstract
BACKGROUND:
Ultrasound-guided central venous
catheterization (CVC) is a commonly performed procedure which carries
significant risks for complications. Current models used for simulation-based
teaching are expensive and may not replicate tissue feel and ultrasound qualities
of human tissues. We aimed to evaluate a tissue model composed of chicken
breast and balloons and compare it to a commercially available mannequin.
METHODS:
Forty attending physicians from four
departments with extensive CVC experience were enrolled. Participants completed
an ultrasound-guided central line placement utilizing both models during a
hands-on workshop. Following CVC placement on each model, participants
completed a survey to assess their experience with that particular model.
RESULTS:
40 attending physicians (12 (30%) anesthesia,
11 (28%) emergency medicine, 11 (28%) internal medicine, and 6 (15%) surgery)
participated in the study. The chicken model was rated significantly higher
than the mannequin model with regard to ultrasound quality (p=0.02) and tissue
feel (p=0.002). In a direct comparison, participants rated the chicken model
more highly than the mannequin in all categories except similarity to the human
anatomy. Overall the chicken model was preferred to the mannequin, (mean score
44.5; standard deviation 26.0). The mannequin was rated higher with regard to
similarity to human anatomy (mean score 52.8; standard deviation 25.7). The
comparison between key features (ultrasound characteristics, similarity to
human anatomy and teaching trainees) of the models did not vary significantly
by area of practice, with the exception of ease of use (p=0.045).
CONCLUSIONS:
In this prospective study of experienced
clinicians we found that a novel tissue model for ultrasound-guided CVC
placement was rated more highly compared to a commercially available mannequin
task trainer.
PMID: 28377943
17.
Am J Audiol. 2016 Sep 1;25(3):211-23. doi:
10.1044/2016_AJA-16-0029.
Use of
Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent
Counseling Education.
Alanazi AA1, Nicholson N2, Atcherson SR2,
Franklin C2, Anders M3, Nagaraj N2, Franklin J2, Highley P2.
Author information:
1-University of Arkansas for Medical Sciences,
Little RockUniversity of Arkansas at Little RockKing Saud bin Abdulaziz
University for Health Sciences, Riyadh, Saudi Arabia.
2-University of Arkansas for Medical Sciences,
Little RockUniversity of Arkansas at Little Rock.
3-University of Arkansas for Medical Sciences,
Little Rock.
Abstract
PURPOSE:
The primary purpose of this study was to test
the effect of the combined use of trained standardized parents and a baby
simulator on students' hearing screening and parental counseling knowledge and
skills.
METHOD:
A one-group pretest-posttest
quasi-experimental study design was used to assess self-ratings of confidence
in knowledge and skills and satisfaction of the educational experience with
standardized parents and a baby simulator. The mean age of the 14 audiology
students participating in this study was 24.79 years (SD = 1.58). Participants
completed a pre- and postevent questionnaire in which they rated their level of
confidence for specific knowledge and skills. Six students (2 students in each
scenario) volunteered to participate in the infant hearing screening and
counseling scenarios, whereas others participated as observers. All
participants participated in the briefing and debriefing sessions immediately
before and after each of 3 scenarios. After the last scenario, participants
were asked to complete a satisfaction survey of their learning experience using
simulation and standardized parents.
RESULTS:
Overall, the pre- and post-simulation event
questionnaire revealed a significant improvement in the participants'
self-rated confidence levels regarding knowledge and skills. The mean
difference between pre- and postevent scores was 0.52 (p < .01). The mean
satisfaction level was 4.71 (range = 3.91-5.00; SD = 0.30) based on a Likert
scale, where 1 = not satisfied and 5 = very satisfied.
CONCLUSIONS:
The results of this novel educational activity
demonstrate the value of using infant hearing screening and parental counseling
simulation sessions to enhance student learning. In addition, this study
demonstrates the use of simulation and standardized parents as an important
pedagogical tool for audiology students. Students experienced a high level of
satisfaction with the learning experience.
PMID: 27653494 [Indexed for MEDLINE]
