by Tate Skinner and Adam Dubrowski
1. BMC Med Educ. 2016
Aug 12;16(1):203. doi: 10.1186/s12909-016-0726-x.
Does video feedback
analysis improve CPR performance in phase 5 medical students?
Spence AD1, Derbyshire S2, Walsh IK2, Murray JM2.
Author information:
1The Clinical Skills Education Centre, Medical Biology
Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern
Ireland, UK. andy.spence@gmail.com.
2The Clinical Skills Education Centre, Medical Biology
Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern
Ireland, UK.
Abstract
BACKGROUND:
The use of simulation in medical education is increasing,
with students taught and assessed using simulated patients and manikins.
Medical students at Queen's University of Belfast are taught advanced life
support cardiopulmonary resuscitation as part of the undergraduate curriculum.
Teaching and feedback in these skills have been developed in Queen's University
with high-fidelity manikins. This study aimed to evaluate the effectiveness of
video compared to verbal feedback in assessment of student cardiopulmonary
resuscitation performance.
METHODS:
Final year students participated in this study using a
high-fidelity manikin, in the Clinical Skills Centre, Queen's University Belfast.
Cohort A received verbal feedback only on their performance and cohort B
received video feedback only. Video analysis using 'StudioCode' software was
distributed to students. Each group returned for a second scenario and
evaluation 4 weeks later. An assessment tool was created for performance
assessment, which included individual skill and global score evaluation.
RESULTS:
One hundred thirty eight final year medical students
completed the study. 62 % were female and the mean age was 23.9 years. Students
having video feedback had significantly greater improvement in overall scores
compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8-15.8).
Individual skills, including ventilation quality and global score were
significantly better with video feedback (p = 0.002 and p < 0.001,
respectively) when compared with cohort A. There was a positive change in
overall score for cohort B from session one to session two (p < 0.001, 95 %
CI: 6.3-15.8) indicating video feedback significantly benefited skill
retention. In addition, using video feedback showed a significant improvement
in the global score (p < 0.001, 95 % CI: 3.3-7.2) and drug administration
timing (p = 0.004, 95 % CI: 0.7-3.8) of cohort B participants, from session one
to session two.
CONCLUSIONS:
There is increased use of simulation in medicine but a
paucity of published data comparing feedback methods in cardiopulmonary
resuscitation training. Our study shows the use of video feedback when teaching
cardiopulmonary resuscitation is more effective than verbal feedback, and
enhances skill retention. This is one of the first studies to demonstrate the
benefit of video feedback in cardiopulmonary resuscitation teaching.
PMID: 27519273 [PubMed - in process]
2. Br J Surg. 2016
Aug 18. doi: 10.1002/bjs.10236. [Epub ahead of print]
Systematic review of
e-learning for surgical training.
Maertens H1, Madani A2, Landry T3, Vermassen F1, Van
Herzeele I1, Aggarwal R2,4.
Author information:
1Department of Thoracic and Vascular Surgery, Ghent
University Hospital, Ghent, Belgium.
2Department of Surgery, McGill University, Montreal, Canada.
3Montreal General Hospital Medical Library, McGill
University Health Centre, Montreal, Canada.
4Steinberg Centre for Simulation and Interactive Learning,
Faculty of Medicine, McGill University, Montreal, Canada.
Abstract
BACKGROUND:
Internet and software-based platforms (e-learning) have
gained popularity as teaching tools in medical education. Despite widespread
use, there is limited evidence to support their effectiveness for surgical
training. This study sought to evaluate the effectiveness of e-learning as a
teaching tool compared with no intervention and other methods of surgical
training.
METHODS:
A systematic literature search of bibliographical databases
was performed up to August 2015. Studies were included if they were RCTs
assessing the effectiveness of an e-learning platform for teaching any surgical
skill, compared with no intervention or another method of training.
RESULTS:
From 4704 studies screened, 87 were included with 7871
participants enrolled, comprising medical students (52 studies), trainees (51
studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning
tools were used for teaching cognitive (71 studies), psychomotor (36 studies)
and non-technical (8 studies) skills. Tool features included multimedia (84
studies), interactive learning (60 studies), feedback (27 studies), assessment
(26 studies), virtual patients (22 studies), virtual reality environment (11
studies), spaced education (7 studies), community discussions (2 studies) and
gaming (2 studies). Overall, e-learning showed either greater or similar
effectiveness compared with both no intervention (29 and 4 studies
respectively) and non-e-learning interventions (29 and 22 studies
respectively).
CONCLUSION:
Despite significant heterogeneity amongst platforms,
e-learning is at least as effective as other methods of training.
© 2016 BJS Society Ltd Published by John Wiley & Sons
Ltd
3.Auris Nasus Larynx.
2016 Aug 17. pii: S0385-8146(16)30225-5. doi: 10.1016/j.anl.2016.07.017. [Epub
ahead of print]
Papercraft temporal
bone in the first step of anatomy education.
Hiraumi H1, Sato H2, Ito J3.
Author information:
1Department of Otolaryngology, Head and Neck Surgery, Iwate
Medical University, Morioka, Japan; Department of Otolaryngology, Head and Neck
Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Kyoto
College of Medical Health, Kyoto, Japan. Electronic address:
hhiraumi@iwate-med.ac.jp.
2Department of Otolaryngology, Head and Neck Surgery, Iwate
Medical University, Morioka, Japan.
3Department of Otolaryngology, Head and Neck Surgery,
Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
OBJECTIVE:
(1) To compare temporal bone anatomy comprehension taught to
speech therapy students with or without a papercraft model. (2) To explore the
effect of papercraft simulation on the understanding of surgical approaches in
first-year residents.
METHODS:
(1) One-hundred and ten speech therapy students were divided
into three classes. The first class was taught with a lecture only. The
students in the second class were given a lecture and a papercraft modeling
task without instruction. The third class modeled a papercraft with instruction
after the lecture. The students were tested on their understanding of temporal
bone anatomy. (2) A questionnaire on the understanding of surgical approaches
was completed by 10 residents before and after the papercraft modeling. The
papercraft models were cut with scissors to simulate surgical approaches.
RESULTS:
(1) The average scores were 4.4/8 for the first class, 4.3/8
for the second class, and 6.3/8 for the third class. The third class had
significantly better results than the other classes (p<0.01, Kruskal-Wallis
test). (2) The average scores before and after the papercraft modeling and
cutting were 2.6/7 and 4.9/7, respectively. The numerical rating scale score
significantly improved (p<0.01, Wilcoxon signed-rank test).
CONCLUSION:
The instruction of the anatomy using a papercraft temporal
bone model is effective in the first step of learning temporal bone anatomy and
surgical approaches.
Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
4.Pediatr Radiol.
2016 Aug 25. [Epub ahead of print]
Evaluation of a
pediatric fluoroscopy training module to improve performance of upper
gastrointestinal procedures in neonates with bilious emesis.
Benya EC1,2, Wyers MR3,4, O'Brien EK5.
Author information:
1Department of Medical Imaging, Ann & Robert H. Lurie
Children's Hospital of Chicago, 225 E. Chicago Ave. #9, Chicago, IL, 60611,
USA. ebenya@luriechildrens.org.
2Department of Radiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA. ebenya@luriechildrens.org.
3Department of Medical Imaging, Ann & Robert H. Lurie
Children's Hospital of Chicago, 225 E. Chicago Ave. #9, Chicago, IL, 60611,
USA.
4Department of Radiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA.
5Department of Medical Education, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND:
Life-threatening midgut volvulus usually occurs in infants
with malrotation and requires rapid diagnosis and surgical treatment to prevent
bowel necrosis and death. However, because of the low frequency of upper
gastrointestinal studies performed in infants younger than 1 month, many
diagnostic radiology residents finish their residency training having limited
or no opportunity to perform or observe an upper gastrointestinal (GI) series for
evaluation of bilious emesis in a neonate.
OBJECTIVE:
To determine whether adding simulated upper GI series on
neonates with bilious emesis to the curriculum improves residents' skill and
accuracy in diagnosing midgut volvulus.
MATERIALS AND METHODS:
We assessed the performance of 12 residents in training
whose curriculum included simulated upper GI series (study group) and 10
traditionally trained residents (control group) using a multiple-choice test,
checklist procedure evaluation and diagnostic accuracy scores for 3 randomly
selected simulated upper GI series. We then compared the results from the study
group that had simulation curriculum to the scores for the control group using
the Mann-Whitney test. We also analyzed the scores for the study group obtained
prior to and after simulation curriculum using Wilcoxon signed rank test.
RESULTS:
There was a significant difference in test scores (study
group median = 84.5%, control group median = 67.2%, P=0.001), overall
diagnostic accuracy (study group median = 100%, control group median = 50%,
P=0.011) and checklist evaluation (study group median = 83.3%, control group
median = 70.8%, P=0.025) for the residents in the study group who completed
simulation curriculum compared with the control group. There was also a
significant difference in multiple-choice test scores for the study group
before and after completion of simulation curriculum (before simulation
curriculum median = 56.9%, after simulation curriculum median = 84.5%,
P=0.002), checklist evaluation (before simulation curriculum median = 58.3%,
after simulation curriculum median = 83.3%, P=0.002) and overall diagnostic
accuracy scores (before simulation curriculum median = 50%, after simulation
curriculum median = 100%, P=0.024).
CONCLUSION:
Radiology residents had significantly higher scores on a
multiple-choice test, checklist procedure evaluation and overall diagnostic
accuracy after completing a structured pediatric fluoroscopy curriculum that
included simulated neonatal upper GI series and when compared to a control
group of traditionally trained residents.
5.Gut Liver. 2016 Sep
15;10(5):764-72. doi: 10.5009/gnl16044.
The Efficacy of a
Newly Designed, Easy-to-Manufacture Training Simulator for Endoscopic Biopsy of
the Stomach.
Ahn JY1, Lee JS1, Lee GH1, Lee JW1, Na HK1, Jung KW1, Lee
JH1, Kim do H1, Choi KD1, Song HJ1, Jung HY1, Kim JH1.
Author information:
1Department of Gastroenterology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea.
Abstract
BACKGROUND/AIMS:
We developed a new endoscopic biopsy training simulator and
determined its efficacy for improving the endoscopic biopsy skills of
beginners.
METHODS:
This biopsy simulator, which presents seven biopsy sites,
was constructed using readily available materials. We enrolled 40 participants:
14 residents, 11 first-year clinical fellows, 10 second-year clinical fellows,
and five staff members. We recorded the simulation completion time for all
participants, and then simulator performance was assessed via a questionnaire using
the 7-point Likert scale.
RESULTS:
The mean times for completing the five trials were
417.7±138.8, 145.2±31.5, 112.7±21.9, and 90.5±20.0 seconds for the residents,
first-year clinical fellows, second-year clinical fellows, and staff members,
respectively. Endoscopists with less experience reported that they found this
simulator more useful for improving their biopsy technique (6.8±0.4 in the
resident group and 5.7±1.0 in the first-year clinical fellow group). The
realism score of the simulator for endoscopic handling was 6.4±0.5 in the staff
group.
CONCLUSIONS:
This new, easy-to-manufacture endoscopic biopsy simulator is
useful for biopsy training for beginner endoscopists and shows good efficacy
and realism.
PMID: 27563021 [PubMed - in process]
6.Med Educ. 2016
Sep;50(9):969-78. doi: 10.1111/medu.13107.
Influence of learner
knowledge and case complexity on handover accuracy and cognitive load: results
from a simulation study.
Young JQ1, van Dijk SM2, O'Sullivan PS3, Custers EJ2, Irby
DM3, Ten Cate O2.
Author information:
1Department of Psychiatry, Hofstra Northwell School of
Medicine, Hofstra University, Hempstead, NY, USA.
2Centre for Research and Development of Education,
University Medical Centre Utrecht, Utrecht, The Netherlands.
3Research and Development of Medical Education, School of Medicine,
University of California San Francisco, San Francisco, CA, USA.
Abstract
CONTEXT:
The handover represents a high-risk event in which errors
are common and lead to patient harm. A better understanding of the cognitive
mechanisms of handover errors is essential to improving handover education and
practice.
OBJECTIVES:
This paper reports on an experiment conducted to study the
effects of learner knowledge, case complexity (i.e. cases with or without a
clear diagnosis) and their interaction on handover accuracy and cognitive load.
METHODS:
Participants were 52 Dutch medical students in Years 2 and
6. The experiment employed a repeated-measures design with two explanatory
variables: case complexity (simple or complex) as the within-subject variable,
and learner knowledge (as indicated by illness script maturity) as the
between-subject covariate. The dependent variables were handover accuracy and
cognitive load. Each participant performed a total of four simulated handovers
involving two simple cases and two complex cases.
RESULTS:
Higher illness script maturity predicted increased handover
accuracy (p < 0.001) and lower cognitive load (p = 0.007). Case complexity
did not independently affect either outcome. For handover accuracy, there was
no interaction between case complexity and illness script maturity. For
cognitive load, there was an interaction effect between illness script maturity
and case complexity, indicating that more mature illness scripts reduced
cognitive load less in complex cases than in simple cases.
CONCLUSIONS:
Students with more mature illness scripts performed more
accurate handovers and experienced lower cognitive load. For cognitive load,
these effects were more pronounced in simple than complex cases. If replicated,
these findings suggest that handover curricula and protocols should provide
support that varies according to the knowledge of the trainee.
© 2016 John Wiley & Sons Ltd and The Association for the
Study of Medical Education.
PMID: 27562896 [PubMed - in process]
7.Med Educ. 2016
Sep;50(9):955-68. doi: 10.1111/medu.13086.
Thrive or overload?
The effect of task complexity on novices' simulation-based learning.
Haji FA1,2,3, Cheung JJ1,2, Woods N1, Regehr G4, de
Ribaupierre S3, Dubrowski A5.
Author information:
1Wilson Centre, Faculty of Medicine, University of Toronto,
Toronto, Ontario, Canada.
2SickKids Learning Institute, Hospital for Sick Children,
Toronto, Ontario, Canada.
3Division of Clinical Neurological Sciences, Faculty of
Medicine, Western University, London, Ontario, Canada.
4Centre for Health Education Scholarship, Faculty of
Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
5Division of Emergency Medicine, Faculty of Medicine,
Memorial University of Newfoundland, St John's, Newfoundland, Canada.
Abstract
CONTEXT:
Fidelity is widely viewed as an important element of
simulation instructional design based on its purported relationship with
transfer of learning. However, higher levels of fidelity may increase task
complexity to a point at which novices' cognitive resources become overloaded.
OBJECTIVES:
In this experiment, we investigate the effects of variations
in task complexity on novices' cognitive load and learning during
simulation-based procedural skills training.
METHODS:
Thirty-eight medical students were randomly assigned to
simulation training on a simple or complex lumbar puncture (LP) task.
Participants completed four practice trials on this task (skill acquisition).
After 10 days of rest, all participants completed one additional trial on their
assigned task (retention) and one trial on a 'very complex' simulation designed
to be similar to the complex task (transfer). We assessed LP performance and
cognitive load on each trial using multiple measures.
RESULTS:
In both groups, LP performance improved significantly during
skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention.
The simple task group demonstrated superior performance compared with the
complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31).
Cognitive load declined significantly in the simple task group (p < 0.009, f
= 0.48-0.76), but not in the complex task group during skill acquisition, and
remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer,
LP performance declined and cognitive load increased in the simple task group,
whereas both remained stable in the complex task group. At transfer, no group
differences were observed in LP performance and cognitive load, except that the
simple task group made significantly fewer breaches of sterility (p = 0.023, d
= 0.80).
CONCLUSIONS:
Reduced task complexity was associated with superior LP
performance and lower cognitive load during skill acquisition and retention,
but mixed results on transfer to a more complex task. These results indicate
that task complexity is an important factor that may mediate (via cognitive
overload) the relationship between instructional design elements (e.g.
fidelity) and simulation-based learning outcomes.
© 2016 John Wiley & Sons Ltd and The Association for the
Study of Medical Education.
PMID: 27562895 [PubMed - in process
8.Am J Surg. 2016 Aug
1. pii: S0002-9610(16)30380-4. doi: 10.1016/j.amjsurg.2016.06.024. [Epub ahead
of print]
Predicting surgical
skill acquisition in preclinical medical students.
Martin AN1, Hu Y1, Le IA1, Brooks KD1, Mahmutovic A1, Choi
J1, Kim H1, Rasmussen SK2.
Author information:
1Department of Surgery, University of Virginia,
Charlottesville, VA, USA.
2Department of Surgery, University of Virginia,
Charlottesville, VA, USA. Electronic address: skr3f@virginia.edu.
Abstract
BACKGROUND:
The purpose of this study was to identify factors that
predict medical student success in acquiring invasive procedural skills. We
hypothesized that students with interest in surgery and with prior procedural
experience would have higher rates of success.
METHODS:
Preclinical students were enrolled in a simulation course
comprised of suturing, intubation, and central venous catheterization. Students
completed surveys to describe demographics, specialty interest area, prior
experience, and confidence. Using linear regression, variables predictive of
proficiency were identified.
RESULTS:
Forty-five participants completed the course. Under
univariate analysis, composite pretest score was inversely associated with
confidence (P = .039). Under multivariable analysis, female gender was
associated with higher pretest suturing score (P = .016). Male gender (P =
.029) and high confidence (P = .021) were associated with greater improvement
in suturing.
CONCLUSIONS:
Among novices, higher confidence can predict lower baseline
technical proficiency. Although females had higher pretest suturing scores,
high confidence and male gender were associated with the greatest degree of
improvement.
Copyright © 2016 Elsevier Inc. All rights reserved.
PMID: 27567113 [PubMed - as supplied by publisher
9.GMS J Med Educ.
2016 Aug 15;33(4):Doc56. doi: 10.3205/zma001055. eCollection 2016.
Mastery learning
improves students skills in inserting intravenous access: a pre-post-study.
Friederichs H1, Brouwer B1, Marschall B2, Weissenstein A1.
Author information:
1University of Muenster, Studienhospital, Muenster, Germany.
2University of Muenster, Institute of Medical Education -
IfAS, Muenster, Germany.
Abstract
OBJECTIVE:
Inserting peripheral venous catheters (PVCs) has been
identified as a core competency for medical students. Because the performance -
even of hygienic standards - of both students and novice physicians is
frequently inadequate, medical faculties must focus on competence-based
learning objectives and deliberate practice, features that are combined in
mastery learning. Our aim was to determine the competency of students in
inserting PVCs before and after an educational intervention.
DESIGN:
This study comprised a skills assessment with pre- and
post-tests of a group of third-year students who received a simulation-based
intervention. A newly established curriculum involved one hour of practice at
inserting PVCs on simulators. Students were required to pass a test (total 21
points, pass mark 20 points) developed on the concept of mastery learning. An
unannounced follow-up test was performed one week (8 days) after the
intervention.
SETTING:
The simulation center of the medical faculty in Muenster.
PARTICIPANTS:
Third-year students who received the intervention.
RESULTS:
One hundred and nine complete data sets were obtained from
133 students (82.5%). Most students (97.2%) passed the test after the
intervention (mean score increase from 15.56 to 20.50, P<0.001). There was a
significant decrease in students' performance after one week (8 days): only
74.5% of participants passed this retest (mean score reduction from 20.50 to
20.06, P<0.001).
CONCLUSION:
Mastery learning is an effective form of teaching practical
skills to medical students, allowing a thorough preparation for the challenges
of daily clinical practice.
PMID: 27579356 [PubMed - in process]
10.Arq Bras Cir Dig.
2015 Jul-Sep;28(3):204-6. doi: 10.1590/S0102-67202015000300015.
White box: low cost
box for laparoscopic training.
[Article in English, Portuguese]
Martins JM1, Ribeiro RV1, Cavazzola LT1.
Author information:
1Hospital de Clínicas de Porto Alegre, Porto Alegre, RS,
Brazil.
Abstract
BACKGROUND:
Laparoscopic surgery is a reality in almost all surgical
centers. Although with initial greater technical difficulty for surgeons, the
rapid return to activities, less postoperative pain and higher quality
aesthetic stimulates surgeons to evolve technically in this area. However,
unlike open surgery where learning opportunities are more accessible, the
laparoscopic training represents a challenge in surgeon formation.
AIM:
To present a low cost model for laparoscopic training box.
METHODS:
This model is based in easily accessible materials; the
equipment can be easily found based on chrome mini jet and passes rubber thread
and a webcam attached to an aluminum handle.
RESULTS:
It can be finalized in two days costing R$ 280,00 (US$ 90).
CONCLUSION:
It is possible to stimulate a larger number of surgeons to
have self training in laparoscopy at low cost seeking to improve their surgical
skills outside the operating room
11.World J Emerg
Surg. 2016 Aug 31;11(1):45. doi: 10.1186/s13017-016-0104-3. eCollection 2016.
Ex-vivo and live
animal models are equally effective training for the management of a
penetrating cardiac injury.
Izawa Y1, Hishikawa S2, Muronoi T3, Yamashita K3, Maruyama
H4, Suzukawa M3, Lefor AK5.
Author information:
1Center of Development for Advanced Medical Technology,
Jichi Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498
Japan ; Department of Emergency and Critical Care Medicine, Jichi Medical
University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498 Japan.
2Center of Development for Advanced Medical Technology,
Jichi Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498
Japan ; Department of Emergency and Critical Care Medicine, Jichi Medical
University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498 Japan ;
Department of Digestive Surgery, Jichi Medical University, 3311-1 Yakushiji,
Shimotsukeshi, Tochigiken 329-0498 Japan.
3Department of Emergency and Critical Care Medicine, Jichi
Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498 Japan.
4Department of Digestive Surgery, Jichi Medical University,
3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498 Japan.
5Center of Development for Advanced Medical Technology,
Jichi Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigiken 329-0498
Japan ; Department of Digestive Surgery, Jichi Medical University, 3311-1
Yakushiji, Shimotsukeshi, Tochigiken 329-0498 Japan.
Abstract
BACKGROUND:
Live tissue models are considered the most useful simulation
for training in the management for hemostasis of penetrating injuries. However,
these models are expensive, with limited opportunities for repetitive training.
Ex-vivo models using tissue and a fluid pump are less expensive, allow
repetitive training and respect ethical principles in animal research. The
purpose of this study is to objectively evaluate the effectiveness of ex-vivo
training with a pump, compared to live animal model training. Staff surgeons
and residents were divided into live tissue training and ex-vivo training
groups. Training in the management of a penetrating cardiac injury was
conducted for each group, separately. One week later, all participants were
formally evaluated in the management of a penetrating cardiac injury in a live
animal.
RESULTS:
There are no differences between the two groups regarding
average years of experience or previous trauma surgery experience. All
participants achieved hemostasis, with no difference between the two groups in
the Global Rating Scale score (ex-vivo: 25.2 ± 6.3, live: 24.7 ± 6.3,
p = 0.646), blood loss (1.6 ± 0.7, 2.0 ± 0.6, p = 0.051), checklist score
(3.7 ± 0.6, 3.6 ± 0.9, p = 0.189), or time required for repair (101 s ± 31, 107
s ± 15, p = 0.163), except overall evaluation (3.8 ± 0.9, 3.4 ± 0.9,
p = 0.037). The internal consistency reliability and inter-rater reliability in
the Global Rating Scale were excellent (0.966 and 0.953 / 0.719 and 0.784,
respectively), and for the checklist were moderate (0.570 and 0.636 / 0.651 and
0.607, respectively). The validity is rated good for both the Global Rating
Scale (Residents: 21.7 ± 5.6, Staff: 28.9 ± 4.7, p = 0.000) and checklist
(Residents: 3.4 ± 0.9, Staff Surgeons: 3.9 ± 0.3, p = 0.003). The results of
self-assessment questionnaires were similarly high (4.2-4.9) with scores in
self-efficacy increased after training (pre: 1.7 ± 0.8, post: 3.2 ± 1.0,
p = 0.000 in ex-vivo, pre: 1.9 ± 1.0, post: 3.7 ± 0.7, p = 0.000 in live).
Scores comparing pre-training and post-evaluation (pre: 1.7 ± 0.8, post:
3.7 ± 0.9, p = 0.000 in ex-vivo, pre: 1.9 ± 1.0, post: 3.8 ± 0.7, p = 0.000 in
live) were increased.
CONCLUSION:
Training with an ex-vivo model and live tissue training are
similar for the management of a penetrating cardiac injury, with increased
self-efficacy of participants in both groups. The ex-vivo model is useful to
learn hemostatic skills in trauma surgery.
12.West J Emerg Med.
2015 Nov;16(6):907-12. doi: 10.5811/westjem.2015.10.26974. Epub 2015 Nov 22.
Correlation of
Simulation Examination to Written Test Scores for Advanced Cardiac Life Support
Testing: Prospective Cohort Study.
Strom SL1, Anderson CL2, Yang L3, Canales C 3, Amin A4,
Lotfipour S2, McCoy CE2, Langdorf MI2.
Author information:
1University of California Irvine School of Medicine,
Department of Anesthesia and Perioperative Care, Irvine, California.
2University of California Irvine School of Medicine,
Department of Emergency.
3Medicine, Irvine, California.
4University of California Irvine, Irvine,
CaliforniaUniversity of California Irvine School of Medicine, Department of
Medicine, Irvine, California.
Abstract
INTRODUCTION:
Traditional Advanced Cardiac Life Support (ACLS) courses are
evaluated using written multiple-choice tests. High-fidelity simulation is a
widely used adjunct to didactic content, and has been used in many specialties
as a training resource as well as an evaluative tool. There are no data to our
knowledge that compare simulation examination scores with written test scores
for ACLS courses.
OBJECTIVE:
To compare and correlate a novel high-fidelity
simulation-based evaluation with traditional written testing for senior medical
students in an ACLS course.
METHODS:
We performed a prospective cohort study to determine the
correlation between simulation-based evaluation and traditional written testing
in a medical school simulation center. Students were tested on a standard acute
coronary syndrome/ventricular fibrillation cardiac arrest scenario. Our primary
outcome measure was correlation of exam results for 19 volunteer fourth-year
medical students after a 32-hour ACLS-based Resuscitation Boot Camp course. Our
secondary outcome was comparison of simulation-based vs. written outcome
scores.
RESULTS:
The composite average score on the written evaluation was
substantially higher (93.6%) than the simulation performance score (81.3%, absolute
difference 12.3%, 95% CI [10.6-14.0%], p<0.00005). We found a statistically
significant moderate correlation between simulation scenario test performance
and traditional written testing (Pearson r=0.48, p=0.04), validating the new
evaluation method.
CONCLUSION:
Simulation-based ACLS evaluation methods correlate with
traditional written testing and demonstrate resuscitation knowledge and skills.
Simulation may be a more discriminating and challenging testing method, as
students scored higher on written evaluation methods compared to simulation.
13.BMC Health Serv
Res. 2016 Sep 7;16:475. doi: 10.1186/s12913-016-1683-0.
The impact of
web-based and face-to-face simulation on patient deterioration and patient
safety: protocol for a multi-site multi-method design.
Cooper SJ1, Kinsman L2, Chung C3, Cant R3, Boyle J4, Bull
L5, Cameron A6, Connell C7, Kim JA3, McInnes D8, McKay A2, Nankervis K5, Penz
E9, Rotter T10.
Author information:
1School of Nursing Midwifery and Healthcare, Federation
University Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350,
Australia. s.cooper@federation.edu.au.
2School of Nursing, The University of Tasmania, PO Box 1322,
Launceston, Tasmania, 7250, Australia.
3School of Nursing Midwifery and Healthcare, Federation University
Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350, Australia.
4St John of God Health Care Berwick, Gibb St, Berwick,
Victoria, 3806, Australia.
5Department of Nursing and Midwifery Education and Strategy,
Monash Health, Clayton Rd, Clayton, Victoria, 3168, Australia.
6Latrobe Regional Hospital, 10 Village Ave, Traralgon, VIC,
3844, Australia.
7Nursing and Midwifery, Monash University, McMahons Rd,
Frankston, Victoria, 3199, Australia.
8Central Gippsland Health Service, 155 Guthridge Parade,
Sale, VIC, 3850, Australia.
9College of Medicine, University of Saskatchewan, Saskatoon,
SK, S7N 5E5, Canada.
10College of Pharmacy and Nutrition, University of
Saskatchewan, Saskatoon, SK, S7N 5E5, Canada.
Abstract
BACKGROUND:
There are international concerns in relation to the
management of patient deterioration which has led to a body of evidence known
as the 'failure to rescue' literature. Nursing staff are known to miss cues of
deterioration and often fail to call for assistance. Medical Emergency Teams
(Rapid Response Teams) do improve the management of acutely deteriorating
patients, but first responders need the requisite skills to impact on patient
safety.
METHODS/DESIGN:
In this study we aim to address these issues in a mixed
methods interventional trial with the objective of measuring and comparing the
cost and clinical impact of face-to-face and web-based simulation programs on
the management of patient deterioration and related patient outcomes. The
education programs, known as 'FIRST(2)ACT', have been found to have an impact
on education and will be tested in four hospitals in the State of Victoria,
Australia. Nursing staff will be trained in primary (the first 8 min) responses
to emergencies in two medical wards using a face-to-face approach and in two
medical wards using a web-based version FIRST(2)ACTWeb. The impact of these
interventions will be determined through quantitative and qualitative
approaches, cost analyses and patient notes review (time series analyses) to
measure quality of care and patient outcomes.
DISCUSSION:
In this 18 month study it is hypothesised that both
simulation programs will improve the detection and management of deteriorating
patients but that the web-based program will have lower total costs. The study
will also add to our overall understanding of the utility of simulation
approaches in the preparation of nurses working in hospital wards.
(ACTRN12616000468426, retrospectively registered 8.4.2016).
PMID: 27604599 [PubMed - in process]
14.AJR Am J
Roentgenol. 2016 Sep 9:1-5. [Epub ahead of print]
Simulation-Based
Training May Improve Resident Skill in Ultrasound-Guided Biopsy.
Fulton N1, Buethe J1, Gollamudi J1, Robbin M1.
Author information:
11 Department of Radiology, University Hospitals Case
Medical Center, 11100 Euclid Ave, Cleveland, OH 44106.
Abstract
OBJECTIVE:
The purpose of this study was to determine whether
simulation-based training can improve resident performance in ultrasound-guided
biopsy.
SUBJECTS AND METHODS:
Forty radiology residents from a single academic institution
enrolled in the study. Each resident performed an initial biopsy on an
abdominal imaging phantom using direct ultrasound guidance. Twenty of the
residents underwent a 30-minute training session with the phantom device, and
20 residents received no additional training. The residents performed a repeat
biopsy of the same lesion and were graded on overall procedure time, number of
skin surface punctures, number of gross needle adjustments, and subjective
performance as determined by a blinded grader.
RESULTS:
Residents who participated in the training had a
statistically significant 92.3-second reduction in procedure time (68%
improvement, p = 0.01), 1.1 reduction in number of skin punctures per biopsy
(50% improvement, p = 0.05), 2.5 reduction in number of needle adjustments (66%
improvement, p = 0.04), and an increase of 0.85 points in score on a 5-point
Likert grading scale (23% improvement, p < 0.01). Residents who did not
receive any additional training did not improve in any performance metric.
CONCLUSION:
Simulation-based training improves overall procedure time,
number of skin punctures and needle adjustments, and subjective performance.
15.World Neurosurg.
2016 Sep 6. pii: S1878-8750(16)30802-6. doi: 10.1016/j.wneu.2016.08.118. [Epub
ahead of print]
Coconut Model for
Learning First Steps of Craniotomy Techniques and CSF Leak Avoidance.
Braga BD1, Peleja SB2, Macedo G3, Drummond CR4, Costa PH5,
Garcia-Zapata MT6, Oliveira MM7.
Author information:
1Santa Casa da Misericórdia de Goiânia and Pontificial
Catholic University of Goiás, Brazil; Goiânia General Hospital, Goiás, Brazil;
Federal University of Goiás, Brazil. Electronic address:
bernardodrummond@yahoo.com.br.
2Santa Casa da Misericórdia de Goiânia and Pontificial
Catholic University of Goiás, Brazil; Goiânia General Hospital, Goiás, Brazil.
3 Santa Casa da Misericórdia de Goiânia and Pontificial
Catholic University of Goiás, Brazil.
4Goiânia General Hospital, Goiás, Brazil.
5Department of Surgery, Federal University of Minas Gerais,
Brazil.
6Federal University of Goiás, Brazil.
7Federal University of Goiás, Brazil; Department of Surgery,
Federal University of Minas Gerais, Brazil.
Abstract
INTRODUCTION:
Neurosurgery simulation has gained attention recently due to
changes in the medical system. First-year neurosurgical residents in low-income
countries usually perform their first craniotomy on a real subject. Development
of high-fidelity, cheap, and largely available simulators is a challenge in
residency training. An original model for the first steps of craniotomy with
cerebrospinal fluid (CSF) leak avoidance practice using a coconut is described.
MATERIAL AND METHODS:
The coconut is a drupe from Cocos nucifera L. (coconut
tree). The green coconut has four layers and some similarity can be seen
between these layers and the human skull. The materials used in the simulation
are the same as those used in the operating room.
PROCEDURE:
The coconut is placed on the head holder support with the
face up. The burr holes are made until endocarp is reached. The mesocarp is
dissected, and the conductor is passed from one hole to the other with the
Gigli saw. The hook handle for the wire saw is positioned, and the mesocarp and
endocarp are cut. After sawing the four margins, mesocarp is detached from
endocarp. Four burr holes are made from endocarp to endosperm. Careful
dissection of the endosperm is done, avoiding liquid albumen leak. The Gigli
saw is passed through the trephine holes. Hooks are placed, and the endocarp is
cut. After cutting the four margins, it is dissected from the endosperm and
removed. The main goal of the procedure is to remove the endocarp without fluid
leakage.
DISCUSSION:
The coconut model for learning the first steps of craniotomy
and CSF leak avoidance has some limitations. It is more realistic while trying
to remove the endocarp without damage to the endosperm. It is also cheap and
can be widely used in low-income countries. However, the coconut does not have
anatomical landmarks. The mesocarp makes the model less realistic because it
has fibers that make the procedure more difficult and different from a real
craniotomy.
CONCLUSION:
The model has a potential pedagogic neurosurgical
application for freshman residents before they perform a real craniotomy for
the first time. Further validity is necessary to confirm this hypothesis.
Copyright © 2016 Elsevier Inc. All rights reserved.
PMID: 27613497 [PubMed - as supplied by publisher]
16. Revisiting ‘A
critical review of simulation-based medical education research: 2003–2009’
Authors
William C McGaghie,
S Barry Issenberg,
Emil R Petrusa,
Ross J Scalese
First published: 15 September 2016Full publication history
DOI: 10.1111/medu.12795View/save citation
Objectives
This article reviews and critically evaluates historical and
contemporary research on simulation-based medical education (SBME). It also
presents and discusses 12 features and best practices of SBME that teachers
should know in order to use medical simulation technology to maximum
educational benefit.
Methods
This Qualitative synthesis of SBME research and scholarship
was carried out in two stages. Firstly, we summarised the results of three SBME
research reviews covering the years 1969-2003. Secondly, we performed a
selective critical review of SBME research and scholarship published during
2003-2009.
Results
The historical and contemporary research synthesis is
reported to inform the medical education community about 12 features and best
practices of SBME: (i) feedback; (ii)deliberate practice; (iii) curriculum
integration; (iv) outcome measurement; (v) simulation fidelity;(vi) skill acquisition
and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team
training; (x) high-stakes testing; (xi) instructor training; and (xii)
educational and professional context. Each of these is discussed in the light
of available evidence. The scientific quality of contemporary SBME research is
much improved compared with the historical record.
Conclusions
Development of and research into SBME have grown and matured
over the past 40 years on substantive and methodological grounds. We believe
the impact and educational utility of SBME are likely to increase in the
future. More thematic programmes of research are needed. Simulation-based
medical education is a complex service intervention that needs to be planned
and practised with attention to organisational contexts.
