by Tate Skinner and Adam Dubrowski
Using Virtual Patients to Teach Empathy: A
Randomized Controlled Study to Enhance Medical Students' Empathic
Communication.
Abstract
INTRODUCTION:
Physician empathy is a complex
phenomenon known to improve illness outcomes; however, few tools are available
for deliberate practice of empathy. We used a virtual patient (VP) to teach
empathic communication to first-year medical students. We then evaluated
students' verbal empathy in a standardized patient (SP) interaction.
METHODS:
Seventy medical students, randomly
assigned to 3 separate study groups, interacted with (1) a control VP
portraying depression, (2) a VP with a backstory simulating patient shadowing,
or (3) a VP able to give immediate feedback about empathic communication
(empathy-feedback VP). Subsequently, the students interviewed an SP portraying
a scenario that included opportunities to express empathy. All SP interviews
were recorded and transcribed. The study outcomes were (1) the students' verbal
response to the empathic opportunities presented by the SP, as coded by
reliable assessors using the Empathic Communication Coding System, and (2) the
students' responses as coded by the SPs, using a communication checklist.
RESULTS:
There were no significant differences
in student demographics between groups. The students who interacted with the
empathy-feedback VP showed higher empathy in the SP interview than did the
students in the backstory VP and the control VP groups [mean (SD) empathy
scores coded on a 0-6 scale were 2.91 (0.16) vs. 2.20 (0.22) and 2.27 (0.21),
respectively). The difference in scores was significant only for the
empathy-feedback VP versus the backstory VP group (P = 0.027). The SPs rated
the empathy-feedback and the backstory VP groups significantly higher than the
control VP group on offering empathic statements (P < 0.0001), appearing warm
and caring (P = 0.015), and forming rapport (P = 0.004).
CONCLUSIONS:
Feedback on empathy in a VP
interaction increased students' empathy in encounters with SPs, as rated by
trained assessors, whereas a simulation of patient shadowing did not. Both VP
interventions increased students' empathy as rated by SPs, compared with the
control VP group.
2.Prehosp Disaster Med. 2016
Aug 5:1-8. [Epub ahead of print]
Case-based Learning Outperformed Simulation Exercises
in Disaster Preparedness Education Among Nursing Trainees in India: A
Randomized Controlled Trial.
Aluisio AR1, Daniel P2, Grock A3, Freedman J2, Singh
A4, Papanagnou D5, Arquilla B2.
Abstract
OBJECTIVE:
In resource-constrained environments, appropriately
employing triage in disaster situations is crucial. Although both case-based
learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching
disaster preparedness to adult learners, there is no substantial evidence
supporting one as a more efficacious methodology. This randomized controlled
trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to
standard didactic instruction in knowledge attainment pertaining to disaster
triage preparedness.
METHODS:
This RCT was performed during a one-day disaster
preparedness course in Lucknow, India during October 2014. Following provision
of informed consent, nursing trainees were randomized to knowledge assessment
after didactic teaching (control group); didactic plus CBL (Intervention Group
1); or didactic plus SE (Intervention Group 2). The educational curriculum used
the topical focus of triage processes during disaster situations. Cases for the
educational intervention sessions were scripted, identical between modalities,
and employed structured debriefing. Trained live actors were used for SEs.
After primary assessment, the groups underwent crossover to take part in the
alternative educational modality and were re-assessed. Two standardized
multiple-choice question batteries, encompassing key core content, were used
for assessments. A sample size of 48 participants was calculated to detect a
≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of
randomization was evaluated using X 2, anova, and t-tests. Mean knowledge
attainment scores were compared using one- and two-sample t-tests for intergroup
and intragroup analyses, respectively.
RESULTS:
Among 60 enrolled participants, 88.3% completed
follow-up. No significant differences in participant characteristics existed
between randomization arms. Mean baseline knowledge score in the control group
was 43.8% (standard deviation=11.0%). Case-based learning training resulted in
a significant increase in relative knowledge scores at 20.8% (P=0.003) and
10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared
to control, SEs did not significantly alter knowledge attainment scores with an
average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs
were found to result in a 26.0% decrement in mean assessment score (P <
.001).
CONCLUSIONS:
Among nursing trainees assessed in this RCT, the CBL
modality was superior to SEs in short-term disaster preparedness educational
translation. Simulation exercises resulted in no detectable improvement in
knowledge attainment in this population, suggesting that CBL may be utilized
preferentially for adult learners in similar disaster training settings.
Aluisio AR , Daniel P , Grock A , Freedman J , Singh A , Papanagnou D ,
Arquilla B . Case-based learning outperformed simulation exercises in disaster
preparedness education among nursing trainees in India: a randomized controlled
trial. Prehosp Disaster Med. 2016;31(5):1-8.
PMID: 27491847 [PubMed - as supplied by publisher]
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3. J Surg Educ. 2016 Jul 31. pii:
S1931-7204(16)30090-3. doi: 10.1016/j.jsurg.2016.06.014. [Epub ahead of print]
Cadaver-Based Simulation Increases Resident
Confidence, Initial Exposure to Fundamental Techniques, and May Augment
Operative Autonomy.
Kim SC1, Fisher JG1, Delman KA1, Hinman JM1,
Srinivasan JK2.
Abstract
OBJECTIVE:
Surgical simulation is an important adjunct in
surgical education. The majority of operative procedures can be simplified to
core components. This study aimed to quantify a cadaver-based simulation course
utility in improving exposure to fundamental maneuvers, resident and attending
confidence in trainee capability, and if this led to earlier operative
independence.
DESIGN:
A list of fundamental surgical procedures was
established by a faculty panel. Residents were assigned to a group led by a
chief resident. Residents performed skills on cadavers appropriate for PGY
level. A video-recorded examination where they narrated and demonstrated a task
independently was then graded by attendings using standardized rubrics.
Participants completed surveys regarding improvements in knowledge and
confidence.
SETTING:
The course was conducted at the Emory University
School of Medicine and the T3 Laboratories in Atlanta, GA.
PARTICIPANTS:
A total of 133 residents and 41 attendings
participated in the course. 133 (100%) participating residents and 32 (78%)
attendings completed surveys.
RESULTS:
Resident confidence in completing the assigned skill
independently increased from 3 (2-3) to 4 (3-4), p < 0.01. Residents stated
that a median of 40% (interquartile range: 20%-60%) of procedures were
performed for the first time in the course, and the same number had been
performed only in the course. The percentage of skills attendings believed
residents could perform independently increased from 40% (40%-60%) to 60%
(60%->80%), p < 0.04. Attendings were more likely to grant autonomy in
the operating room after this exercise (4 [3-5]).
CONCLUSIONS:
A cadaveric skills course focused on fundamental
maneuvers with objective confirmation of success is a viable adjunct to
clinical operative experience. Residents were formally exposed to fundamental
surgical maneuvers earlier as a result of this course. This activity improved
both resident and attending confidence in trainee operative skill, resulting in
increased attending willingness to grant a higher level of autonomy in the
operating room.
4. Clin Teach. 2016 Aug 3. doi: 10.1111/tct.12558.
[Epub ahead of print]
Near-peer medical student simulation training.
Cash T1, Brand E1, Wong E1, Richardson J1, Athorn S2,
Chowdhury F3.
Abstract
BACKGROUND:
There is growing concern that medical students are
inadequately prepared for life as a junior doctor. A lack of confidence
managing acutely unwell patients is often cited as a barrier to good clinical
care. With medical schools investing heavily in simulation equipment, we set
out to explore if near-peer simulation training is an effective teaching
format.
METHODS:
Medical students in their third year of study and
above were invited to attend a 90-minute simulation teaching session. The
sessions were designed and delivered by final-year medical students using
clinical scenarios mapped to the Sheffield MBChB curriculum. Candidates were
required to assess, investigate and manage an acutely unwell simulated patient.
Pre- and post-simulation training Likert scale questionnaires were completed
relating to self-reported confidence levels. There is growing concern that medical
students are inadequately prepared for life as a junior doctor RESULTS:
Questionnaires were completed by 25 students (100% response rate); 52 per cent
of students had no prior simulation experience. There were statistically
significant improvements in self-reported confidence levels in each of the six
areas assessed (p < 0.005). Thematic analysis of free-text comments
indicated that candidates enjoyed the practical format of the sessions and
found the experience useful.
DISCUSSION:
Our results suggest that near-peer medical student
simulation training benefits both teacher and learner and that this simplistic
model could easily be replicated at other medical schools. As the most junior
members of the team, medical students are often confined to observer status.
Simulation empowers students to practise independently in a safe and protected
environment. Furthermore, it may help to alleviate anxiety about starting work
as a junior doctor and improve future patient care.
© 2016 John Wiley & Sons Ltd and The Association
for the Study of Medical Education.
PMID: 27488259 [PubMed - as supplied by publisher]
5. BMC Palliat Care. 2016 Aug 2;15(1):67. doi:
10.1186/s12904-016-0143-2.
The impact of a simulated intervention on attitudes of
undergraduate nursing and medical students towards end of life care provision.
Lewis C1, Reid J2, McLernon Z2, Ingham R3, Traynor M2.
Abstract
BACKGROUND:
The concerns of undergraduate nursing and medical
students' regarding end of life care are well documented. Many report feelings
of emotional distress, anxiety and a lack of preparation to provide care to
patients at end of life and their families. Evidence suggests that increased
exposure to patients who are dying and their families can improve attitudes
toward end of life care. In the absence of such clinical exposure, simulation
provides experiential learning with outcomes comparable to that of clinical practice.
The aim of this study was therefore to assess the impact of a simulated
intervention on the attitudes of undergraduate nursing and medical students
towards end of life care.
METHODS:
A pilot quasi-experimental, pretest-posttest design.
Attitudes towards end of life care were measured using the Frommelt Attitudes
Towards Care of the Dying Part B Scale which was administered pre and post a
simulated clinical scenario. 19 undergraduate nursing and medical students were
recruited from one large Higher Education Institution in the United Kingdom.
RESULTS:
The results of this pilot study confirm that a
simulated end of life care intervention has a positive impact on the attitudes
of undergraduate nursing and medical students towards end of life care (p < 0.001).
CONCLUSIONS:
Active, experiential learning in the form of
simulation teaching helps improve attitudes of undergraduate nursing and
medical students towards end of life. In the absence of clinical exposure,
simulation is a viable alternative to help prepare students for their
professional role regarding end of life care.
6.Ultrasound Med Biol. 2016 Jul 26. pii:
S0301-5629(16)30152-1. doi: 10.1016/j.ultrasmedbio.2016.06.021. [Epub ahead of
print]
Point of Care Ultrasound: A WFUMB Position Paper.
Dietrich CF1, Goudie A2, Chiorean L3, Cui XW4, Gilja
OH5, Dong Y6,Abramowicz JS7, Vinayak S8, Westerway SC9, Nolsøe CP10, Chou YH11,
Blaivas M12.
Abstract
Over the last decade, the use of portable ultrasound
scanners has enhanced the concept of point of care ultrasound (PoC-US), namely,
"ultrasound performed at the bedside and interpreted directly by the
treating clinician." PoC-US is not a replacement for comprehensive
ultrasound, but rather allows physicians immediate access to clinical imaging
for rapid and direct solutions. PoC-US has already revolutionized everyday
clinical practice, and it is believed that it will dramatically change how
ultrasound is applied in daily practice. However, its use and teaching are
different from continent to continent and from country to country. This World
Federation for Ultrasound in Medicine and Biology position paper discusses the
current status and future perspectives of PoC-US. Particular attention is given
to the different uses of PoC-US and its clinical significance, including within
emergency and critical care medicine, cardiology, anesthesiology, rheumatology,
obstetrics, neonatology, gynecology, gastroenterology and many other
applications. In the future, PoC-US will be more diverse than ever and be
included in medical student training
7. J
Perinat Neonatal Nurs. 2016 Jul-Sep;30(3):174-8. doi:
10.1097/JPN.0000000000000173.
Debriefing and Feedback in the Current Healthcare
Environment.
Hunter LA1.
Abstract
Over the past several decades, simulation-based learning
and postsimulation debriefing have become a mainstay of clinical education in
healthcare. With origins in both the military and aviation industries,
debriefing in particular has been used across multiple nursing and medicine
disciplines to promote team training and reflective learning. Self-reflection
and improvement in practice are at the core of effective debriefing. Feedback
and simulation experts have continued to develop more effective debriefing
strategies. Several models are described in the literature, and healthcare
educators now have a variety of resources at their disposal. Many of these
debriefing techniques offer thoughtful guidance for providing constructive,
real-time clinical feedback to students. Incorporating reflective feedback strategies
in clinical learning promotes meaningful learning. This, in turn, will only
strengthen the capabilities of students and better prepare them for the
complexities they will face in clinical practice.
PMID: 27465443 [PubMed - in process]
8. Nurse
Educ. 2016 Jul 21. [Epub ahead of print]
Virtually Nursing: Emerging Technologies in Nursing
Education.
Foronda CL1, Alfes CM, Dev P, Kleinheksel AJ, Nelson
DA Jr, OʼDonnell JM, Samosky JT.
Abstract
Augmented reality and virtual simulation technologies
in nursing education are burgeoning. Preliminary evidence suggests that these
innovative pedagogical approaches are effective. The aim of this article is to
present 6 newly emerged products and systems that may improve nursing
education. Technologies may present opportunities to improve teaching efforts,
better engage students, and transform nursing education.
PMID: 27454054 [PubMed - as supplied by publisher]
9. Nurse Educ Today. 2016 Jul 12;45:120-125. doi:
10.1016/j.nedt.2016.07.002. [Epub ahead of print]
The effects of using high-fidelity simulators and
standardized patients on the thorax, lung, and cardiac examination skills of
undergraduate nursing students.
Tuzer H1, Dinc L2, Elcin M3.
Abstract
BACKGROUND:
Existing research literature indicates that the use of
various simulation techniques in the training of physical examination skills
develops students' cognitive and psychomotor abilities in a realistic learning
environment while improving patient safety.
OBJECTIVES:
The study aimed to compare the effects of the use of a
high-fidelity simulator and standardized patients on the knowledge and skills
of students conducting thorax-lungs and cardiac examinations, and to explore
the students' views and learning experiences.
DESIGN:
A mixed-method explanatory sequential design.
SETTINGS:
The study was conducted in the Simulation Laboratory
of a Nursing School, the Training Center at the Faculty of Medicine, and in the
inpatient clinics of the Education and Research Hospital.
PARTICIPANTS:
Fifty-two fourth-year nursing students.
METHODS:
Students were randomly assigned to Group I and Group
II. The students in Group 1 attended the thorax-lungs and cardiac examination
training using a high-fidelity simulator, while the students in Group 2 using
standardized patients. After the training sessions, all students practiced
their skills on real patients in the clinical setting under the supervision of
the investigator.
RESULTS:
Knowledge and performance scores of all students
increased following the simulation activities; however, the students that
worked with standardized patients achieved significantly higher knowledge
scores than those that worked with the high-fidelity simulator; however, there
was no significant difference in performance scores between the groups. The
mean performance scores of students on real patients were significantly higher
compared to the post-simulation assessment scores (p<0.001).
CONCLUSIONS:
Results of this study revealed that use of
standardized patients was more effective than the use of a high-fidelity
simulator in increasing the knowledge scores of students on thorax-lungs and
cardiac examinations; however, practice on real patients increased performance
scores of all students without any significant difference in two groups.
10. Cureus.
2016 Jun 19;8(6):e647. doi: 10.7759/cureus.647.
Merging Problem-Based Learning with Simulation-Based
Learning in the Medical Undergraduate Curriculum: The PAIRED Framework for
Enhancing Lifelong Learning.
Koh J1, Dubrowski A2.
Abstract
Lifelong learning is an essential trait that is
expected of every physician. The CanMeds 2005 Physician Competency Framework
emphasizes lifelong learning as a key competency that physicians must achieve
in becoming better physicians. However, many physicians are not competent at
engaging in lifelong learning. The current medical education system is
deficient in preparing medical students to develop and carry out their own lifelong
learning curriculum upon graduation. Despite understanding how physicians learn
at work, medical students are not trained to learn while working. Similarly,
although barriers to lifelong learning are known, medical students are not
adequately skilled in overcoming these barriers. Learning to learn is just as
important, if not more, as acquiring the skills and knowledge required of a
physician. The medical undergraduate curriculum lacks a specific learning
strategy to prepare medical students in becoming an adept lifelong learner. In
this article, we propose a learning strategy for lifelong learning at the
undergraduate level. In developing this novel strategy, we paid particular
attention to two parameters. First, this strategy should be grounded on
literature describing a physician's lifelong learning process. Second, the
framework for implementing this strategy must be based on existing
undergraduate learning strategies to obviate the need for additional resources,
learner burden, and faculty time. In this paper, we propose a Problem,
Analysis, Independent Research Reporting, Experimentation Debriefing (PAIRED)
framework that follows the learning process of a physician and serves to
synergize the components of problem-based learning and simulation-based
learning in specifically targeting the barriers to lifelong learning.
11. BMC Med
Educ. 2016 Jul 15;16(1):177.
A simulated night shift in the emergency room
increases students' self-efficacy independent of role taking over during
simulation.
Stroben F1,2, Schröder T3,4, Dannenberg KA3,5, Thomas
A 4,Exadaktylos A6, Hautz WE6.
Abstract
BACKGROUND:
Junior doctors do not feel well prepared when they
start into postgraduate training. High self-efficacy however is linked to
better clinical performance and may thus improve patient care. What factors
affect self-efficacy is currently unknown. We conducted a simulated night shift
in an emergency room (ER) with final-year medical students to identify factors
contributing to their self-efficacy and thus inform simulation training in the
ER.
METHODS:
We simulated a night in the ER using best educational
practice including multi-source feedback, simulated patients and vicarious
learning with 30 participants. Students underwent 7 prototypic cases in groups
of 5 in different roles (leader, member and observer). Feeling of preparedness
was measured at baseline and 5 days after the event. After every case students
recorded their confidence dependent of their role during simulation and
evaluated the case.
RESULTS:
Thirty students participated, 18 (60 %) completed all
surveys. At baseline students feel unconfident (Mean -0.34). Feeling of
preparedness increases significantly at follow up (Mean 0.66, p = 0.001,
d = 1.86). Confidence after simulation is independent of the role during
simulation (F(2,52) = 0.123, p = 0.884). Observers in a simulation can estimate
leader's confidence independent of their own (r = 0.188, p = 0.32) while team
members cannot (r = 0.61, p < 0.001).
CONCLUSIONS:
Simulation improves self-efficacy. The improvement of
self-efficacy is independent of the role taken during simulation. As a
consequence, groups can include observers as participants without impairing
their increase in self-efficacy, providing a convenient way for educators to
increase simulation efficiency. Different roles can furthermore be included
into multi-source peer-feedback
12. N Z Med J.
2016 Aug 5;129(1439):59-67.
Improved scores for observed teamwork in the clinical
environment following a multidisciplinary operating room simulation
intervention.
Weller JM1, Cumin D2, Civil ID3, Torrie J4, Garden A5,
MacCormick AD6,Gurusinghe N7, Boyd MJ8, Frampton C9, Cokorilo M10, Tranvik
M10,Carlsson L10, Lee T11, Ng WL12, Crossan M13, Merry AF14.
Abstract
AIMS:
We ran a Multidisciplinary Operating Room Simulation
(MORSim) course for 20 complete general surgical teams from two large
metropolitan hospitals. Our goal was to improve teamwork and communication in
the operating room (OR). We hypothesised that scores for teamwork and
communication in the OR would improve back in the workplace following MORSim.
We used an extended Behavioural Marker Risk Index (BMRI) to measure teamwork
and communication, because a relationship has previously been documented
between BMRI scores and surgical patient outcomes.
METHODS:
Trained observers scored general surgical teams in the
OR at the two study hospitals before and after MORSim, using the BMRI.
RESULTS:
Analysis of BMRI scores for the 224 general surgical
cases before and 213 cases after MORSim showed BMRI scores improved by more
than 20% (0.41 v 0.32, p<0.001). Previous research suggests that this
improved teamwork score would translate into a clinically important reduction
in complications and mortality in surgical patients.
CONCLUSIONS:
We demonstrated an improvement in scores for teamwork
and communication in general surgical ORs following our intervention. These
results support the use of simulation-based multidisciplinary team training for
OR staff to promote better teamwork and communication, and potentially improve
outcomes for general surgical patients
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