By Tate Skinner and Dr. Adam Dubrowski
1.
J Surg Educ. 2017 Jan 10. pii:
S1931-7204(16)30378-6. doi: 10.1016/j.jsurg.2016.12.008. [Epub ahead of print]
Practice Makes
Perfect: Correlations Between Prior Experience in High-level Athletics and
Robotic Surgical Performance Do Not Persist After Task Repetition.
Shee K1, Ghali FM2, Hyams ES3.
Author information:
1Geisel School of Medicine, Hanover, New Hampshire. Electronic
address: Kevin.Shee.MED@dartmouth.edu.
2Geisel School of Medicine, Hanover, New Hampshire.
3Department of Urology, Dartmouth-Hitchcock Medical Center,
Lebanon, New Hampshire.
Abstract
OBJECTIVE:
Robotic surgical skill development is central to training in
urology as well as in other surgical disciplines. Here, we describe a pilot
study assessing the relationships between robotic surgery simulator performance
and 3 categories of activities, namely, videogames, musical instruments, and athletics.
DESIGN:
A questionnaire was administered to preclinical medical students
for general demographic information and prior experiences in surgery,
videogames, musical instruments, and athletics. For follow-up performance
studies, we used the Matchboard Level 1 and 2 modules on the da Vinci Skills
Simulator, and recorded overall score, time to complete, economy of motion,
workspace range, instrument collisions, instruments out of view, and drops.
Task 1 was run once, whereas task 2 was run 3 times.
SETTING:
All performance studies on the da Vinci Surgical Skills Simulator
took place in the Simulation Center at Dartmouth-Hitchcock Medical Center.
PARTICIPANTS:
All participants were medical students at the Geisel School of
Medicine. After excluding students with prior hands-on experience in surgery, a
total of 30 students completed the study.
RESULTS:
We found a significant correlation between athletic skill level
and performance for both task 1 (p = 0.0002) and task 2 (p = 0.0009). No
significant correlations were found for videogame or musical instrument skill
level. Students with experience in certain athletics (e.g., volleyball, tennis,
and baseball) tended to perform better than students with experience in other
athletics (e.g., track and field). For task 2, which was run 3 times, this
association did not persist after the third repetition due to significant
improvements in students with low-level athletic skill (levels 0-2).
CONCLUSIONS:
Our study suggests that prior experience in high-level athletics,
but not videogames or musical instruments, significantly influences surgical
proficiency in robot-naive students. Furthermore, our study suggests that practice
through task repetition can overcome initial differences that may be related to
a background in athletics. These novel relationships may have broader
implications for the future recruitment and training of robotic surgeons and
may warrant further investigation.
Copyright © 2016 Association of Program Directors in Surgery.
Published by Elsevier Inc. All rights reserved.
2.
Clin Anat. 2016 May;29(4):446-53. doi:
10.1002/ca.22675. Epub 2015 Dec 26.
Personalized
augmented reality for anatomy education.
Ma M1, Fallavollita P1, Seelbach I2, Von Der Heide AM3, Euler E3,
Waschke J4, Navab N1,5.
Author information:
1Chair for Computer Aided Medical Procedures & Augmented
Reality, Technische Universität München, Munich, Germany.
2Ludwig-Maximilians, Universität München, Munich, Germany.
3Klinik Für Allgemeine, Unfall-, Hand- Und Plastische Chirurgie,
Klinikum Der Universität München, Munich, Germany.
4Anatomische Anstalt Der Ludwig-Maximilians-Universität München,
Munich, Germany.
5Johns Hopkins University, Baltimore, USA.
Abstract
Anatomy education is a challenging but vital element in forming
future medical professionals. In this work, a personalized and interactive
augmented reality system is developed to facilitate education. This system
behaves as a "magic mirror" which allows personalized in-situ
visualization of anatomy on the user's body. Real-time volume visualization of
a CT dataset creates the illusion that the user can look inside their body. The
system comprises a RGB-D sensor as a real-time tracking device to detect the
user moving in front of a display. In addition, the magic mirror system shows
text information, medical images, and 3D models of organs that the user can
interact with. Through the participation of 7 clinicians and 72 students, two
user studies were designed to respectively assess the precision and
acceptability of the magic mirror system for education. The results of the
first study demonstrated that the average precision of the augmented reality
overlay on the user body was 0.96 cm, while the results of the second study
indicate 86.1% approval for the educational value of the magic mirror, and
91.7% approval for the augmented reality capability of displaying organs in
three dimensions. The usefulness of this unique type of personalized augmented
reality technology has been demonstrated in this paper.
3.
Anaesth Crit Care Pain Med. 2017 Jan 18.
pii: S2352-5568(16)30114-X. doi: 10.1016/j.accpm.2016.11.007. [Epub ahead of
print]
Peripheral venous
catheter insertion simulation training: a randomized controlled trial comparing
performance after instructor-led teaching versus peer-assisted learning.
Pelloux S1, Grégoire A2, Kirmizigul P3, Maillot S4, Bui-Xuan B3,
Llorca G3, Boet S5, Lehot JJ6, Rimmelé T2.
Author information:
1Département de Médecine Générale, Faculté de Médecine Lyon Est,
Université Claude Bernard Lyon 1, France. Electronic address:
s.pelloux@gmail.com.
2Centre Lyonnais d'Enseignement par la Simulation en Santé,
Université Claude Bernard Lyon 1, France; Service d'Anesthésie-Réanimation,
Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
3Centre Lyonnais d'Enseignement par la Simulation en Santé,
Université Claude Bernard Lyon 1, France.
4Institut de Formation en Soins Infirmiers de Bourgoin-Jallieu,
France.
5Department of Anesthesiology and Pain Medicine, The Ottawa
Hospital, Ontario, Canada; Skills and Simulation Centre (uOSSC), The Ottawa
Hospital Research Institute, Ontario, Canada; Department of Innovation in
Medical Education, University of Ottawa, Ontario, Canada.
6Centre Lyonnais d'Enseignement par la Simulation en Santé,
Université Claude Bernard Lyon 1, France; Service d'Anesthésie-Réanimation,
Hôpital Pierre Wertheimer, Hospices Civils de Lyon, France.
Abstract
INTRODUCTION:
Peripheral venous catheter insertion is a procedural skill that
every medical student should master. Training is often limited to a small number
of students and is poorly evaluated. The objective of this study was to
evaluate the performance of peer-assisted learning in comparison to
instructor-led teaching for peripheral venous catheter insertion training.
METHODS:
Students were randomized to the control group attending a
traditional instructor-led training session (slideshow and demonstration by an
anaesthetist instructor, followed by training on a procedural simulator) or to
the test group attending a peer-assisted training session (slideshow and
demonstration video-recorded by the same instructor, followed by training on a
procedural simulator. The primary endpoint was the performance of peripheral
venous catheter insertion, assessed on procedural simulator one week later by
blinded experts using a standardized 20-item grid. Students self-evaluated
their confidence levels using a numeric 10-point scale.
RESULTS:
86 students were included, 73 of whom attended the assessment
session. The median performance score was 12/20 [8 - 15] in the instructor-led
teaching group versus 13/20 [11 - 15] in the peer-assisted learning group (p =
0.430). Confidence levels improved significantly after the assessment session
and were significantly higher in the peer-assisted learning group (7.6/10 [7.0
- 8.0] versus 7.0/10 [5.0 - 8.0], p = 0.026).
CONCLUSION:
Peer-assisted learning is effective for peripheral venous catheter
insertion training and can be as effective instructor-led teaching. Given the
large number of students to train, this finding is important for optimizing the
cost-effectiveness of peripheral venous catheter insertion training.
4.
Eur J Dent Educ. 2017 Jan 24. doi: 10.1111/eje.12254.
[Epub ahead of print]
The effect of
repeated testing vs repeated practice on skills learning in undergraduate
dental education.
Sennhenn-Kirchner S1,2, Goerlich Y3, Kirchner B1, Notbohm M 4,
Schiekirka S3, Simmenroth A3,5, Raupach T4,6.
Author information:
1Department of Oral and Maxillofacial Surgery, University Medical
Centre Goettingen, Göttingen, Germany.
2Dental skills lab SINUZ, University Medical Centre Goettingen,
Göttingen, Germany.
3Student Training Centre of Clinical Practice and Simulation,
University Medical Centre Goettingen, Göttingen, Germany.
4Study Deanery, University Medical Center Goettingen, Göttingen,
Germany.
5Department of General Practice, University Medical Centre
Goettingen, Göttingen, Germany.
6Department of Cardiology & Pneumology, University Medical
Centre Goettingen, Göttingen, Germany.
Abstract
OBJECTIVES:
Recent studies in undergraduate medical education have
demonstrated the advantage of repeated testing over repeated practice with
regard to knowledge and skills retention. The aim of this study was to
investigate whether this "testing effect" also applies to skills
retention in undergraduate dental education.
METHODS:
In this prospective, randomised controlled trial, fourth-year
dental students at Göttingen University Medical Centre participated in a
training session on surgical suturing in winter term 2014/2015. Following this,
they were either assigned to two sessions of additional skills training (group
A) or two sessions of skills assessment with feedback (group B). These sessions
were spaced over a period of 4 weeks. Skills retention was assessed in a
summative objective structured clinical examination (OSCE) at the end of term,
that is 6 months after the initial teaching session.
RESULTS:
A total of 32 students completed the study. With regard to
suturing, OSCE performance was significantly better in group B than group A
(81.9±13.1% vs 63.0±15.4%; P=0.001; Cohen's d=1.33). There was no significant
OSCE performance difference in the two groups with regard to other learning
objectives that were addressed in the end-of-term examination. Thus, the group
difference was specific to suturing skills.
CONCLUSIONS:
This is the first study to demonstrate that in dental education,
repeated testing produces more favourable skills retention than repeated
practice. Test-enhanced learning might be a viable concept for skills retention
in undergraduate dentistry education.
5.
J Ultrasound Med. 2017 Jan 27. doi:
10.7863/ultra.15.12025. [Epub ahead of print]
Learner
Improvement From a Simulation-Enhanced Ultrasonography Curriculum for
First-Year Medical Students.
Miller GT1, Scerbo MW2, Zybak S2, Byars DV1, Goodmurphy CW1,
Lattanzio FA1, Knapp BJ1, Toreno F1, Levitov A1, Shaves S1, Abuhamad A1.
Author information:
1Eastern Virginia Medical School, Norfolk, Virginia, USA.
2Old Dominion University, Norfolk, Virginia, USA.
Abstract
OBJECTIVES:
We describe a simulation-enhanced ultrasonography (US) curriculum
for first-year medical students as part of a comprehensive curricular
integration of US skills. Our goal was to assess student knowledge and
performance of US and determine their satisfaction with the integrated
curriculum.
METHODS:
A committee of basic science, clinical, and interinstitutional
faculty developed 7 educational US modules integrated into existing anatomy and
physiology courses. First-year students in years 2012 through 2014 were
administered a demographic survey and a knowledge-based pretest at the outset
of the US program and assessed with a posttest, satisfaction survey, and their
image acquisition abilities in an objective structured clinical examination
with standardized patients on completion of the program.
RESULTS:
Data from 390 students showed a significant increase in knowledge
from the pretest to the posttest [t(389) = 58.027; P < .0001]. Students
with higher spatial abilities or some previous US experience performed better
on the posttest. The objective structured clinical examination results showed
that about 83% of the students were able to capture acceptable or marginally
acceptable images. Ninety-five percent of students indicated that the US
educational experience enhanced their medical education.
CONCLUSIONS:
Initial results show that we were able to successfully develop,
implement, and evaluate performance of first-year medical students on their
fundamental knowledge and performance of basic US using a model that emphasized
hands-on simulation-enhanced training. Furthermore, most students found the
experience to be a beneficial component of their education and indicated a
desire for more US training in the medical curricula.
6.
Anaesthesia. 2017 Jan 27. doi:
10.1111/anae.13812. [Epub ahead of print]
The application
of three-dimensional printing technology in anaesthesia: a systematic review.
Chao I1, Young J2, Coles-Black J3, Chuen J4, Weinberg L4, Rachbuch
C1.
Author information:
1Department of Anaesthesia, Box Hill Hospital, Eastern Health,
Melbourne, Victoria, Australia.
2Department of Anaesthesia and Acute Pain Medicine, St Vincent's
Hospital, Melbourne, Victoria, Australia.
3Melbourne Medical School, The University of Melbourne, Parkville,
Victoria, Australia.
4Austin Health, Melbourne, Victoria, Australia.
Abstract
Three-dimensional printing has rapidly become an easily
accessible, innovative and versatile technology, with a vast range of
applications across a wide range of industries. There has been a recent
emergence in the scientific literature relating to its potential application
across a multitude of fields within medicine and surgery; however, its use
within anaesthesia has yet to be formally explored. We undertook a systematic
review using MEDLINE and EMBASE databases of three-dimensional printing in
anaesthesia. We identified eight relevant articles. Due to the paucity of
studies, we also completed a narrative review of the applications of
three-dimensional printing pertinent to anaesthetic practice that our
department are currently exploring, and suggest potential future uses for this
technology relevant to our speciality.
© 2017 The Association of Anaesthetists of Great Britain and
Ireland.
7.
Acad Pediatr. 2017 Jan 23. pii:
S1876-2859(17)30012-8. doi: 10.1016/j.acap.2017.01.010. [Epub ahead of print]
A Virtual Reality
Curriculum for Pediatric Residents Decreases Rates of Influenza Vaccine
Refusal.
Real FJ1, DeBlasio D2, Beck AF3, Ollberding NJ4, Davis D5, Cruse
B5, Samaan Z2, McLinden D6, Klein MD3.
Author information:
1Division of General and Community Pediatrics, Cincinnati
Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229
United States. Electronic address: francis.real@cchmc.org.
2Division of General and Community Pediatrics, Cincinnati
Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229
United States.
3Division of General and Community Pediatrics, Cincinnati
Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229
United States; Division of Hospital Medicine, Cincinnati Children's Hospital
Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States.
4Division of Biostatistics and Epidemiology, Cincinnati Children's
Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States.
5Division of Learning and Development, Cincinnati Children's
Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States.
6Division of General and Community Pediatrics, Cincinnati
Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229
United States; Division of Learning and Development, Cincinnati Children's
Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States.
Abstract
OBJECTIVE:
Influenza vaccine hesitancy is common in the primary care setting.
Though physicians can affect caregivers' attitudes toward vaccination,
physicians report uneasiness discussing vaccine hesitancy. Few studies have
targeted physician-patient communication training as a means to decrease
vaccination refusal.
METHODS:
An immersive virtual reality (VR) curriculum was created to teach
pediatric residents communication skills when discussing influenza vaccine
hesitancy. This pilot curriculum consisted of three VR simulations during which
residents counseled graphical character representatives (avatars) who expressed
vaccine hesitancy. Participants were randomized to the intervention (n=24) or
the control group (n=21). Only residents in the intervention group underwent
the VR curriculum. Impact of the curriculum was assessed through difference in
influenza vaccine refusal rates between the intervention and control groups in
the three months following the VR curriculum.
RESULTS:
Participants included postgraduate level (PL) 2 and PL3 pediatric
residents. All eligible residents (n=45) participated and the survey response
rate was 100%. In patients aged 6-59 months, residents in the intervention
group had a decreased rate of influenza vaccination refusal in the post-curriculum
period when compared to the control group (27.8% v. 37.1%; p=0.03).
CONCLUSIONS:
This pilot study suggests that immersive VR might be an effective
modality to teach communication skills to medical trainees. Next steps include
evaluation of the curriculum in a larger, multi-site trial.
8.
J Pediatr Surg. 2017 Jan 10. pii:
S0022-3468(17)30008-8. doi: 10.1016/j.jpedsurg.2017.01.003. [Epub ahead of
print]
Piloting a
pediatric trauma course in Western Jamaica: Lessons learned and future
directions.
Wesson HK1, Plant V2, Helou M3, Wharton K4, Fray D5, Haynes J2,
Bagwell C6.
Author information:
1Department of Surgery, Johns Hopkins University, Baltimore, MD,
USA.
2Division of Pediatric Surgery, Department of Surgery, Virginia
Commonwealth University Health System, Richmond, VA, USA.
3Department of Pediatrics, Virginia Commonwealth University Health
System, Richmond, VA, USA.
4Department of Neonatology, Mednax, Richmond, VA, USA.
5Department of Pediatric Surgery, Cornwall Hospital, Montego Bay,
Jamaica.
6Division of Pediatric Surgery, Department of Surgery, Virginia
Commonwealth University Health System, Richmond, VA, USA. Electronic address:
Charles.bagwell@vcuhealth.org.
Abstract
INTRODUCTION:
Pediatric injuries are a leading cause of death in low- and
middle-income countries (LMICs). Despite this, there are few formal
pediatric-specific trauma educational initiatives available in LMICs. While new
educational tools are being developed to address this, they have not been
piloted in LMICs. In Jamaica, pediatric injuries are a leading cause of
hospital admission but care is limited by a lack of training in triage and
stabilization. Our objective was to implement and evaluate a pediatric trauma
course in Jamaica to determine the impact this may have on further course
development.
MATERIALS AND METHODS:
A pediatric trauma course was conducted at the Cornwall Regional
Hospital in Montego Bay, Jamaica sponsored by the Children's Medical Services
International, a nonprofit organization. Participants took part in six didactic
modules, an infant airway intubation skills session, and three clinical
simulation scenarios. Participants completed a postcourse survey at the
conclusion of the course.
RESULTS:
Twenty-five participants including surgical, pediatric, and
emergency medicine residents from regional- and district-level hospitals in
Jamaica participated in the course. Participants viewed the course favorably.
Strengths included good review of pediatric trauma physiology, short modules,
hands-on practice, and applicable clinical scenarios. Using a Likert-type
rating scale of 1 to 10, with 1 being minimal and 10 being very knowledgeable,
precourse knowledge was ranked as 5.9, which increased to 9.2 after the course.
Using a similar scale, the precourse comfort level to run a pediatric trauma
was 4.9 and increased to 8.5 following the course.
DISCUSSION:
Implementation of this pilot pediatric trauma course was feasible
and successful through collaboration with the hosting regional hospital. The
lack of formal pediatric training can be overcome by a course such as this
which includes both didactics and hands-on clinical patient simulations.
LEVEL OF EVIDENCE:
4.
9.
J Obstet Gynaecol. 2017 Jan 31:1-4.
doi: 10.1080/01443615.2016.1196476. [Epub ahead of print]
Training on
Kielland's forceps: A survey of trainees' opinions.
Al Wattar BH1, Mahmud A2,3, Janjua A2,3, Parry-Smith W4,5, Ismail
KM2,3.
Author information:
1a Women's Health Research Unit - Blizard Institute - Barts and
the London School of Medicine and dentistry, Queen Mary University , London ,
UK.
2b Birmingham Women's Hospital - Mindelsohn Way , Birmingham , UK.
3c Birmingham Centre for Women's and Children's Health, School of
Clinical and Experimental Medicine, College of Medical and Dental Sciences,
University of Birmingham , Birmingham , UK.
4d The Maternity Centre, University Hospital of North
Staffordshire , Stoke-On-Trent , UK.
5e Clinical Education Centre, Keele University , Staffordshire ,
UK.
Abstract
We conducted a cross-sectional survey including specialist
trainees in obstetrics and gynaecology in the Health Education West Midlands
region, UK, to capture their views and assess training opportunities on the use
of Kielland's forceps. Half of the trainees in the region completed the survey
(87/172, 50%). Only 31% of our trainees worked in units that supported the
training on these forceps (27/87, 31%). The majority reported that they did not
get enough exposure to using Kielland's forceps (53/87, 60.9%). Only a minority
(5.7%, 5/87) felt confident to perform a Kielland's rotational delivery
independently. The majority (64.3%, 56/87) were keen to continue using
Kielland's forceps in the future if competent. More than two-thirds (86.2%,
75/87) felt that simulation could aid their training. There was large
enthusiasm for training on the safe use of Kielland's forceps among trainees in
obstetrics and gynaecology in the West Midlands region. A national assessment
of training resources is needed to better plan training recourses on this
complex skill.
10.
Nurse Educ. 2017 Feb 1. doi:
10.1097/NNE.0000000000000365. [Epub ahead of print]
Interprofessional
Mass Casualty Incident Simulation Design Protocol to Prepare Prelicensure
Nursing Students to Respond to a Disaster.
Strout K1, Saber DA, Caruso LS, Ingwell-Spolan C, Koplovsky A,
Caron EM, Federico J, Hulst C, Etro I.
Author information:
1Author Affiliations: Assistant Professor (Drs Strout, Saber, and
Ingwell-Spolan), Lecturer (Dr Caruso), Student (Mr Hulst and Ms Federico),
School of Nursing, University of Maine, Orono; Staff Developer, Clinical
Education Eastern Maine Medical Center, Bangor (Ms Caron); Assistant Chief,
University Volunteer Ambulance Corps, University of Maine, Orono (Mr
Koplovsky); and Student, School of Theater and Performing Arts (Ms Eltro).
Abstract
Nurses need to be prepared to respond to mass casualty incidents.
Simulation is an ideal teaching intervention that can be used to prepare
nursing students to effectively triage patients and allocate limited resources.
This article describes a detailed interprofessional mass casualty simulation of
a bus crash with 32 victims. Nursing students trained with emergency responders
with students acting as charge nurses throughout the simulation. The details of
the simulation are provided for faculty to replicate.
PMID: 28146034 [PubMed - as supplied by publisher]
11.
Ann Am Thorac Soc. 2017 Feb 3. doi:
10.1513/AnnalsATS.201610-773OC. [Epub ahead of print]
How Well Prepared
Are Medical and Nursing Students to Identify Common Hazards in the ICU?
Clay AS1, Chudgar SM2, Turner KM3, Vaughn J4, Knudsen NW5, Farnan
JM6, Arora VM7, Molloy MA8.
Author information:
1Duke University, Department of Surgery and Medicine , DUMC 2945 ,
Durham, North Carolina, United States , 27710 ; alison.clay@duke.edu.
2Duke University School of Medicine, Medicine , DUMC 3534 ,
Durham, North Carolina, United States , 27710 ; saumil.chudgar@duke.edu.
3Duke University School of Nursing, Durham, North Carolina, United
States ; kathleen.turner@duke.edu.
4Duke University School of Nursing, Durham, North Carolina, United
States ; jacqueline.vaughn@duke.edu.
5Duke University School of Medicine, 12277, Anesthesiology,
Durham, North Carolina, United States ; nancy.knudsen@duke.edu.
6University of Chicago Medicine, Medicine, Chicago, Illinois,
United States ; jfarnan@medicine.bsd.uchicago.edu.
7University of Chicago, Department of Medicine, Chicago, Illinois,
United States ; varora@medicine.bsd.uchicago.edu.
8Duke University School of Nursing, Center for Nursing Discovery,
Durham, North Carolina, United States ; margory.molloy@duke.edu.
Abstract
RATIONALE:
Care in the hospital is hazardous. Harm in the hospital may
prolong hospitalization, increase suffering, result in death, and increase
costs of care. While the interprofessional team is critical to eliminating
hazards that may result in adverse events to patients, professional students'
formal education may not prepare students adequately for this role.
OBJECTIVES:
To determine if medical and nursing students can identify hazards
of hospitalization that could result in harm to patients and to detect differences
between professions in the types of hazards identified.
METHODS:
Mixed-methods observational study of graduating nursing (n=51) and
medical students (n=93) who completed two "Room of Horrors"
simulations to identify patient safety hazards. Qualitative analysis was used
to extract themes from students' written hazard descriptions. Fisher's exact
test was used to determine differences in frequency of hazards identified
between groups.
RESULTS:
Identification of hazards by students was low: 66% did not
identify missing personal protective equipment for a patient on contact
isolation, and 58% did not identify a medication administration error
(medication hanging for a patient with similar name). Interprofessional
differences existed in how hazards were identified: medical students noted that
restraints were not indicated (73% vs. 2%, p<0.001), while nursing students
noted that there was no order for the restraints (58.5% vs. 0%, p<0.0001).
Nursing students discovered more issues with malfunctioning or incorrectly used
equipment than medical students. Teams performed better than individuals,
especially for hazards in the second simulation that were similar to the first:
need to replace a central line with erythema (73% teams identified) versus need
to replace a peripheral intravenous (10% individuals, p<0.0001). Nevertheless,
teams of students missed many ICU-specific hazards: 54% failed to identify the
presence of pressure ulcers, 85% did not notice high tidal volumes on the
ventilator, and 90% did not identify the absence of missing spontaneous
awakening/breathing trials and absent stress ulcer prophylaxis.
CONCLUSIONS:
Graduating nursing and medical students missed several hazards of
hospitalization, especially those related to the ICU. Orientation for residents
and new nurses should include education on hospitalization hazards. Ideally,
this orientation should be interprofessional to allow appreciation for each
other's roles and responsibilities.
12.
BMC Med Educ. 2017 Feb 8;17(1):36.
doi: 10.1186/s12909-017-0871-x.
Immersive high
fidelity simulation of critically ill patients to study cognitive errors: a
pilot study.
Prakash S1,2, Bihari S3, Need P4, Sprick C5, Schuwirth L6,7.
Author information:
1Prideaux Centre for Research in Health Professions Education,
Flinders University, Bedford Park, South Australia, 5042, Australia. shivesh.prakash@health.sa.gov.au.
2Department of Intensive care, Flinders Medical Centre, 1 Flinders
drive, Bedford Park, South Australia, 5042, Australia.
shivesh.prakash@health.sa.gov.au.
3Department of Intensive care, Flinders Medical Centre, 1 Flinders
drive, Bedford Park, South Australia, 5042, Australia.
4Director of General Practice Training, Flinders Medical Centre,
Flinders Drive, Bedford Park, SA, 5042, Australia.
5Simulation Unit, School of Medicine - Flinders University,
Bedford Park, South Australia, 5042, Australia.
6Prideaux Centre for Research in Health Professions Education,
Flinders University, Bedford Park, South Australia, 5042, Australia.
7Health Professions Education, School of Medicine, Flinders
University, Bedford Park, South Australia, 5042, Australia.
Abstract
BACKGROUND:
The majority of human errors in healthcare originate from
cognitive errors or biases. There is dearth of evidence around relative
prevalence and significance of various cognitive errors amongst doctors in
their first post-graduate year. This study was conducted with the objective of
using high fidelity clinical simulation as a tool to study the relative
occurrence of selected cognitive errors amongst doctors in their first
post-graduate year.
METHODS:
Intern simulation sessions on acute clinical problems, conducted
in year 2014, were reviewed by two independent assessors with expertise in
critical care. The occurrence of cognitive errors was identified using Likert
scale based questionnaire and think-aloud technique. Teamwork and leadership
skills were assessed using Ottawa Global Rating Scale.
RESULTS:
The most prevalent cognitive errors included search satisfying
(90%), followed by premature closure (PC) (78.6%), and anchoring (75.7%). The
odds of occurrence of various cognitive errors did not change with time during
internship, in contrast to teamwork and leadership skills (x2 = 11.9,
P = 0.01). Anchoring appeared to be significantly associated with delay in
diagnoses (P = 0.007) and occurrence of PC (P = 0.005). There was a negative
association between occurrence of confirmation bias and the ability to make
correct diagnosis (P = 0.05).
CONCLUSIONS:
Our study demonstrated a high prevalence of anchoring, premature
closure, and search satisfying amongst doctors in their first post-graduate
year, using high fidelity simulation as a tool. The occurrence of selected
cognitive errors impaired clinical performance and their prevalence did not
change with time.
13.
BMC Med Educ. 2017 Feb 10;17(1):37.
doi: 10.1186/s12909-017-0876-5.
Medical students'
situational motivation to participate in simulation based team training is
predicted by attitudes to patient safety.
Escher C1,2, Creutzfeldt J3,4, Meurling L3,4, Hedman L4,5, Kjellin
A4,6, Felländer-Tsai L4,7.
Author information:
1Department of Clinical Science Intervention and Technology
(CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet,
Stockholm, Sweden. cecilia.escher@sll.se.
2Center for Advanced Medical Simulation and Training (CAMST),
Karolinska University Hospital, Stockholm, Sweden. cecilia.escher@sll.se.
3Department of Clinical Science Intervention and Technology
(CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet,
Stockholm, Sweden.
4Center for Advanced Medical Simulation and Training (CAMST),
Karolinska University Hospital, Stockholm, Sweden.
5Department of Psychology, Umeå University, Umeå, Sweden.
6Department of Clinical Science Intervention and Technology
(CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden.
7Department of Clinical Science Intervention and Technology
(CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet,
Stockholm, Sweden.
Abstract
BACKGROUND:
Patient safety education, as well as the safety climate at
clinical rotations, has an impact on students' attitudes. We explored medical
students' self-reported motivation to participate in simulation-based teamwork
training (SBTT), with the hypothesis that high scores in patient safety
attitudes would promote motivation to SBTT and that intrinsic motivation would
increase after training.
METHODS:
In a prospective cohort study we explored Swedish medical
students' attitudes to patient safety, their motivation to participate in SBTT
and how motivation was affected by the training. The setting was an integrated
SBTT course during the surgical semester that focused on non-technical skills
and safe treatment of surgical emergencies. Data was collected using the
Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety
Questionnaire (APSQ).
RESULTS:
We found a positive correlation between students' individual
patient safety attitudes and self-reported motivation (identified regulation)
to participate in SBTT. We also found that intrinsic motivation increased after
training. Female students in our study scored higher than males regarding some
of the APSQ sub-scores and the entire group scored higher or on par with
comparable international samples.
CONCLUSION:
In order to enable safe practice and professionalism in
healthcare, students' engagement in patient safety education is important. Our
finding that students' patient safety attitudes show a positive correlation to
motivation and that intrinsic motivation increases after training underpins
patient safety climate and integrated teaching of patient safety issues at
medical schools in order to help students develop the knowledge, skills and
attitudes required for safe practice.
