Current assessment and future directions of surgical skills laboratories

BACKGROUND

Educational, medicolegal, and financial constraints have pushed surgical residency programs to find alternative methods to operating room teaching for surgical skills training. Several studies have demonstrated that the use of skills laboratories is effective and enhances performance; however, little is known about the facilities available to residents.

STUDY DESIGN

A survey was distributed to 40 general surgery program directors who, in an earlier questionnaire, indicated that they had skills laboratory facilities at their institutions. The survey included the following sections: demographics, facilities, administrative infrastructure, curriculum, learners, and opinions/thoughts of program directors.

RESULTS

Of the 34 program directors that completed the survey, 76% are from a university program. The average facility is 1400 square feet, and most skills laboratories are located in the hospital. Nearly all skills facilities have dry laboratories (90%), and the most common equipment is box trainers (90%). Average start-up costs were $450,000. Sixty-two percent of programs have a skills curriculum for residents. Responders agreed that skills laboratories have a high value and should be part of residency curricula.

CONCLUSIONS

The results of this survey provide a preliminary view of skills laboratories. There is variation in the size, location, and availability of simulators in skills laboratory facilities. Variations also exist in types of curricula formats, subspecialties who make use of the laboratory, and some administrative approaches. There is strong agreement among respondents that skills laboratories are a necessary and valuable component of residency education. Results also indicated concerns for recruiting faculty to teach in the skills laboratory, securing ongoing funding, and implementing a skills laboratory curriculum.

Computer-assisted mammography feedback program (CAMFP) an electronic tool for continuing medical education

RATIONALE AND OBJECTIVES

Our goal was to develop and evaluate software to support a computer assisted mammography feedback program (CAMFP) to be used for continuing medical education (CME).

MATERIALS AND METHODS

Thirty-five radiologists from our region signed consent to participate in an institutional review board-approved film-reading study. The radiologists primarily assessed digitized mammograms and received feedback in five film interpretation sessions. A bivariate analysis was used to evaluate the joint effects of the training on sensitivity and specificity, and the effects of image quality on reading performance were explored.

RESULTS

Interpretation was influenced by the CAMFP intervention: Sensitivity increased (Delta sensitivity = 0.086, P < .001) and specificity decreased (Delta specificity = -0.057, P = .04). Variability in interpretation among radiologists also decreased after the training sessions (P = .035).

CONCLUSION

The CAMFP intervention improved sensitivity and decreased variability among radiologist's interpretations. Although this improvement was partially offset by decreased specificity, the program is potentially useful as a component of continuing medical education of radiologists. Dissemination via the web may be possible using digital mammography.

The Neighborhood: a Web-based platform to support conceptual teaching and learning

The need for reform in nursing education has been clearly defined.The difficulty has been in finding ways to facilitate the process. This article describes an innovative web-based virtual community, The Neighborhood, used to promote conceptual learning across a new curriculum at the University of New Mexico College of Nursing. The Neighborhood features 30 fictional characters that represent various cultural and socioeconomic backgrounds and demonstrate a range of health and psychosocial prob-lems. These characters interact with various community agencies in numerous health care settings. The Neighborhood has strong links to three well-founded teaching strategies: storytelling, case-based learning, and interpretive pedagogy. Because the cases unfold over time, in much the same way problems develop in real life, ongoing exposure to a concept is permitted, facilitating deep understanding.

Dedicated core clerkship in radiology for medical students development, implementation, evaluation, and comparison with distributed clerkship

RATIONALE AND OBJECTIVES

The authors performed this study to develop, implement, and evaluate a dedicated core clerkship in radiology for the required clinical clerkship year of medical school, and to compare it with the distributed core clerkship that it replaced.

MATERIALS AND METHODS

A dedicated 5-day clerkship was added to the clinical core year of medical school. The course offered a variety of learning experiences, including lectures, clinical observation, case discussions, and a team project. Learner achievement was measured by posttest and compared with a control group. Student satisfaction was determined by structured and unstructured surveys. Faculty comment was elicited by survey, and administrative staff perspective was established through interviews. The evaluation of the dedicated clerkship was compared with the distributed clerkship along the dimensions of learner achievement, student satisfaction, faculty comment, and administrative staff perspective.

RESULTS

The dedicated clerkship was developed and implemented successfully. Compared with the distributed clerkship, there was no significant difference in learner achievement or student satisfaction for the dedicated clerkship, but the dedicated clerkship was easier to conduct for faculty and administrative staff.

CONCLUSION

The dedicated clerkship was advantageous for faculty and administrative staff, whereas maintaining a comparable level of learner achievement and student satisfaction as the distributed clerkship.

Designing Learning Experiences

Creation of significant learning experiences follows basic steps of instructional design related to situational factors, goals and objectives, feedback and evaluation methods, teaching and learning activities, alignment of the preceding elements, and course evaluation. Goals should reflect what students will learn at the end of the course and what will still be with them several years later. Objectives should focus on learner performance, not teacher performance, and on behavior, not subject matter; there should be only one learning outcome per objective. Students learn more and retain their knowledge longer if they acquire it in an active rather than a passive manner. The situational factors, goals and objectives, feedback and evaluation, and teaching and learning activities should all reflect and support each other. The act of course evaluation closes the educational loop of design, implement, evaluate, and modify.

Human Patient Simulation

The use of human patient simulation as a teaching methodology for nursing students has become popular. Using human patient simulation effectively demands paying careful attention to the details of the simulation, debriefing, and evaluation processes. Our experience in designing simulation experiences and evaluating student behaviors confirms the resource-intensive nature of human patient simulation and the need for clear, measurable objectives. When used properly, human patient simulation offers a unique opportunity to teach nursing students important patient safety principles.

Contextual interference effects in learning volleyball skills

The aim of this study was to examine the contextual interference effect on learning three volleyball skills. Participants were 26 novice female volleyball players (M age= 12.4 yr., SD= 1.2). They were assigned into two groups, Low Interference (n = 13) and High Interference (n = 13). Two practice schedules were used: blocked (Low Interference) and random (High Interference). The training period lasted for 10 weeks and included 2 training sessions of 75 min. each per week. The pretest was performed before the first training session, the posttest was performed after the completion of the last training period, and the retention test was performed two weeks after the posttest. A 2 (Groups) x 3 (Measurement Periods) analysis of variance with repeated measures indicated significant improvement in performance between pre- and posttests for both High Interference and Low Interference groups for the three skills included in this study. There was no significant main effect of group or interaction effect of group and measure. These findings suggest that either blocked or random practice could be effectively used in learning of volleyball skills by unskilled children.

Integrating imaging informatics into the radiology residency curriculum: rationale and example curriculum

Imaging informatics, as part of the wider emerging discipline of medical informatics, remains poorly defined. However, many educators agree that formalized and flexible training in the collection, display, manipulation, storage, retrieval, and communication of imaging data, as well as the integration of these data into larger databases, should be introduced into the period of radiology residency training. The authors review the importance of such training to those individuals now preparing for clinical practice and research. They describe a sample imaging informatics curriculum that can be incorporated into a 4-year radiology residency program and the significance of such training in establishing a new subdiscipline focusing on imaging information technologies.

Simply the Best: Teaching Gerontological Nursing Students to Teach Evidence-Based Practice

This article describes a teaching strategy used in an undergraduate gerontological nursing clinical course to familiarize students with evidence-based practice. Students are required to read and summarize an assigned evidence-based practice guideline published by The University of Iowa Gerontological Nursing Interventions Research Center. They then develop a "tip sheet," based on the assigned guideline, to disseminate to health care staff at their practicum sites, which is either a long-term care facility or a hospital-based skilled nursing facility. Nursing students' reactions to the assignment and nursing staff's responses to the tip sheets are discussed.

Use of the innovation-decision process teaching strategy to promote evidence-based practice

The purpose of this article is to describe the innovation-decision process teaching strategy (I-DPTS) based on the model of diffusion of innovations [Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press]. A goal of baccalaureate nursing education is to develop competencies required for evidence-based practice. Such practice merges clinician expertise, patient preferences, and critical evaluation of the literature to improve patient outcomes and reduce health care costs [Melnyk, B. M. (2005). A primer on evidence-based practice. Paper presented at the Purdue School of Nursing Seventh Annual Helen R. Johnson Leadership Conference, West Lafayette, IN]. Several strategies to promote evidence-based practice have appeared in the literature. However, when they are examined in light of the innovation-decision process (Rogers, 2003), they do not address all the essential steps for adoption to occur. The I-DPTS allows students to achieve competencies necessary to overcome barriers associated with implementing best practices. This strategy was successfully implemented in a senior-level introductory nursing research class. Community representatives identified practice issues that could be addressed by student groups. After conducting a search of the literature, students analyzed the evidence, determined best practice based on the evidence, and developed a policy for implementation in clinical settings. At course end, representatives were invited to attend oral and poster presentations. Use of the I-DPTS better prepares students to implement best practice as they embark on their professional careers.

Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units

AIMS

The authors developed a video-centred teaching program based on social learning principles to demonstrate hand-washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand-washing skills.

BACKGROUND

Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital-acquired infections. A number of studies have shown that increased compliance with hand-washing guidelines for health-care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first.

STUDY DESIGN

Quasi-experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention.

METHODS

A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups - one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand-washing skills using simple illustrations. A 20-item hand-washing checklist was used to examine hand-washing compliance and accuracy.

RESULTS

No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels.

CONCLUSION

The video-based teaching program was effective in increasing compliance and accuracy with a hand-washing policy among families with children in intensive care units.

RELEVANCE TO CLINICAL PRACTICE

The education program is a simple, low-cost, low technology intervention for substantially reducing the incidence of nosocomial infection.

Diversity and the NCLEX-RN: a double-loop approach

The United States is increasingly ethnically diverse. To provide culturally congruent care to this changing population, nursing programs must attract and support ethnically diverse students through to successful completion of the National Council Licensure Examination for Registered Nurses. Critically examining the literature on this topic revealed three themes: need for a diverse nursing workforce, lack of formal evidence, and narratives of concern. A double-loop theoretical approach that encompasses interventions in elementary and secondary schools, traditional student support services, faculty development initiatives focused on cultural competence, formative and summative evaluations, quantitative and qualitative research, and evidence-based interventions is proposed to address this multifaceted concern.

Teaching Can Never Be Innocent: Fostering an Enlightening Educational Experience

Becoming cognizant of the actual and potential oppressive dimensions of the teaching practices of nurse educators is essential in establishing a more democratic and enlightening experience for both teachers and students. Although there has been an ardent trend toward the promotion of critical thinking and reflective ability among nursing students, rarely has attention focused on the ability of nurse educators to be critically reflective of their own teaching. The authors pose key questions about the reality of nursing education today and how it can sometimes continue to reflect a philosophy that seems to contravene the notion of a more liberated approach to teaching. In that process, they reflect critically on the subtle incongruities and complexities between teachers' intentions and their practice.

Revitalizing the humanistic imperative in nursing education

This article describes a teaching strategy that focuses students' attention on the humanistic imperative in nursing practice. The Humanistic Teaching Method provides a framework for adapting nursing courses to accommodate person-to-person, human-centered nursing care alongside scientific and technological competencies. Through this approach, students integrate concepts such as humanism, existentialism, and phenomenology into patient interactions. In addition to producing a favorable effect on patients and colleagues, this approach contributes to personal gratification in making a difference in the lives of others. Pedagogical strategies currently in use may need to be modified to accommodate the humanistic conceptual framework.

Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors' skills and attitudes towards teachers and teaching

BACKGROUND

Development of students' teaching skills is increasingly recognised as an important component of UK undergraduate medical curricula and, in consequence, there is renewed interest in the potential benefits of cross-year peer tutoring. Whilst several studies have described the use of cross-year peer tutoring in undergraduate medical courses, its use in the clinical setting is less well reported, particularly the effects of peer tutoring on volunteer tutors' views of teachers and teaching. This study explored the effects of participation in a cross-year peer tutoring programme in clinical examination skills ('OSCE tutor') on volunteer tutors' own skills and on their attitudes towards teachers and teaching.

METHODS

Volunteer tutors were final year MBChB students who took part in the programme as part of a Student Selected Component (SSC). Tutees were year 3 MBChB students preparing for their end of year 'OSCE' examination. Pre and post participation questionnaires, including both Likert-type and open response questions, were used. Paired data was compared using the Wilcoxon signed-rank test. All tests were two-tailed with 5% significance level.

RESULTS

Tutors reflected their cohort in terms of gender but were drawn from among the more academically successful final year students. Most had previous teaching experience. They were influenced to participate in 'OSCE tutor' by a desire to improve their own teaching and associated generic skills and by contextual factors relating to the organisation or previous experience of the OSCE tutor programme. Issues relating to longer term career aspirations were less important. After the event, tutors felt that participation had enhanced their skills in various areas, including practical teaching skills, confidence in speaking to groups and communication skills; and that as a result of taking part, they were now more likely to undertake further teacher training and to make teaching a major part of their career. However, whilst a number of students reported that their views of teachers and teaching had changed as a result of participation, this did not translate into significant changes in responses to questions that explored their views of the roles and qualities required of a good clinical teacher.

CONCLUSION

Findings affirm the benefits to volunteer tutors of cross-year peer tutoring, particularly in terms of skills enhancement and reinforcement of positive attitudes towards future teaching responsibilities, and have implications for the design and organisation of such programmes.

An instructional seminar for online case-based discussions

OBJECTIVE

To assess a training seminar developed to prepare pharmacy instructors to facilitate online discussions.

DESIGN

A 2-part seminar was developed to train faculty members and teaching assistants to facilitate online case-based discussions. A preseminar survey instrument was distributed to potential attendees and a postseminar survey instrument was given to those who attended the seminar.

ASSESSMENT

Twenty (91%) instructors completed the preseminar survey instrument. Eleven of these instructors attended at least 1 session of the seminar and indicated that the didactic and/or application portions were either "helpful" or "very helpful." These faculty members and teaching assistants also completed the postseminar survey instrument and conveyed a significant increase in level of comfort in their ability to facilitate online case-based discussions (p=0.004). The 3 most frequently perceived barriers to online teaching remained consistent despite training or teaching experience.

CONCLUSIONS

After attending a training seminar and/or facilitating an online case discussion, participants' comfort level in their ability to teach online increased. Further study of the impact of faculty development programs on teaching effectiveness and student satisfaction with online pharmacy education is warranted.