Twelve tips for developing and implementing an effective surgical simulation programme

Recent changes to the working practices of physicians in both Europe and the United States have led to concerns regarding a reduced exposure of surgical trainees to operations and thus a potential for a decreased operative experience throughout training. Simulation has been used in many professional fields such as the aeronautical industry to prepare pilots prior to real-life situations and has become recognised as a potentially useful educational tool in surgery. Surgical skills from basic knot-tying to more sophisticated simulation programmes for aortic aneurysm surgery have been introduced in surgical training programmes. Surgical simulation has been demonstrated to have validity in preparing surgeons for operative situations; however, a commitment from educators, protected time and well-orchestrated sessions are key elements in the success of a simulation programme. This article provides 12 tips for the development and implementation of an effective surgical simulation programme informed by experience of large-scale simulation at an academic institution and relevant literature regarding simulation training.

Criteria to assess the quality of virtual patients

Quality assessment of virtual patients (VP) is important but still insufficiently standardized. We developed categories and criteria to assess the quality of virtual patients. These categories reflect the life cycle of a VP from the planning to the development, implementation and evaluation. Such elaborated criteria will help authors to create VPs and curriculum planners to assess the quality of implemented VPs and choose high quality VPs from repositories.

Recommendation of standardized health learning contents using archetypes and semantic web technologies

Linking Electronic Healthcare Records (EHR) content to educational materials has been considered a key international recommendation to enable clinical engagement and to promote patient safety. This would suggest citizens to access reliable information available on the web and to guide them properly. In this paper, we describe an approach in that direction, based on the use of dual model EHR standards and standardized educational contents. The recommendation method will be based on the semantic coverage of the learning content repository for a particular archetype, which will be calculated by applying semantic web technologies like ontologies and semantic annotations.

Video teleconferencing in the compounding laboratory component of a dual-campus doctor of pharmacy program

OBJECTIVES

To design, implement, and assess the effectiveness of using a live video teleconferencing system to connect the main campus and a satellite campus during laboratory compounding exercises in a doctor of pharmacy (PharmD) program.

DESIGN

A new laboratory facility with identical equipment and supplies to the main campus was built at the satellite campus and teleconferencing equipment was set up. Students on both campuses prepared 20 compounded formulations over a 5-course pharmaceutical care laboratory sequence. Live video teleconferencing was used for students to ask questions and for the lead faculty instructor to observe the students' technique. Faculty and staff members and teaching assistants facilitated the laboratory sessions on both campuses.

ASSESSMENT

The performance of students on assayed products at the main campus was compared with that of students at the satellite campus to ensure program integrity with the compounding laboratory component. The use of video teleconferencing for teaching compounding was successful and no difference in overall student pass rates was seen. The few observed differences in student performance between the 2 campuses were believed to be a result of variations in instructor communication with distant students.

CONCLUSION

Video teleconferencing can be used successfully to deliver curriculum in laboratory compounding to pharmacy students.

Computer-based script training for aphasia: emerging themes from post-treatment interviews

This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded comments that were categorized into ten themes. Five of the themes related to the communication behaviors of the participant, whereas the other five related to the computer program and study procedures. Examples of each theme are presented. The themes provide qualitative evidence of change and generalization, supporting the use of this computer-based script training program.

Effectiveness of the computer enhanced visual learning method in teaching the society for fetal urology hydronephrosis grading system for urology trainees

OBJECTIVE

A novel educational tool, Computer Enhanced Visual Learning (CEVL), has been used to improve resident performance of routine orchiopexy. Our objective was to assess the effect of a CEVL teaching module on the diagnostic accuracy of medical trainees in grading neonatal hydronephrosis on ultrasound using the Society for Fetal Urology (SFU) grading system.

METHODS

The authors designed an online-based computerized tutorial to teach the grading of hydronephrosis using multimedia, practice cases and a grading checklist. In a crossover design trial, 29 residents and medical students were asked to grade 16 standard neonatal renal ultrasounds using the SFU grading system before and after viewing the web-based e-learning module. Primary outcome was percent improvement in grading accuracy.

RESULTS

The mean percentages of ultrasounds that were graded correctly before and after CEVL intervention were 51% and 72% respectively (mean improvement 21%, 95% CI 3-13%, P < 0.001). Residents graded correctly 56% of ultrasounds before and 74% after CEVL (mean 18%, 7-28%, P = 0.002). Medical students graded correctly 37% before and 69% after CEVL (mean improvement 32%, 95% CI 16-48%, P = 0.002).

CONCLUSION

Exposure to a computer-based learning module based on the CEVL platform improved urology residents' and medical students' correct assignment of SFU hydronephrosis grading to newborn renal ultrasounds.

The quality of on-line communication in a national learning programme for newly qualified nurses, midwives and allied health professionals

Asynchronous communication has become the dominant mode of on-line instruction and has been incorporated into Flying Start NHS, an on-line programme for newly qualified NMAHPs in the transition phase from student to registered practitioner. On-line programmes have a number of objectives including the delivery of educational materials and the development of on-line communities. This study sought to provide a direct and objective understanding of the quality of the on-line community within Flying Start NHS and give an indication of areas of strength and weakness. The study used mixed methods including a Gricean analysis of on-line communication focusing on quantity, quality, relevance, and manner, and a thematic analysis of communication content. There was little evidence that students engaged in the type of interactive communication essential for creating on-line learning communities. The majority of postings related to progression through Flying Start. The small number of communications which did begin to engage with the learning materials were limited with little evidence of the development of critical debate. Analysis of the qualitative data indicates that the period of transition continues to be stressful with Flying Start NHS being undertaken concurrently with local CPD being seen as duplication of effort.

Benefits of computer screen-based simulation in learning cardiac arrest procedures

OBJECTIVES

What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high-fidelity patient simulators, but have also demonstrated their limits. New computer screen-based multimedia simulators have fewer constraints than high-fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen-based simulator to more realistic situations such as those encountered with high-fidelity patient simulators.

METHODS

We tested the benefits of learning cardiac arrest procedures using a multimedia computer screen-based simulator in 28 Year 2 medical students. Just before the end of the traditional resuscitation course, we compared two groups. An experiment group (EG) was first asked to learn to perform the appropriate procedures in a cardiac arrest scenario (CA1) in the computer screen-based learning environment and was then tested on a high-fidelity patient simulator in another cardiac arrest simulation (CA2). While the EG was learning to perform CA1 procedures in the computer screen-based learning environment, a control group (CG) actively continued to learn cardiac arrest procedures using practical exercises in a traditional class environment. Both groups were given the same amount of practice, exercises and trials. The CG was then also tested on the high-fidelity patient simulator for CA2, after which it was asked to perform CA1 using the computer screen-based simulator. Performances with both simulators were scored on a precise 23-point scale.

RESULTS

On the test on a high-fidelity patient simulator, the EG trained with a multimedia computer screen-based simulator performed significantly better than the CG trained with traditional exercises and practice (16.21 versus 11.13 of 23 possible points, respectively; p<0.001).

CONCLUSIONS

Computer screen-based simulation appears to be effective in preparing learners to use high-fidelity patient simulators, which present simulations that are closer to real-life situations.

[E-learning and the continuing professional development in medicine]

E-learning is widely used in continuing medical education but three main problems still face health decision makers: the substantial heterogeneity among the characteristics of the web-based educational projects; the concerns about the e-learning effectiveness; the variety of outcomes used to evaluate the effectiveness. Systematic reviews suggest e-learning has effectiveness similar to traditional educational methods.The attention should now be given to how and when can we use e-learning to improve the health workers' performance and better healthcare.

Web-based instruction on substance abuse and drug diversion

OBJECTIVES

To develop a pilot study to assess the effectiveness of a Web-based educational module on enhancing understanding of substance abuse and drug diversion, and to assess students' abilities and confidence in applying the information.

DESIGN

A Web-based instructional module was presented to students enrolled in their second pre-professional year, and students were informed that it was part of a research study. Knowledge was tested using 10 pre- and post-module questions. Students were also presented with 5 survey questions assessing abilities related to the learning objectives.

ASSESSMENT

The median percentage of correct responses increased from 60% (Interquartile range [IQR] 20%) for the pre-module questions to 90% (IQR = 10%) for the post-module questions. The median percent gain in knowledge was 20% (IQR = 20%) which was significant (p < 0.0001).

CONCLUSIONS

Web-based instruction is an alternative method for engaging students in course content. We found that 59% of our pilot study group worked in a pharmacy. From the success of the pilot study, the module was implemented as an extra credit assignment in a required course to provide a foundation for developing professional responsibility.

Application description and policy model in collaborative environment for sharing of information on epidemiological and clinical research data sets

BACKGROUND

Sharing of epidemiological and clinical data sets among researchers is poor at best, in detriment of science and community at large. The purpose of this paper is therefore to (1) describe a novel Web application designed to share information on study data sets focusing on epidemiological clinical research in a collaborative environment and (2) create a policy model placing this collaborative environment into the current scientific social context.

METHODOLOGY

The Database of Databases application was developed based on feedback from epidemiologists and clinical researchers requiring a Web-based platform that would allow for sharing of information about epidemiological and clinical study data sets in a collaborative environment. This platform should ensure that researchers can modify the information. A Model-based predictions of number of publications and funding resulting from combinations of different policy implementation strategies (for metadata and data sharing) were generated using System Dynamics modeling.

PRINCIPAL FINDINGS

The application allows researchers to easily upload information about clinical study data sets, which is searchable and modifiable by other users in a wiki environment. All modifications are filtered by the database principal investigator in order to maintain quality control. The application has been extensively tested and currently contains 130 clinical study data sets from the United States, Australia, China and Singapore. Model results indicated that any policy implementation would be better than the current strategy, that metadata sharing is better than data-sharing, and that combined policies achieve the best results in terms of publications.

CONCLUSIONS

Based on our empirical observations and resulting model, the social network environment surrounding the application can assist epidemiologists and clinical researchers contribute and search for metadata in a collaborative environment, thus potentially facilitating collaboration efforts among research communities distributed around the globe.

Defining quality criteria for online continuing medical education modules using modified nominal group technique

INTRODUCTION

The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules.

METHODS

Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members.

RESULTS

A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important.

DISCUSSION

This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research.

The role of intellectual property in creating, sharing and repurposing virtual patients

Medical schools are integrating more technology into the training of health care practitioners. Electronic Virtual Patients (VPs) provide interactive simulations to facilitate learning. The time, cost and effort required to create robust VPs on an individual school basis are significant; sharing of VPs by medical schools allows for access to a broad range of VPs across a variety of disciplines with lower investment. When this digital content is shared with other schools and distributed widely, digital copyright issues come into play. Unless all intellectual property rights (IPRs) and plans of the authors regarding the VP are confirmed upfront, the ability of the school to share the VP may be inhibited. Schools should also identify under what licensing/sharing model they plan to distribute the VPs - how do you plan to share the VPs and what will allow users to do with the VPs in the context of IPRs? This article highlights the role of IPRs in VPs and discusses a case-study of a European Virtual Patient collaboration to demonstrate how IPRs were managed.

12 Tips: Guidelines for authoring virtual patient cases

BACKGROUND

Virtual patient cases are an increasingly utilized and compelling pedagogical strategy for medical education informatics. They provide educators with the opportunity to develop richly layered, multidimensional teaching situations for their learners. However, 'virtual patients are notoriously difficult to author, adapt and exchange' (MedBiquitous Virtual Patient Specification, Virtual Patient Working Group 2007), and case creation can be daunting. Authors may be uncertain about the process of virtual patient case development and this can translate into ambiguity and hesitation.

AIMS

This installment of the '12 tips' presents specific guidelines that are intended to provide medical educators with guidelines to facilitate the development of virtual patient cases.

METHODS

These 12 tips are based upon comprehensive, research-based, theory-grounded and criterion-referenced guidelines and founded in pedagogical principles, theories of cognition, and recognition of current technology and availability of authoring applications.

RESULTS

It is anticipated that the 12 tips will provide medical educators interested in authoring virtual patient cases one set of useful guidelines to facilitate the process.

CONCLUSIONS

Virtual patient cases provide medical educators with an innovative tool for medical education. These guidelines will assist authors in case development.

Class size as related to the use of technology, educational practices, and outcomes in Web-based nursing courses

With the expanding numbers of nursing students enrolled in Web-based courses and the shortage of faculty, class sizes are increasing. This exploratory descriptive study examined class size in relation to the use of technology and to particular educational practices and outcomes. The sample consisted of undergraduate (n = 265) and graduate (n = 863) students enrolled in fully Web-based nursing courses. The Evaluating Educational Uses of Web-based Courses in Nursing survey (Billings, D., Connors, H., Skiba, D. (2001). Benchmarking best practices in Web-based nursing courses. Advances in Nursing Science, 23, 41--52) and the Social Presence Scale (Gunawardena, C. N., Zittle, F. J. (1997). Social presence as a predictor of satisfaction within a computer-mediated conferencing environment. The American Journal of Distance Education, 11, 9-26.) were used to gather data about the study variables. Class sizes were defined as very small (1 to 10 students), small (11 to 20 students), medium (21 to 30 students), large (31 to 40 students), and very large (41 students and above). Descriptive and inferential statistics were used to analyze the data. There were significant differences by class size in students' perceptions of active participation in learning, student-faculty interaction, peer interaction, and connectedness. Some differences by class size between undergraduate and graduate students were also found, and these require further study.

Face and construct validity of virtual reality simulation of laparoscopic gynecologic surgery

OBJECTIVE

The objective of the study was to validate virtual reality simulation in assessing laparoscopic skills in gynecology by establishing the extent of realism of the simulation to the actual task (face validity) and the degree to which the results of the test one uses reflects the subject tested (construct validity).

STUDY DESIGN

Subjects (n = 56) were divided into 3 groups: novices (n = 15), intermediates (n = 20), and experts (n = 21). Participants completed 3 repetitions of a training program consisting of 4 basic skills and 3 gynecologic procedural simulations. The performance was compared between groups using a post hoc Student t test with the Bonferroni technique. Face validity was determined by using a questionnaire of 27 statements.

RESULTS

Resulting from the questionnaire, the opinion about the realism and training capacities of the tasks was favorable among all groups. The degree of prior laparoscopic experience was reflected in the outcome performance parameters of the tasks. Experts achieved significant better scores on specific parameters.

CONCLUSION

The results of this study indicate acceptance and thus face validity of the system among both reference (novice, intermediate) and expert group. There is a significant difference between subjects with different laparoscopic experience and thereby construct validity for the laparoscopic simulator could be established.

Simulation-based medical education is no better than problem-based discussions and induces misjudgment in self-assessment

Simulation-based teaching (SBT) is increasingly used in medical education. As an alternative to other teaching methods there is a lack of evidence concerning its efficacy. The aim of this study was to evaluate the potency of SBT in anesthesia in comparison to problem-based discussion (PBD) with students in a randomized controlled setting. Thirty-three fourth-year medical students attending a curricular anesthesiology course were randomly allocated to either a session of SBT or a session of PBD on an emergency induction method. Ten days later all students underwent examination in a simulator. The performance of each student was evaluated by weighted tasks, established according to a modified Delphi process. Confidence and a multiple-choice questionnaire were additionally performed pre- and post-intervention. A total of 32 students completed the study. Participants in the SBT group presented with significantly higher self-assessment scores after the intervention than students in the PBD group. However, students in the SBT group achieved only slightly and statistically insignificantly higher scores in the theoretical and simulator examination (p > 0.05) with only a moderate effect size of d = 0.52. The current study demonstrates that both PBD and SBT lead to comparable short-term outcomes in theoretical knowledge and clinical skills. However, undesirably, SBT students overrated their anticipated clinical abilities and knowledge improvement.

Web-based learning strategies in combination with published guidelines to change practice of primary care professionals

BACKGROUND

Published clinical guidelines need to be combined with effective educational interventions to produce change in practice. Problem-based learning (PBL) groups are effective; however, research studies have not looked at change in practice following PBL that is independent of group interaction.

AIM

To determine whether clinical guidelines combined with modified PBL e-learning modules, in which dialogue between learners is replaced by interaction with a computer, could increase knowledge, result in changes in practice, and be acceptable to participants as a mode of modifying practice.

DESIGN OF STUDY

Quantitative and qualitative methods.

SETTING

Web-based application.

RESULTS

Online PBL modules were studied by 45 primary care clinicians. Replacement of group functions by interaction with the computer was found to be an acceptable form of learning, and resulted in reported changes in practice among GPs choosing this method of study. This study shows that changes were independent of demonstrable knowledge gains.

CONCLUSION

Online PBL modules could complement other arms of guideline-implementation strategies. More work is needed to determine which groups would benefit most.

Making generic tutorials content specific: recycling evidence-based practice (EBP) tutorials for two disciplines

Librarians at the Boston University Medical Center constructed two interactive online tutorials, "Introduction to EBM" and "Formulating a Clinical Question (PICO)," for a Family Medicine Clerkship and then quickly repurposed the existing tutorials to support an Evidence-based Dentistry course. Adobe's ColdFusion software was used to populate the tutorials with course-specific content based on the URL used to enter each tutorial, and a MySQL database was used to collect student input. Student responses were viewable immediately by course faculty on a password-protected Web site. The tutorials ensured that all students received the same baseline training and allowed librarians to tailor a subsequent library skills workshop to student tutorial answers. The tutorials were well-received by the medical and dental schools and have been added to mandatory first-year Evidence-based Medicine (EBM) and Evidence-based Dentistry (EBD) courses, meaning that every medical and dental student at BUMC will be expected to complete these tutorials.

Computerized patient education in kidney transplantation: testing the content validity and usability of the Organ Transplant Information System (OTIS)

OBJECTIVE

To test content validity and usability of the Organ Transplant Information System (OTIS).

METHODS

This study used qualitative methods. The purposive sample consisted of 8 clinicians and 14 patients. Clinicians rated the content's congruence with current medical practice. We used the clinicians' evaluations to revise the OTIS content; then each patient evaluated the revised OTIS modules using the thinking-aloud method and via structured interviews. Descriptive statistics were applied for demographic and clinical data, and for the clinicians' ratings. Content data usability and validity were analyzed using Content Analysis.

RESULTS

Clinicians identified deviations from current medical practice regarding content, language, and information structure of OTIS. Seven rated OTIS as non-relevant for implementation into clinical practice. Five rated the program's content--with the stipulated adaptations--as important for patients. All patients encountered usability problems, mostly regarding the program's interface. Emerging categories from the patients' perspectives vis à vis content were knowledge acquisition, illness management, and partnership forming.

CONCLUSION

Problems arose regarding OTIS's initial content validity and usability, demonstrating the need to establish the presented material's content validity and usability by involving clinicians and patients before its clinical implementation.

PRACTICE IMPLICATIONS

High quality computer-learning-software is needed to enhance patient self-management.