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Ting DS, Lee JC, Loo BK, Baisa K, Koo WH, Cook S, Lim BL. A nationwide, resident-led teaching programme for medical students in Singapore: SingHealth Student Internship Programme Bootcamp. Singapore Med J 2017; 57:233-7. [PMID: 27211310 DOI: 10.11622/smedj.2016092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to describe the planning, development and evaluation of the success of the first nationwide, resident-led, large-group teaching programme for medical students - the Singapore Health Services Student Internship Programme (SIP) Bootcamp. METHODS This was an initial feasibility study evaluating a half-day teaching boot camp initiated, developed and conducted by the resident educators. A three-month preparation period was required to set up an education subcommittee, liaise with medical student leaders, recruit resident educators, meet all the stakeholders and conduct the boot camp. During the SIP Bootcamp, resident educators conducted clinical case presentations using a question-and-answer format. Audience participation was strongly encouraged. A 15-item questionnaire was distributed to assess the participants' learning experience and the resident educators' teaching performance using a five-point Likert scale. RESULTS Overall, 94.8% (n = 110) of the 116 respondents agreed that the teaching sessions were of high quality and content was relevant to their training. The resident educators appeared well-informed (96.6%, n = 112) and enthusiastic about their respective topics (98.3%, n = 114). However, a few students (9.5%, n = 11) felt that the audio-visual aids and handouts could be improved to better aid their learning process. CONCLUSION This teaching boot camp for medical students was the first of its kind in Singapore and feedback from medical students showed that it was well-received. Further research using different teaching methods, including small-group discussions and surgical practical sessions by resident educators from different specialties, would be of great value to students.
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Affiliation(s)
- Daniel Sw Ting
- Singapore National Eye Centre, Singapore Health Services (SingHealth), Singapore
| | - Jill Cs Lee
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore Health Services (SingHealth), Singapore
| | - Benny Kg Loo
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore Health Services (SingHealth), Singapore
| | - Katherine Baisa
- Graduate Medical Education Office, Singapore Health Services (SingHealth), Singapore
| | - Wen Hsin Koo
- SingHealth Education Office, Singapore Health Services (SingHealth), Singapore
| | - Sandy Cook
- Office of Education, Duke-NUS Medical School, Singapore Health Services (SingHealth), Singapore
| | - Boon Leng Lim
- Graduate Medical Education Office, Singapore Health Services (SingHealth), Singapore.,Department of Anesthesiology, Singapore Health Services (SingHealth), Singapore
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Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, Garrity MJ, Lieberman SA, Lindeman B, Lypson ML, Minter RM, Rosenfield J, Thomas J, Wilson MC, Aschenbrener CA. Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1352-1358. [PMID: 27097053 DOI: 10.1097/acm.0000000000001204] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors' expectations and new residents' performance.In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment.The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors' expectations and new residents' performance, enhancing patient safety and increasing residents', educators', and patients' confidence in the care these learners provide in the first months of their residency training.
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Affiliation(s)
- Robert Englander
- R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC, at the time this work was done. He is now associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota.T. Flynn is senior associate dean for clinical affairs, University of Florida College of Medicine, Gainesville, Florida.S. Call is program director for internal medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.C. Carraccio is vice president for competency-based assessment programs, American Board of Pediatrics, Chapel Hill, North Carolina.L. Cleary is vice president for academic affairs, State University of New York Upstate Medical University, Syracuse, New York.T.B. Fulton is professor of biochemistry and biophysics and competency director for medical knowledge, University of California, San Francisco, School of Medicine, San Francisco, California.M.J. Garrity is associate professor of medicine and physiology and associate dean, University of Colorado Anschutz Medical Campus, Aurora, Colorado.S.A. Lieberman is senior dean for administration, University of Texas Medical Branch School of Medicine, Galveston, Texas.B. Lindeman is chief resident, Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.M.L. Lypson is professor of internal medicine and learning health sciences, University of Michigan Medical School, and associate chief of staff for education, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.R.M. Minter was associate professor of surgery and learning health sciences, associate chair for education, Department of Surgery, and associate program director in general surgery, University of Michigan Medical School, Ann Arbor, Michigan, at the time this work was done. She is now professor and Alvin Baldwin Jr. Chair, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.J. Rosenfield is vice dean of the MD program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.J. Thomas is a resident in emergency medicine, Mayo Clinic, Rochester, Minnesota.M.C. Wilson is clinical professor of internal medicine and associate dean for graduate medical education, University of Iowa Carver College of Medicine, and designated institutional official, University of Iowa Hospitals and Clinics, Iowa City, Iowa.C.A. Aschenbrener was chief medical education officer, Association of American Medical Colleges, Washington, DC, at the time this work was done
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Woelfel IA, Takabe K. Successful intravenous catheterization by medical students. J Surg Res 2016; 204:351-360. [PMID: 27565071 PMCID: PMC5002310 DOI: 10.1016/j.jss.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/27/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intravenous (IV) catheter placement is one of the most basic and essential medical procedures. However, IV placement can be a source of anxiety for medical students as it is often their first procedural patient care. We sought to investigate the factors that impact the success rate of this skill and to determine at what rate students improve. MATERIALS AND METHODS A confidential web-based survey was distributed to a total of 367 third and fourth year students at Virginia Commonwealth University School of Medicine. The responses were collected over a 2-wk period in July 2015. RESULTS The response rate was 49.0% (180/367); 65.5% of the M3s and 21.8% of the M4s have never had an opportunity to place an IV. The success rate was higher in students with prior experience as laboratory researchers (86.6%, P = 0.014) as well as emergency medical technicians (81.4%, P = 0.038) when compared to students with no experience. Prior preparation such as reading, watching videos, or even lectures did not increase the success rate. Success rates rapidly improved from 47% for the first attempt to 86% for the fifth attempt. CONCLUSIONS A significant percentage of students did not have opportunities to attempt IV catheter placement. We found prior experience, not only as an emergency medical technician but also as a laboratory researcher, significantly increased the success rate. Prior preparations did not improve success rate, and most of the students were successful after only five attempts.
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Affiliation(s)
- Ingrid A Woelfel
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Breast Surgery, Roswell Park Cancer Institute, Richmond, Virginia
| | - Kazuaki Takabe
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Breast Surgery, Roswell Park Cancer Institute, Richmond, Virginia.
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Fehr JJ, Kuan C. Summer camp, boot camp, and the formation of a new fellow. Paediatr Anaesth 2016; 26:466-7. [PMID: 27059415 DOI: 10.1111/pan.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- James J Fehr
- Departments of Anesthesiology & Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Calvin Kuan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Schoolfield CS, Samra N, Kim RH, Shi R, Zhang WW, Tan TW. Evaluating the Effectiveness of the General Surgery Intern Boot Camp. Am Surg 2016. [DOI: 10.1177/000313481608200318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants’ confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P < 0.001) after the boot camp. Additionally, there were improvements for all subcategories including medical knowledge (2.65 vs 3.36, P < 0.001), technical skill (3.02 vs 3.51, P < 0.001), interpersonal skills and communication (3.04 vs 3.53, P = 0.001), and practice-based learning (2.65 vs 3.41, P = 0.001). There was an improvement in confidence level for both home institution graduates (2.89 vs 3.53, P = 0.022) and other graduates (2.74 vs 3.34, P < 0.001). Similarly, participants from general surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P < 0.001) reported significant improvement in confidence. General surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.
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Affiliation(s)
| | - Navdeep Samra
- From Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Roger H. Kim
- From Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Runhua Shi
- From Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Wayne W. Zhang
- From Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Tze-Woei Tan
- From Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Day K, Schwartz T, Rao V, Khokhar M, Miner T, Harrington D, Ryder B. Medical student clerkship performance and career selection after a junior medical student surgical mentorship program. Am J Surg 2016; 211:431-6. [DOI: 10.1016/j.amjsurg.2015.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/26/2015] [Accepted: 10/02/2015] [Indexed: 11/27/2022]
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Singh P, Aggarwal R, Pucher PH, Darzi A. Development, Organisation and Implementation of a Surgical Skills 'Boot Camp': SIMweek. World J Surg 2016; 39:1649-60. [PMID: 25665671 DOI: 10.1007/s00268-015-2972-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is evidence of increased mortality and reduced efficiency in hospitals due to the annual changeover of junior doctors. This paper describes a framework to develop an intensive simulated week that will recreate experiences and situations that junixor surgical interns will likely face in their first weeks after graduation. METHODS To provide evidence-based recommendations, a systematic review of published literature using the keywords 'surg*', 'boot', 'camp' was performed. Reports of the development, implementation or evaluation of a simulated skills course or 'boot camp' to prepare incoming surgical interns were analysed. RESULTS Eighteen relevant articles were identified. Subjects on internship preparation courses have identified 'hands-on' training sessions to be very useful. In particular, mock pages have been identified as being valuable and didactic lectures have been identified as the weakest parts of the course. We first consider the end-users of the course and their associated learning needs. We subsequently discuss resources required and propose a strategy for the organisation of a course and selection of teaching faculty. Finally, we consider the costs involved in running a course. CONCLUSIONS This paper proposes a framework for the development, organisation and implementation of an intensive simulation course to prepare graduating medical students for their role as junior surgical intern. Facilitating the step change in responsibility from student to surgical intern may improve patient safety in addition to reducing the associated anxiety for the clinician.
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Affiliation(s)
- Pritam Singh
- Academic Surgical Unit, Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, 10th Floor QEQM, South Wharf Road, London, W2 1NY, UK,
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Lindeman BM, Sacks BC, Lipsett PA. Graduating Students' and Surgery Program Directors' Views of the Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: Where are the Gaps? JOURNAL OF SURGICAL EDUCATION 2015; 72:e184-92. [PMID: 26276302 DOI: 10.1016/j.jsurg.2015.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/23/2015] [Accepted: 07/08/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Residency program directors have increasingly expressed concern about the preparedness of some medical school graduates for residency training. The Association of American Medical Colleges recently defined 13 core entrustable professional activities (EPAs) for entering residency that residents should be able to perform without direct supervision on the first day of training. It is not known how students' perception of their competency with these activities compares with that of surgery program directors'. DESIGN Cross-sectional survey. SETTING All surgery training programs in the United States. PARTICIPANTS All program directors (PDs) in the Association of Program Directors in Surgery (APDS) database (n = 222) were invited to participate in an electronic survey, and 119 complete responses were received (53.6%). Among the respondents, 83% were men and 35.2% represented community hospital programs. PDs' responses were compared with questions asking students to rate their confidence in performance of each EPA from the Association of American Medical Colleges Graduation Questionnaire (95% response). RESULTS PDs rated their confidence in residents' performance without direct supervision for every EPA significantly lower when compared with the rating by graduating students. Although PDs' ratings continued to be lower than students' ratings, PDs from academic programs (those associated with a medical school) gave higher ratings than those from community programs. PDs generally ranked all 13 EPAs as important to being a trustworthy physician. PDs from programs without preliminary residents gave higher ratings for confidence with EPA performance as compared with PDs with preliminary residents. Among PDs with preliminary residents, there were equal numbers of those who agreed and those who disagreed that there are no identifiable differences between categorical and preliminary residents (42.7% and 41.8%, respectively). CONCLUSIONS A large gap exists between confidence in performance of the 13 core EPAs for entering residency without direct supervision for graduating medical students and surgery program directors. Both the groups identified several key areas for improvement that may be addressed by medical school curricular interventions or expanding surgical boot camps in hopes to improve resident performance and patient safety.
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Affiliation(s)
- Brenessa M Lindeman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Bethany C Sacks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela A Lipsett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Elnicki DM, Gallagher S, Willett L, Kane G, Muntz M, Henry D, Cannarozzi M, Stewart E, Harrell H, Aiyer M, Salvit C, Chudgar S, Vu R. Course Offerings in the Fourth Year of Medical School: How U.S. Medical Schools Are Preparing Students for Internship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1324-30. [PMID: 27002885 DOI: 10.1097/acm.0000000000000796] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The fourth year of medical school remains controversial, despite efforts to reform it. A committee from the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine examined transitions from medical school to internship with the goal of better academic advising for students. In 2013 and 2014, the committee examined published literature and the Web sites of 136 Liaison Committee on Medical Education-accredited schools for information on current course offerings for the fourth year of medical school. The authors summarized temporal trends and outcomes when available.Subinternships were required by 122 (90%) of the 136 schools and allow students to experience the intern's role. Capstone courses are increasingly used to fill curricular gaps. Revisiting basic sciences in fourth-year rotations helps to reinforce concepts from earlier years. Many schools require rotations in specific settings, like emergency departments, intensive care units, or ambulatory clinics. A growing number of schools require participation in research, including during the fourth year. Students traditionally take fourth-year clinical electives to improve skills, both within their chosen specialties and in other disciplines. Some students work with underserved populations or seek experiences that will be henceforth unavailable, whereas others use electives to "audition" at desired residency sites. Fourth-year requirements vary considerably among medical schools, reflecting different missions and varied student needs. Few objective outcomes data exist to guide students' choices. Nevertheless, both medical students and educators value the fourth year of medical school and feel it can fill diverse functions in preparing for residency.
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Affiliation(s)
- D Michael Elnicki
- D.M. Elnicki is professor and director, Ambulatory Medicine Clerkship, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.S. Gallagher is clerkship director and associate professor, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and Buffalo General Hospital, Buffalo, New York.L. Willett is professor and associate program and subinternship director, Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey.G. Kane is interim chair, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.M. Muntz is clerkship director and associate professor, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.D. Henry is clerkship director, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.M. Cannarozzi is associate professor and clerkship director, Department of Medicine, University of Central Florida College of Medicine, Health Sciences, Orlando, Florida.E. Stewart is associate program director, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.H. Harrell is clerkship director, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida.M. Aiyer is associate dean for academic affairs, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois.C. Salvit is director of medical student education, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.S. Chudgar is director, Undergraduate Medical Education, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.R. Vu is associate clerkship director, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Aschenbrener CA, Ast C, Kirch DG. Graduate Medical Education: Its Role in Achieving a True Medical Education Continuum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1203-9. [PMID: 26177531 DOI: 10.1097/acm.0000000000000829] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nearly half a century ago, Lowell T. Coggeshall recommended, through what has come to be known as the Coggeshall Report, that physician education-medical school (or undergraduate medical education [UME]), residency training (or graduate medical education [GME]), and continuing medical education (CME)-be "planned and provided as a continuum." While the dream of a true continuum remains unfulfilled, recent innovations focused on defining and assessing meaningful outcomes at last offer the anchor for the creation of a seamless, flexible, and ongoing pathway for the preparation of physicians. Recent innovations, including a widely accepted competency framework and entrustable professional activities (EPAs), provide key tools for creating a continuum. The competency framework is being leveraged in UME, GME, and CME and is serving as the foundation for the continuum. Learners and those who assess them are increasingly relying on observable behaviors (e.g., EPAs) to determine progress. The GME community in the United States and Canada has played-and continues to play-a leading role in the creation of these tools and a true medical education continuum. Despite some systemic challenges to implementation (e.g., premedical learner formation, time-in-step requirements), the GME community is already operationalizing these tools as a basis for other innovations that are improving transitions across the continuum (e.g., competency-based progression of residents). The medical education community's greatest responsibility in the years ahead will be to build on these efforts in GME-joining together to learn from one another and develop a continuum that serves the public and the profession.
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Affiliation(s)
- Carol A Aschenbrener
- C.A. Aschenbrener is founding chief medical education officer, Association of American Medical Colleges, Washington, DC. C. Ast is director, executive activities, Office of the President, Association of American Medical Colleges, Washington, DC. D.G. Kirch is president and chief executive officer, Association of American Medical Colleges, Washington, DC
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Wade TJ, Lorbeer K, Awad MM, Woodhouse J, DeClue A, Brunt LM. Outcomes of a proficiency-based skills curriculum at the beginning of the fourth year for senior medical students entering surgery. Surgery 2015; 158:962-9; discussion 969-71. [PMID: 26283204 DOI: 10.1016/j.surg.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesized that a proficiency-based curriculum administered early in the fourth year to senior medical students (MS4) would achieve outcomes comparable to a similar program administered during surgical internship. METHODS MS4 (n = 18) entering any surgical specialty enrolled in a proficiency-based skills curriculum at the beginning of the fourth year that included suturing/knot-tying, on-call problems, laparoscopic, and other skills (urinary catheter, sterile prep/drape, IV placement, informed consent, electrosurgical use). Assessment was at 4-12 weeks after training by a modified Objective Structured Assessment of Technical Skills (OSATS). Suturing and knot tying tasks were assessed by time and OSATS technical proficiency (TP) scores (1 [novice], 3 [proficient], 5 [expert]). Outcomes were compared with PGY-1 residents who received similar training at the beginning of internship and assessment 4-12 weeks later. Data are presented as mean values ± standard deviation; statistical significance was assessed by Student's t test. RESULTS Fifteen of 18 MS4 (83%) reached proficiency on all 15 tasks, and 2 others were proficient on all but 1 laparoscopic task. Compared with PGY-1s, MS4 were significantly faster for 3 of 5 suturing and tying tasks and total task time (547 ± 63 vs 637 ± 127 s; P < .05). Mean TP scores were similar for both groups (MS4, 3.4 ± 0.5 vs PGY-1, 3.1 ± .57; P = NS). MS4 OSATS scores were higher for IV placement, informed consent, and urinary catheter placement, but lower for prep and drape and for management of on-call problems. CONCLUSION MS4 who participate in a proficiency-based curriculum taught early in the fourth year are able to meet proficiency targets in a high percentage of cases. This approach should better prepare MS4 for surgical internship.
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Affiliation(s)
- Thomas J Wade
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Karly Lorbeer
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Michael M Awad
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Julie Woodhouse
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Angela DeClue
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO.
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The Evolving Role of Simulation in Teaching Surgery in Undergraduate Medical Education. Surg Clin North Am 2015. [DOI: 10.1016/j.suc.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Willis RE, Van Sickle KR. Current Status of Simulation-Based Training in Graduate Medical Education. Surg Clin North Am 2015. [PMID: 26210969 DOI: 10.1016/j.suc.2015.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The use of simulation in Graduate Medical Education has evolved significantly over time, particularly during the past decade. The applications of simulation include introductory and basic technical skills, more advanced technical skills, and nontechnical skills, and simulation is gaining acceptance in high-stakes assessments. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and has borne new and exciting national and local consortia that will ensure that the scope and impact of simulation will continue to broaden.
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Affiliation(s)
- Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7737, San Antonio, TX 78229, USA.
| | - Kent R Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7737, San Antonio, TX 78229, USA
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Heskin L, Mansour E, Lane B, Kavanagh D, Dicker P, Ryan D, Gildea-Byrne K, Pawlikowska T, Tierney S, Traynor O. The impact of a surgical boot camp on early acquisition of technical and nontechnical skills by novice surgical trainees. Am J Surg 2015; 210:570-7. [PMID: 26026339 DOI: 10.1016/j.amjsurg.2014.12.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/19/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acquisition of skills early in surgical training represents a significant challenge at present because of training time constraints. The aim of this study was to investigate if an intensive surgical boot camp was effective in transferring skills at the beginning of a surgical training program. METHODS New core surgical trainees (n = 58) took part in a 5-day boot camp. There were pretest and posttest assessments of knowledge, technical skills, and confidence levels. The boot camp used simulation and senior surgical faculty to teach a defined range of technical and nontechnical skills. RESULTS The scores for knowledge (53.8% vs 68.4%, P < .01), technical skills (35.9% to 60.6% vs 50.6% to 78.2%, P < .01), and confidence levels improved significantly during boot camp. Skills improvements were still present a year later. CONCLUSION The 5-day surgical boot camp proved to be an effective way to rapidly acquire surgical knowledge and skills while increasing the confidence levels of trainees.
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Affiliation(s)
- Leonie Heskin
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ehab Mansour
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Lane
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara Kavanagh
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pat Dicker
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Donncha Ryan
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kate Gildea-Byrne
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Teresa Pawlikowska
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Tierney
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oscar Traynor
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Singh P, Aggarwal R, Pucher PH, Hashimoto DA, Beyer-Berjot L, Bharathan R, Middleton KE, Jones J, Darzi A. An immersive "simulation week" enhances clinical performance of incoming surgical interns improved performance persists at 6 months follow-up. Surgery 2015; 157:432-43. [PMID: 25633735 DOI: 10.1016/j.surg.2014.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The transition from student to intern can be challenging. The "August" or "July effect" describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns. METHODS Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data. RESULTS Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs. 78; P = .181], technical skills [48 vs. 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs. 119; P < .001]), and 6 months (OSCE [107 vs. 93; P = .007], technical skills [92.5 vs. 69; P = .044], and confidence [148 vs. 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713). CONCLUSION The immersive simulation course objectively improved subjects' clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group's improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety.
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Affiliation(s)
- Pritam Singh
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
| | - Rajesh Aggarwal
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada
| | - Philip H Pucher
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Daniel A Hashimoto
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Laura Beyer-Berjot
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Centre for Surgical Training & Research, University of Mediterrannee, Marseille, France
| | - Rasiah Bharathan
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Katherine E Middleton
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Joanne Jones
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Ara Darzi
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK
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Blackmore C, Austin J, Lopushinsky SR, Donnon T. Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis. J Grad Med Educ 2014; 6:643-52. [PMID: 26140112 PMCID: PMC4477555 DOI: 10.4300/jgme-d-13-00373.1] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 04/28/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Throughout their medical education, learners face multiple transition periods associated with increased demands, producing stress and concern about the adequacy of their skills for their new role. OBJECTIVE We evaluated the effectiveness of boot camps in improving clinical skills, knowledge, and confidence during transitions into postgraduate or discipline-specific residency programs. METHODS Boot camps are in-training courses combining simulation-based practice with other educational methods to enhance learning and preparation for individuals entering new clinical roles. We performed a search of MEDLINE, CINAHL, PsycINFO, EMBASE, and ERIC using boot camp and comparable search terms. Inclusion criteria included studies that reported on medical education boot camps, involved learners entering new clinical roles in North American programs, and reported empirical data on the effectiveness of boot camps to improve clinical skills, knowledge, and/or confidence. A random effects model meta-analysis was performed to combined mean effect size differences (Cohen's d) across studies based on pretest/posttest or comparison group analyses. RESULTS The search returned 1096 articles, 15 of which met all inclusion criteria. Combined effect size estimates showed learners who completed boot camp courses had significantly "large" improvements in clinical skills (d = 1.78; 95% CI 1.33-2.22; P < .001), knowledge (d = 2.08; 95% CI 1.20-2.96; P < .001), and confidence (d = 1.89; 95% CI 1.63-2.15; P < .001). CONCLUSIONS Boot camps were shown as an effective educational strategy to improve learners' clinical skills, knowledge, and confidence. Focus on pretest/posttest research designs limits the strength of these findings.
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Abstract
Changes in US medical education have not yet paralleled the extraordinary recent advances in biomedical science. This is about to change with recent innovations in undergraduate medical education (UME) pedagogy. These changes include the 'flipped classroom,' new Liaison Committee on Medical Education requirements for learners to function collaboratively on health care teams that include other health professionals, the comprehensive development of professional identity in learning communities and adoption of measurable outcomes, termed 'entrustable professional activities'. These innovations offer the opportunity for a consistent longitudinal educational continuum in the US from UME to Graduate Medical Education (GME) and continuing medical education (CME). Such innovation addresses both individual patient and population health, with the potential for increasing shared decision-making and patient satisfaction. These innovations in US medical education have the potential to address the Institute for Healthcare Improvement's triple aim of improving patient care, improving the health of populations and reducing the per capita cost of health care.
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Affiliation(s)
- ML Osborne
- Oregon Health & Science University, Pulmonary Section Portland VA Medical Center, Portland, Oregon, USA
| | - SA Fields
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Clanton J, Gardner A, Cheung M, Mellert L, Evancho-Chapman M, George RL. The relationship between confidence and competence in the development of surgical skills. JOURNAL OF SURGICAL EDUCATION 2014; 71:405-412. [PMID: 24797858 DOI: 10.1016/j.jsurg.2013.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/01/2013] [Accepted: 08/31/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Confidence is a crucial trait of any physician, but its development and relationship to proficiency are still unknown. This study aimed to evaluate the relationship between confidence and competency of medical students undergoing basic surgical skills training. METHODS Medical students completed confidence surveys before and after participating in an introductory workshop across 2 samples. Performance was assessed via video recordings and compared with pretraining and posttraining confidence levels. RESULTS Overall, 150 students completed the workshop over 2 years and were evaluated for competency. Most students (88%) reported improved confidence after training. Younger medical students exhibited lower pretraining confidence scores but were just as likely to achieve competence after training. There was no association between pretraining confidence and competence, but confidence was associated with demonstrated competence after training (p < 0.001). CONCLUSIONS Most students reported improved confidence after a surgical skills workshop. Confidence was associated with competency only after training. Future training should investigate this relationship on nonnovice samples and identify training methods that can capitalize on these findings.
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Affiliation(s)
- Jesse Clanton
- Department of Surgery, Summa Akron City Hospital, Akron, Ohio.
| | - Aimee Gardner
- Austen BioInnovation Institute of Akron, Akron, Ohio
| | - Maureen Cheung
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Logan Mellert
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | | | - Richard L George
- Department of Surgery, Summa Akron City Hospital, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio
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69
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American College of Surgeons/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment. Am J Surg 2014; 207:165-9. [DOI: 10.1016/j.amjsurg.2013.07.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 06/20/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022]
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The echocardiography "boot camp": a novel approach in pediatric cardiovascular imaging education. J Am Soc Echocardiogr 2013; 26:1187-1192. [PMID: 23860091 DOI: 10.1016/j.echo.2013.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dynamic training schedules introduce novel challenges to medical specialty training programs that require manual dexterity. The aim of this study was to examine the effect of a 3-day, intensive pediatric echocardiography course ("boot camp") on trainee self-efficacy and on the acquisition and short-term retention of basic echocardiographic knowledge and skills for first-year pediatric cardiology fellows (CFs). METHODS The boot camp consisted of hands-on structured practice guided by sonographers and cardiology faculty members, didactic lectures, and reading. Pre-boot camp experience was assessed using an experience score. Outcome measures included written precamp and postcamp examinations, a performance-based test, precamp and postcamp self-efficacy assessments, and the number and quality of echocardiographic examinations performed in the first 3 months of fellowship. RESULTS Six CFs completed the boot camp. Two of the six CFs reported experience scores of 2 out of 10, whereas the remainder reported experience scores of 0 out of 10. Performance-based test scores ranged from 68 to 99 out of 147. All six CFs reported precamp self-efficacy scores of 21 (the minimum score), compared with median postcamp scores of 82 (range, 49-94) (P = .01). Scores on the written examination improved from median of 16 (range, 11-18) to 23.5 (range, 22-28) (P = .01). CFs who completed the boot camp completed 28 independent echocardiographic examinations (median, 4 per CF) during the first 3 months of fellowship, an increase from six independent examinations (median, 1 per CF) by CFs during the year before institution of the boot camp (P = .030). Echocardiograms obtained by CFs who had completed the boot camp scored higher on total quality (P = .004), overall two-dimensional image quality (P = .011), functional assessments (P = .015), and assessment for pericardial effusion (P = .031). CONCLUSIONS The echocardiography boot camp improves self-efficacy in performing an echocardiographic examination and the acquisition and short-term retention of skills and knowledge required to perform pediatric echocardiography.
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Affiliation(s)
- Felix Ankel
- Department of Emergency Medicine; Regions Hospital; St. Paul MN
| | - Douglas Franzen
- Department of Emergency Medicine; Virginia Commonwealth University; Richmond VA
| | - Jason Frank
- Department of Emergency Medicine University of Ottawa; Ottowa Ontario Canada
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Breen N, Egan M, Headon M, Bury G, Steele M. Scenario-based emergency care training and improvement in confidence levels of pre-graduation senior medical students. Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.08.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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