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McKenzie S, Mellis C. The impact on internship of a tailored intern preparation package. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:639-648. [PMID: 30233271 PMCID: PMC6135221 DOI: 10.2147/amep.s164321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION On commencing internship, new medical graduates (new interns) are often required to perform core procedural skills under differing levels of supervision. This variability of knowledge and experience with procedural skills can place patient safety at risk. Consequently, in 2012, we developed a targeted, intensive, 3-day training course for our pre-intern (PrInt) students. The aim of this study was to evaluate the intern preparation package by exploring interns' self-reported knowledge, confidence, and experience in key procedural skills during the early months of internship. METHODS Between 2012 and 2016, 5 cohorts of PrInt students (n=223) participated in our course. In the following years 2013-2017, the same 5 cohorts, at 4-5 months into their internship, were surveyed anonymously and invited to attend focus groups. Descriptive statistics and thematic analysis were used to analyze data. RESULTS Of the 223 interns, 91 (41%) responded. Of the 91, 82 (93%) agreed that the intern preparation package provided during PrInt had been beneficial to their practice as an intern. Awareness of potential risks to patient safety was high, ranging from infection control at 89/89 (100%) to 87/90 (97%) for patient identification. Confidence in performing procedural skills varied from moderate in identifying nasogastric tube placement on X-ray (66/89; 85%), to equal least confidence in managing cardiac-related emergencies (53/90; 59%) and identifying the correct placement of peripherally inserted central catheter lines on X-ray (52/89; 58%). MAJOR QUALITATIVE FINDINGS The preparation package had refreshed interns' procedural skills ability and awareness of risks to patient safety. Integration into the clinical team was positive, but requests to perform procedural skills on day 1 was unexpected. CONCLUSION Interns reported that they had gained substantial benefit from their preparation package, and they performed practical procedures from day 1, further highlighting the need for an intensive preparation course immediately prior to entering internship.
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Affiliation(s)
| | - Craig Mellis
- Education Office, Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia
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102
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Burstein DS, Mille FK, Cohen MS, Ravishankar C. A new, expanded approach to pediatric cardiology fellowship orientation. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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103
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Doss J. Obstetrical Boot Camp: Preclinical Preparation for Undergraduate Nursing Students. J Nurs Educ 2018; 57:511. [DOI: 10.3928/01484834-20180720-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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104
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Karmali RJ, Siu JM, You DZ, Spano S, Winthrop AL, Rudan JF, Reznick RK, Sanfilippo AT, Belliveau P. The Surgical Skills and Technology Elective Program (SSTEP): A comprehensive simulation-based surgical skills initiative for preclerkship medical students. Am J Surg 2018; 216:375-381. [DOI: 10.1016/j.amjsurg.2017.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 11/29/2022]
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Hanchanale V, Kailavasan M, Rajpal S, Koenig P, Yiasemidou M, Palit V, Rogawski K, Eardley I, Terry T, Jain S, Myatt A, Biyani CS. Impact of urology simulation boot camp in improving endoscopic instrument knowledge. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:151-154. [PMID: 35514940 PMCID: PMC8936930 DOI: 10.1136/bmjstel-2018-000313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 01/13/2023]
Abstract
Objective Education and training of surgeons has traditionally focused on the development of individual knowledge, technical skills and decision making. Knowledge about endoscopic instruments is one of the core elements of urological training. We assessed the precourse knowledge of newly appointed urology trainees and the impact of boot camp in improving their knowledge. Methods Newly appointed specialty trainees in urology took part in a pilot 5-day urology simulation boot camp (USBC). The aim of the USBC was to improve their confidence, procedural performance and non-technical skills, with one of the modules looking at the trainees' knowledge about common endoscopic instruments in urology. Delegates were first asked to identify and assemble the instruments, followed by one-to-one teaching about the instruments. An Objective Structured Assessment Tool was used to assess their knowledge in the identification and assembly of the cystoscope, resectoscope and optical urethrotome, before and at the end of the course. Results Data of two successive boot camps were collected to assess knowledge of instruments of newly appointed urology trainees. Majority of the trainees had good precourse knowledge of the cystoscopy kit, with 84% able to correctly identify the parts. Seventy-six per cent of candidates were able to identify the resectoscope equipment, but only approximately a third of trainees were able to correctly identify the urethrotome kit. The assembly of cystoscope, resectoscope and urethrotome was performed correctly in 74%, 42% and 32% at baseline and 94%, 90% and 77% postcourse, respectively. Overall performance improved significantly in the postcourse assessment (<0.001). Conclusion This urology boot camp has addressed gaps in trainees' core equipment knowledge and guided them to improve their knowledge with respect to identification and assembly of cystoscope, resectoscope and urethrotome.
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Affiliation(s)
- Vishwanath Hanchanale
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Mithun Kailavasan
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sanjay Rajpal
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philip Koenig
- Department of Urology, Airedale NHS Foundation Trust, Keighley, UK
| | - Marina Yiasemidou
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Victor Palit
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karol Rogawski
- Department of Urology, Calderdale Royal Hospital, Huddersfield, UK
| | - Ian Eardley
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tim Terry
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sunjay Jain
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Myatt
- Department of Urology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Maskatia SA, Cabrera AG, Morris SA, Altman CA. The pediatric echocardiography Boot Camp: Four-year experience and impact on clinical performance. Echocardiography 2018; 34:1486-1494. [PMID: 28980410 DOI: 10.1111/echo.13649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We previously reported on the short-term impact of an echocardiography "Boot Camp" on a single class of cardiology fellows (CF). The impact of the Boot Camp on performance throughout fellowship is unknown. METHODS We enrolled four classes of CFs and two classes of cardiac ICU fellows (CVs) prospectively into the Boot Camp and compared CFs to a historical cohort. Experience with echocardiography was surveyed. Outcome measures included written pre- and post-Camp exams, a performance based test (PBT), self-efficacy assessments, numbers of echocardiograms performed, and echocardiogram quality during the last 3 months of fellowship. RESULTS A total of 25 CFs and 7 CVs participated in the Boot Camp from July 2012-July 2015. Median experience score was 13/40 (4-23). Median self-efficacy improved from 22/147 (range 21-45) to 90/147 (range 49-133) (P=<.001), and written scores from 14/29 (8-24) to 24/29 (13-29) (P<.001). CFs who completed the Boot Camp performed more independent echocardiograms compared to controls at the end of the 1st (37.7±12.2 vs 28.2±12.1, P=.15), 2nd (71.3±24.4 vs 47.6±16.0, P=.044), and third year of fellowship (130.4±44.0 vs 100.0±29.3, P=.230), and on average achieved 150 total echocardiograms in the 4.8th quarter compared to the 7.8th quarter in controls, P=.053. 2D quality scores were higher and shortening fraction more often obtained in echocardiograms performed by Boot Camp CFs compared to controls. CONCLUSIONS The pediatric echocardiography Boot Camp improved self-efficacy, acquisition, and retention of echocardiography skills and knowledge, and increased echocardiogram performance. Observed differences between Boot Camp and control CFs appear to wane across fellowship.
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Affiliation(s)
- Shiraz A Maskatia
- Section of Pediatric Cardiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Antonio G Cabrera
- Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Shaine A Morris
- Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Carolyn A Altman
- Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Lerner V, Higgins EE, Winkel A. Re-boot: Simulation Elective for Medical Students as Preparation Bootcamp for Obstetrics and Gynecology Residency. Cureus 2018; 10:e2811. [PMID: 30116684 PMCID: PMC6092190 DOI: 10.7759/cureus.2811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a simulation-based elective on medical student preparedness for obstetrics and gynecology (OB/GYN) residency. METHODS A two-week, simulation-based elective course for post-clerkship medical students was developed, and 10 students participated at a single academic institution in 2016 and 2017. Using standardized patients and team-based training, students practiced procedural and surgical skills, as well as the diagnosis, management, and work-up of commonly seen problems. Close coaching with a low student-faculty ratio was employed for each session, allowing for individualized feedback in real time. Prior to and after completing the elective, student knowledge was evaluated using the Preparation for Residency Knowledge Assessment tool (PrepForRes). Written course evaluations were also completed by students at the end of the course. RESULTS Mean scores on the PrepForRes exam increased from 63.6% to 75.3% (p=0.0136). Notably, the average post-course score improved to a passing level, and all but one student achieved a passing score on the post-course test. Course evaluations and student feedback showed high satisfaction rates with the course. CONCLUSIONS This study demonstrates that a simulation-based elective course is an effective tool for helping medical students transition to OB/GYN residency. As medical schools work to facilitate the transition from undergraduate to graduate medical education, simulation can bridge gaps during this transition in order for students to meet entry-level residency requirements.
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Surcouf JW, Mumphrey CG, Barkemeyer BM, Buis M, Gupta RW, Olister S, Patrick-Esteve J, Rivera D, Zeringue A, Chauvin SW. Neonatal Intensive Care Unit Boot Camp: A Preparatory Curriculum for Pediatric Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10720. [PMID: 30800920 PMCID: PMC6342430 DOI: 10.15766/mep_2374-8265.10720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/17/2018] [Indexed: 06/09/2023]
Abstract
Introduction Resident training has changed significantly in recent years, resulting in reduced experiences and practice. Because pediatric residents have fewer required intensive care unit (ICU) rotations, we introduced a neonatal ICU (NICU) boot camp (2014-2015) that continues today to prepare residents immediately prior to beginning an NICU rotation. Methods The NICU boot camp consists of three 1-hour sessions: two interactive lectures with case-based application and one hands-on, integrative learning using simulation. The sessions are designed to cover basic information to assist in daily rounding and decision making while in the NICU. After their NICU rotation, residents complete a 12-item questionnaire. Program evaluation includes direct observation during sessions, faculty debriefing, and a postprogram resident survey. Results Fifty-seven residents participated; questionnaire responses were available from 46 (80.70%). Combined percentages of very useful and extremely useful responses for the three sessions were 82.61%, 78.26%, and 82.60%, with 86.95% for the overall program; 80.40% agreed that repeating boot camp prior to each NICU rotation would be useful. Analysis of narrative responses revealed that participation in boot camp enhanced residents' readiness and confidence for patient care in the NICU and as stated for each educational objective. Discussion Program evaluation results support highly effective and sustainable implementation and achievement of educational objectives. Minor refinements continue for enhancing active learning and content materials and for increasing rigor of program evaluation. Results also suggest that our boot camp may benefit other pediatric programs and serve as a model for use in other resident specialty programs.
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Affiliation(s)
- Jeffrey W. Surcouf
- Assistant Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Christy G. Mumphrey
- Assistant Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Brian M. Barkemeyer
- Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Marlene Buis
- Assistant Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Raegan W. Gupta
- Assistant Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Staci Olister
- Associate Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Jessica Patrick-Esteve
- Assistant Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | - Dana Rivera
- Associate Professor, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans
| | | | - Sheila W. Chauvin
- Professor Emerita, Department of Medicine, Louisiana State University Health Sciences Center New Orleans
- Founding Director, Office of Medical Education and Research and Development, School of Medicine, Louisiana State University Health Sciences Center New Orleans
- Founding Director, the Teaching Academy, Louisiana State University Health Sciences Center New Orleans
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Abstract
OBJECTIVES Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. DESIGN Prospective pre/post interventional pilot study. SETTING University simulation center. SUBJECTS Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America. INTERVENTIONS We conducted an expert opinion survey to guide curriculum development. The curriculum included didactic sessions, case studies, and high-fidelity simulation, based on high-complexity cases, congenital heart disease benchmark procedures, and a mix of lesion-specific postoperative complications. To cover multiple, high-complexity cases, we implemented Rapid Cycle Deliberate Practice method of teaching for selected simulation scenarios using an expert driven checklist. MEASUREMENTS AND MAIN RESULTS Knowledge was assessed with a pre-/posttest format (maximum score, 100%). A paired-sample t test showed a statistically significant increase in the posttest scores (mean [SD], pre test, 36.8% [14.3%] vs post test, 56.0% [15.8%]; p < 0.001). Time to recognize and treat an acute deterioration was evaluated through the use of selected high-fidelity simulation. Median time improved overall "time to task" across these scenarios. There was a significant increase in the proportion of clinically time-sensitive tasks completed within 5 minutes (pre, 60% [30/50] vs post, 86% [43/50]; p = 0.003] Confidence and satisfaction were evaluated with a validated tool ("Student Satisfaction and Self-Confidence in Learning"). Using a five-point Likert scale, the participants reported a high level of satisfaction (4.7 ± 0.30) and performance confidence (4.8 ± 0.31) with the simulation experience. CONCLUSIONS Although simulation boot camps have been used effectively for training physicians and educating critical care providers, this was a novel approach to educating pediatric nurse practitioners from multiple academic centers. The course improved overall knowledge, and the pediatric nurse practitioners reported satisfaction and confidence in the simulation experience.
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O'Brien BC. What to Do About the Transition to Residency? Exploring Problems and Solutions From Three Perspectives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:681-684. [PMID: 29419551 DOI: 10.1097/acm.0000000000002150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Transitions are both a blessing and a curse for learning and professional development. While transitions can afford valuable opportunities for growth, they can also burden learners in ways that stymie performance and development. In this Invited Commentary, the author focuses on the transition from medical school to residency-a transition that many believe has tipped too far toward burden. The commentary explores three ways of problematizing the transition to residency. The first is as a transaction problem involving a complex exchange of information among programs and people. The second is as a transfer problem in which learners must apply knowledge in new contexts. The third is a trajectory problem concerning each learner's progression through medical education. The author describes current efforts aligned with each framing of the problem and discusses potential gaps in these efforts that might be addressed through an overarching framing of transitions in medical education as transformative processes. This framing may help the medical educational community think more holistically about the problems and solutions with transitions.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, and educational researcher, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
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Owei L, Neylan C, Kelz R, Dumon KR, Allen SR, Williams N, Dempsey DT, Fisher C. Resource Usage Implementing the Surgical Resident Prep Curriculum at a Single Institution. JOURNAL OF SURGICAL EDUCATION 2018; 75:650-655. [PMID: 29037824 DOI: 10.1016/j.jsurg.2017.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Resident Prep Curriculum (RPC), published in 2014 and developed as a collaboration of the American College of Surgeons, Association of Program Directors in Surgery, and the Association for Surgical Education, was designed to improve the quality and consistency of medical student preparation for surgical residency. We aim to assess the feasibility of and resource usage for implementation of this curriculum at our institution. DESIGN Our institution expanded upon a pre-existing 2-week surgical preparatory course, adding modules designed to meet the goals and objectives of the RPC. We performed an evaluation of the resources required for these additions, namely time, logistics and incremental cost. SETTING The course took place at the Perelman School of Medicine, which is a large, academic medical center affiliated with the Hospital of the University of Pennsylvania. RESULTS Our course satisfied each of the six domains outlined in the RPC. In 2015, 22 students were enrolled in the course. It was run over a consecutive 4-week period in the spring of 2015, with 9 full and 9 half days. To meet the needs of the Curriculum, approximately 33 hours (38%) were spent in the classroom, 34 hours (39%) in a simulation center, and 20 hours (23%) in the anatomical laboratory. Seventy faculty-hours (from 5 disciplines) and 73 resident-hours (double-counting for cotaught modules) were required to support the course. Besides room availability, funding was required for certain aspects of the course such as cadavers, dedicated anatomy teaching, and the costs of supplies in the simulation center. There is also a cost associated with the use of the Penn Medicine Simulation Center. Taking these into account, the total cost of implementing the curriculum amounted to $30,627.10. CONCLUSION The implementation of the RPC was feasible but relied heavily upon faculty/resident time. As a result of the success of this initiative, our medical school seeks to expand the idea across multiple specialties.
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Affiliation(s)
- Lily Owei
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Neylan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rachel Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve R Allen
- Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Noel Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carla Fisher
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Bamford R, Langdon L, Rodd CA, Eastaugh-Waring S, Coulston JE. Core trainee boot camp, a method for improving technical and non-technical skills of novice surgical trainees. A before and after study. Int J Surg 2018; 57:60-65. [PMID: 29653248 DOI: 10.1016/j.ijsu.2018.03.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The transition to surgical training can be a stressful time for trainees and is most evident during national handover periods where new graduates start and senior trainees rotate to new programmes. During this time, patient mortality can increase and Hospital efficiency reduces. This influence is compounded by the impact of working time directives. Intensive, simulation rich training programmes or "Boot Camps" have been postulated as a solution. This article highlights the development of a surgical boot camp for novice surgical trainees and the impact this can have on training. METHOD A novel surgical boot camp was developed for all trainees within a surgical training region including nine acute NHS trusts. Participating cohort of trainees completed pre and post course questionnaires to assess technical and non-technical skills. RESULTS 25 trainees attended and completed the pre and post boot camp questionnaire. Significant improvements were seen with technical skills (p = 0.0429), overall non-technical skills (p < 0.001) including leadership (p = 0.022), communication (p = 0.010), situational awareness (p = 0.022), patient handover (p = 0.003), ward round skills (p = 0.005) and outpatient skill (p = 0.002). Trainees reported significantly increased ability to assess and manage a critically unwell patient (p = 0.001) and a trauma patient (p = 0.001). 96% of trainees have utilised the skills they learnt on Boot Camp and all trainees would recommend it as an induction programme. CONCLUSION Surgical Boot Camps offer a timely chance to develop technical and non-technical skills whilst enhancing a trainee's confidence and knowledge and reduce the patient safety impact of the handover period.
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Affiliation(s)
- R Bamford
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom.
| | - L Langdon
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - C A Rodd
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - S Eastaugh-Waring
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - J E Coulston
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
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Naik ND, Abbott EF, Gas BL, Murphy BL, Farley DR, Cook DA. Personalized video feedback improves suturing skills of incoming general surgery trainees. Surgery 2018; 163:921-926. [DOI: 10.1016/j.surg.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Development, Implementation, and Assessment of the Intensive Clinical Orientation for Residents (ICOR) Curriculum: A Pilot Intervention to Improve Intern Clinical Preparedness. Acad Pediatr 2018; 18:140-144. [PMID: 29180297 DOI: 10.1016/j.acap.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 12/22/2022]
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King CJ, Bolton A, Guerrasio J, Trosterman A. Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey. South Med J 2017; 110:765-769. [PMID: 29197310 DOI: 10.14423/smj.0000000000000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school. METHODS We developed a mixed-methods survey that was delivered to representatives of 82 schools via an e-mail link to an online survey. RESULTS Our response rate was 54% (44/82). Of those responding, 28% reported that students do not write any patient care orders at their institution and 34% reported not receiving pages related to patient care. Only 26% of institutions provide an increased patient load to students during their final year of training. Students identified many areas to improve the role of fourth-year medical students, including writing patient care orders, answering pages, increasing autonomy, defining their role better, and providing them with a longer subinternship experience. CONCLUSIONS Our survey suggests that students are graduating from the undergraduate medical education system and moving to the graduate medical education system in the United States without a guarantee of having answered a page related to patient care or having placed a patient care order. Further studies of students' experiences should be conducted to explore whether exposure to these skills improves first-year resident performance.
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Affiliation(s)
- Christopher J King
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Andrew Bolton
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Jeannette Guerrasio
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Adam Trosterman
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
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Bommer C, Sullivan S, Campbell K, Ahola Z, Agarwal S, O'Rourke A, Jung HS, Gibson A, Leverson G, Liepert AE. Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance. Am J Surg 2017; 215:266-271. [PMID: 29174166 DOI: 10.1016/j.amjsurg.2017.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making. METHODS Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty. RESULTS The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p < 0.05). CONCLUSIONS Pre-simulation orientation reduces anxiety while increasing confidence and improving performance.
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Affiliation(s)
- Cassidy Bommer
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Sarah Sullivan
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Krystle Campbell
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Zachary Ahola
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Suresh Agarwal
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Ann O'Rourke
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Hee Soo Jung
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Angela Gibson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Glen Leverson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Amy E Liepert
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States.
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Ireland JD, Deloney LA, Renfroe S, Jambhekar K. The Use of Team-Building Activities to Build a Better Resident. Curr Probl Diagn Radiol 2017; 46:399-401. [DOI: 10.1067/j.cpradiol.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022]
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Rábago JL, López-Doueil M, Sancho R, Hernández-Pinto P, Neira N, Capa E, Larraz E, Redondo-Figuero CG, Maestre JM. Learning outcomes evaluation of a simulation-based introductory course to anaesthesia. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:431-440. [PMID: 28347552 DOI: 10.1016/j.redar.2016.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/21/2016] [Accepted: 12/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. MATERIAL AND METHOD Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. RESULTS Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. CONCLUSIONS A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.
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Affiliation(s)
- J L Rábago
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - M López-Doueil
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - R Sancho
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - P Hernández-Pinto
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - N Neira
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - E Capa
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - E Larraz
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España
| | - C G Redondo-Figuero
- Hospital virtual Valdecilla, Santander, España; Instituto de Investigación Sanitaria Valdecilla, Santander, España
| | - J M Maestre
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España.
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Dulay M. An Intensive Continuity Clinic Immersion Experience for Interns: A Springboard to Confidence and Satisfaction With Continuity Clinic. J Grad Med Educ 2017; 9:622-626. [PMID: 29075384 PMCID: PMC5646922 DOI: 10.4300/jgme-d-16-00696.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/09/2017] [Accepted: 06/13/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Providing a robust continuity clinic experience is difficult due to uneven distribution of resident time. Immersion experiences early in training may improve residents' learning experiences. OBJECTIVE We designed and implemented a continuity immersion experience to improve internal medicine interns' satisfaction and confidence with their outpatient skills, and we evaluated the timing of the experience and its benefits for learners. METHODS Two cohorts of interns at 1 academic institution participated in a 3-week immersion block (during the first or second quarter of the intern year). Interns were surveyed twice about satisfaction and confidence. Analysis included independent and paired sample t tests to compare interns' responses pre- and postimmersion, and to evaluate effects over time. RESULTS A total of 124 interns completed the immersion, with a survey response rate of 61%. Interns' self-rated confidence on a 5-point Likert scale improved significantly compared with preimmersion in the areas of medical knowledge and confidence with their electronic health record and communication skills (P ≤ .010 for all assessments). Interns reported high satisfaction with continuity clinic following immersion (cohort 1: 4.5 ± 0.54; cohort 2: 4.3 ± 0.68; on a 5-point scale with 5 = very satisfied). Improvements in knowledge, skills, and satisfaction in cohort 1 were sustained over 3 months. CONCLUSIONS A 3-week immersion experience in the first 6 months of residency improved interns' confidence in ambulatory content areas and satisfaction with clinic.
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McMurray L, Hall AK, Rich J, Merchant S, Chaplin T. The Nightmares Course: A Longitudinal, Multidisciplinary, Simulation-Based Curriculum to Train and Assess Resident Competence in Resuscitation. J Grad Med Educ 2017; 9:503-508. [PMID: 28824766 PMCID: PMC5559248 DOI: 10.4300/jgme-d-16-00462.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/22/2016] [Accepted: 03/23/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Postgraduate medical education programs would benefit from a robust process for training and assessment of competence in resuscitation early in residency. OBJECTIVE To describe and evaluate the Nightmares Course, a novel, competency-based, transitional curriculum and assessment program in resuscitation medicine at Queen's University in Kingston, Ontario, Canada. METHODS First-year residents participated in the longitudinal Nightmares Course at Queen's University during the 2015-2016 academic year. An expert working group developed the entrustable professional activity and curricular design for the course. Formative feedback was provided following each simulation-based session, and we employed a summative objective structured clinical examination (OSCE) utilizing a modified Queen's Simulation Assessment Tool. A generalizability study and resident surveys were performed to evaluate the course and assessment process. RESULTS A total of 40 residents participated in the course, and 23 (58%) participated in the OSCE. Eight of 23 (35%) did not meet the predetermined competency threshold and required remediation. The OSCE demonstrated an acceptable phi coefficient of 0.73. The approximate costs were $240 per Nightmares session, $10,560 for the entire 44-session curriculum, and $3,900 for the summative OSCE. CONCLUSIONS The Nightmares Course demonstrated feasibility and acceptability, and is applicable to a broad array of postgraduate medical education programs. The entrustment-based assessment detected several residents not meeting a minimum competency threshold, and directed them to additional training.
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Neylan CJ, Nelson EF, Dumon KR, Morris JB, Williams NN, Dempsey DT, Kelz RR, Fisher CS, Allen SR. Medical School Surgical Boot Camps: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:384-389. [PMID: 27939818 DOI: 10.1016/j.jsurg.2016.10.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 05/13/2023]
Abstract
PURPOSE Many medical schools have begun to offer surgical boot camps to senior medical students. The aim of the present study is to systematically review the literature and evidence surrounding medical school surgical boot camps to direct future research into the effectiveness of boot camps. METHODS A systematic review was conducted, searching MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. The review was conducted according to the PICOTS structure, with an intervention of a surgical boot camp for senior medical students entering surgical residencies. RESULTS The search resulted in 5351 database hits, from which we identified 10 published studies that met the inclusion criteria. Two reviews were identified that met the PICOTS criteria but were excluded from data synthesis. Boot camps increase the confidence and competence of medical students entering their surgical internships. There is no objective assessment of the effect of boot camps on the clinical performance of interns. CONCLUSIONS Despite the success of medical school surgical boot camps, no objective data exist to show that boot camps translate into improved performance during internship.
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Affiliation(s)
- Christopher J Neylan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth F Nelson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jon B Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carla S Fisher
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven R Allen
- Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
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Wancata LM, Morgan H, Sandhu G, Santen S, Hughes DT. Using the ACMGE Milestones as a Handover Tool From Medical School to Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2017; 74:519-529. [PMID: 27908638 DOI: 10.1016/j.jsurg.2016.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/09/2016] [Accepted: 10/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To map current medical school assessments for graduating students to the Accreditation Council for Graduate Medical Education (ACGME) milestones in general surgery, and to pass forward individual performance metrics on level 1 milestones to receiving residency programs. DESIGN The study included 20 senior medical students who were accepted into surgery internship positions. Data from medical school performance assessments from the third-year surgery clerkship, fourth-year surgery rotations, fourth-year surgery boot camp, Clinical Competency Assessment Examination, and United States Medical Licensing Examination (USMLE) Step 1 and 2 examinations were used to map each student's competency assessments to the General Surgery Milestones based on a scoring system created and validated by independent assessors. This Milestones Assessment was then provided to each student's receiving program director. SETTING The study was conducted at the University of Michigan Medical School, in Ann Arbor, Michigan. PARTICIPANTS Fourth-year medical students entering into surgical internship. RESULTS Of 16 Accreditation Council for Graduate Medical Education (ACGME) General Surgery Milestones subcompetencies, 12 were able to be evaluated with current medical school assessments. Of the 20 students, 11 met criteria for all the level 1 milestones and 9 needed improvement in at least 1 domain. CONCLUSIONS It was feasible to use medical school assessments to feed forward information about senior medical students on 12 of the 16 General Surgery Milestones subcompetency domains.
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Affiliation(s)
- Lauren M Wancata
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sally Santen
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David T Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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A Longitudinal Regional Educational Model for Pulmonary and Critical Care Fellows Emphasizing Small Group- and Simulation-based Learning. Ann Am Thorac Soc 2017; 13:469-74. [PMID: 26845063 DOI: 10.1513/annalsats.201601-027ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recent trends have necessitated a renewed focus on how we deliver formal didactic and simulation experiences to pulmonary and critical care medicine (PCCM) fellows. To address the changing demands of training PCCM fellows, as well as the variability in the clinical training, fund of knowledge, and procedural competence of incoming fellows, we designed a PCCM curriculum that is delivered regionally in the Baltimore/Washington, DC area in the summer and winter. The educational curriculum began in 2008 as a collaboration between the Critical Care Medicine Department at the National Institutes of Health and the Pulmonary and Critical Care Section of the Department of Medicine at MedStar Washington Hospital Center and now includes 13 individual training programs in PCCM, critical care medicine, and pulmonary diseases in Baltimore and Washington, DC. Informal and formal feedback from the fellows who participated led to substantial changes to the course curriculum, allowing for continuous improvement. The educational consortium has helped build a local community of educators to share ideas, support each other's career development, and collaborate on other endeavors. In this article, we describe how we developed and deliver this curriculum and report on lessons learned.
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Validation of a new ENT emergencies course for first-on-call doctors. The Journal of Laryngology & Otology 2017; 131:106-112. [PMID: 28069096 DOI: 10.1017/s002221511601001x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND First-on-call ENT cover is often provided by junior doctors with limited ENT experience; yet, they may have to manage life-threatening emergencies. An intensive 1-day simulation course was developed to teach required skills to junior doctors. METHODS A prospective, single-blinded design was used. Thirty-seven participants rated their confidence before the course, immediately following the course and after a two-month interval. Blinded assessors scored participant performance in two video-recorded simulated scenarios before and after the course. RESULTS Participant self-rated confidence was increased in the end-of-course survey (score of 27.5 vs 53.0; p < 0.0001), and this was maintained two to four months after the course (score of 50.5; p < 0.0001). Patient assessment and management in video-recorded emergency scenarios was significantly improved following course completion (score of 9.75 vs 18.75; p = 0.0093). CONCLUSION This course represents an effective method of teaching ENT emergency management to junior doctors. ENT induction programmes benefit from the incorporation of a simulation component.
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McKenzie S, Mellis C. Practically prepared? Pre-intern student views following an education package. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:111-120. [PMID: 28184172 PMCID: PMC5291458 DOI: 10.2147/amep.s116777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Graduating medical students enter their internship with varied levels of practical experience in procedural skills. To address this problem, many medical schools have introduced intensive skill training courses immediately prior to graduation. This study examines the impact of a pre-intern (PrInt) education package, consisting of a short intensive course, followed by a one-month clinical attachment. METHODS In September 2014, all PrInt students (n = 53) at the Central Clinical School (Sydney, NSW, Australia) attended three days of intensive training. This included a didactic introduction, case-based scenarios, and interactive workshops. This was followed by four weeks of targeted, experiential learning during a clinical attachment (PrInt term). Immediately prior to training and following PrInt, all students were invited to complete a six-domain questionnaire containing 40 subscale closed questions to assess their knowledge, experience, and confidence in key practical skills essential for a successful internship. RESULTS A total of 41/53 (77%) students completed an identical questionnaire prior to PrInt, and 37/53 (70%) immediately following PrInt. Respondents reported statistically significant increases in their experience, ability, knowledge, and confidence in a number of domains. The key changes were the following: knowledge of pharmacy skills (mean improvement = 26.48, confidence interval 95% [CI 95%] = 17.29-35.66, p ≤ 0.0001) and management of procedural skills (mean = 24.46, CI 95% = 16.58-32.34, p ≤ 0.0001). Despite the positive overall increase in most domains, some subscale results remained low following the educational package; only 44% students had inserted a nasogastric tube; only 44% reported confidence in commencing patients on warfarin; and only 42% in managing a hospital emergency. Surprisingly, there was a slight decline both in confidence in communicating with members of the hospital team (10%) and in awareness of the causes of hypoglycemia (7%). CONCLUSION Final year students perceived substantial benefit from an educational package specifically aimed at improving their practical skills immediately prior to internship.
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Affiliation(s)
- Susan McKenzie
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
- Correspondence: Susan McKenzie, Central Clinical School, Sydney Medical School, The University of Sydney, Building 63, Level 4, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia, Tel +61 2 9515 6548, Email
| | - Craig Mellis
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
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Abstract
UNLABELLED Introduction New paediatric cardiology trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have limited or no exposure during residency. The Pediatric Cardiology Fellowship Boot Camp (PCBC) at Boston Children's Hospital was designed to provide incoming fellows with an intensive exposure to congenital cardiac pathology and a broad overview of major areas of paediatric cardiology practice. METHODS The PCBC curriculum was designed by core faculty in cardiac pathology, echocardiography, electrophysiology, interventional cardiology, exercise physiology, and cardiac intensive care. Individual faculty contributed learning objectives, which were refined by fellowship directors and used to build a programme of didactics, hands-on/simulation-based activities, and self-guided learning opportunities. RESULTS A total of 16 incoming fellows participated in the 4-week boot camp, with no concurrent clinical responsibilities, over 2 years. On the basis of pre- and post-PCBC surveys, 80% of trainees strongly agreed that they felt more prepared for clinical responsibilities, and a similar percentage felt that PCBC should be offered to future incoming fellows. Fellows showed significant increase in their confidence in all specific knowledge and skills related to the learning objectives. Fellows rated hands-on learning experiences and simulation-based exercises most highly. CONCLUSIONS We describe a novel 4-week-long boot camp designed to expose incoming paediatric cardiology fellows to the broad spectrum of knowledge and skills required for the practice of paediatric cardiology. The experience increased trainee confidence and sense of preparedness to begin fellowship-related responsibilities. Given that highly interactive activities were rated most highly, boot camps in paediatric cardiology should strongly emphasise these elements.
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Castro D, Tcharmtchi MH, Thammasitboon S. A Practical Application of Educational Theories in Developing a Boot Camp Program for Pediatric Critical Care Fellows. Acad Pediatr 2016; 16:707-711. [PMID: 27772694 DOI: 10.1016/j.acap.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Danny Castro
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX.
| | - M Hossein Tcharmtchi
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX
| | - Satid Thammasitboon
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX
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El-Beheiry M, McCreery G, Schlachta CM. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents' simulation curriculum. Surg Endosc 2016; 31:1643-1650. [PMID: 27572069 DOI: 10.1007/s00464-016-5152-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/23/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of this study was to assess the effect of a serious game skills competition on voluntary usage of a laparoscopic simulator among first-year surgical residents' standard simulation curriculum. METHODS With research ethics board approval, informed consent was obtained from first-year surgical residents enrolled in an introductory surgical simulation curriculum. The class of 2013 served as a control cohort following the standard curriculum which mandates completion of six laparoscopic simulator skill tasks. For the 2014 competition cohort, the only change introduced was the biweekly and monthly posting of a leader board of the top three and ten fastest peg transfer times. Entry surveys were administered assessing attitudes towards simulation-based training and competition. Cohorts were observed for 5 months. RESULTS There were 24 and 25 residents in the control and competition cohorts, respectively. The competition cohort overwhelmingly (76 %) stated that they were not motivated to deliberate practice by competition. Median total simulator usage time was 132 min (IQR = 214) in the competition cohort compared to 89 (IQR = 170) in the control cohort. The competition cohort completed their course requirements significantly earlier than the control cohort (χ 2 = 6.5, p = 0.01). There was a significantly greater proportion of residents continuing to use the simulator voluntarily after completing their course requirements in the competition cohort (44 vs. 4 %; p = 0.002). Residents in the competition cohort were significantly faster at peg transfer (194 ± 66 vs. 233 ± 53 s, 95 % CI of difference = 4-74 s; p = 0.03) and significantly decreased their completion time by 33 ± 54 s (95 % CI 10-56 s; paired t test, p = 0.007). CONCLUSIONS A simple serious games skills competition increased voluntary usage and performance on a laparoscopic simulator, despite a majority of participants reporting they were not motivated by competition. Future directions should endeavour to examine other serious gaming modalities to further engage trainees in simulated skills development.
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Affiliation(s)
- Mostafa El-Beheiry
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada.
| | - Greig McCreery
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada
| | - Christopher M Schlachta
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada
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Burns R, Mangold K, Adler M, Trainor J. Pediatric Boot Camp Series: Obtaining a Consult, Discussing Difficult News. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10437. [PMID: 31008216 PMCID: PMC6464432 DOI: 10.15766/mep_2374-8265.10437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Transitioning from medical student to intern requires individuals to possess medical knowledge, clinical skills, and the ability to communicate with a wide variety of health care professional as well as patients and their families. New doctors may be expected to function within the health care team without having received explicit instruction in communication previously. The materials associated with this publication are intended to be used as resources for small-group education of graduating medical students entering into pediatric, family medicine, or emergency medicine residencies. METHODS Four pediatric cases serve as the focus points for discussion and role-play around calling consultants and discussing difficult news with families and patients. Brief didactics and detailed facilitator notes help prime learning and guide discussion. The included facilitator notes and slide sets are part of the comprehensive materials necessary to implement this 4-hour course at your own institution. RESULTS This curriculum has been used since 2012 with graduating medical students entering into pediatric, family medicine, and emergency medicine residencies at two institutions within the United States. Feedback has been overwhelmingly positive, and students have reported increased confidence in their ability to communicate with families and other health care providers. DISCUSSION This publication is the second part of a two-part curriculum but may be used independently of the first part. Although the cases are based on pediatrics, the content regarding communication is universal to many medical specialties.
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Affiliation(s)
- Rebekah Burns
- Assistant Professor in Pediatrics, University of Washington School of Medicine
- Attending Physician, Division of Emergency Medicine, Seattle Children's Hospital
- Corresponding author:
| | - Karen Mangold
- Assistant Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Attending Physician, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Mark Adler
- Attending Physician, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
- Associate Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Director of Educational Research and Innovation, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Jennifer Trainor
- Associate Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Associate Chair for Education, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago
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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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Burns R, Adler M, Mangold K, Trainor J. A Brief Boot Camp for 4th-Year Medical Students Entering into Pediatric and Family Medicine Residencies. Cureus 2016; 8:e488. [PMID: 27014522 PMCID: PMC4786377 DOI: 10.7759/cureus.488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The transition from medical student to intern is a challenging process characterized by a steep learning curve. Focused courses targeting skills necessary for success as a resident have increased self-perceived preparedness, confidence, and medical knowledge. Our aim was to create a brief educational intervention for 4th-year medical students entering pediatric, family practice, and medicine/pediatric residencies to target skills necessary for an internship. The curriculum used a combination of didactic presentations, small group discussions, role-playing, facilitated debriefing, and simulation-based education. Participants completed an objective structured clinical exam requiring synthesis and application of multiple boot camp elements before and after the elective. Participants completed anonymous surveys assessing self-perceived preparedness for an internship, overall and in regards to specific skills, before the elective and after the course. Participants were asked to provide feedback about the course. Using checklists to assess performance, students showed an improvement in performing infant lumbar punctures (47.2% vs 77.0%; p < 0.01, 95% CI for the difference 0.2, 0.4%) and providing signout (2.5 vs. 3.9 (5-point scale) p < 0.01, 95% CI for the difference 0.6, 2.3). They did not show an improvement in communication with a parent. Participants demonstrated an increase in self-reported preparedness for all targeted skills, except for obtaining consults and interprofessional communication. There was no increase in reported overall preparedness. All participants agreed with the statements, “The facilitators presented the material in an effective manner,” “I took away ideas I plan to implement in internship,” and “I think all students should participate in a similar experience.” When asked to assess the usefulness of individual modules, all except order writing received a mean Likert score > 4. A focused boot camp addressing key knowledge and skills required for pediatric-related residencies was well received and led to improved performance of targeted skills and increased self-reported preparedness in many targeted domains.
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Affiliation(s)
- Rebekah Burns
- Pediatrics, Seattle Children's Hospital - University of Washington School of Medicine
| | - Mark Adler
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Mangold
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Trainor
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lamba S, Wilson B, Natal B, Nagurka R, Anana M, Sule H. A suggested emergency medicine boot camp curriculum for medical students based on the mapping of Core Entrustable Professional Activities to Emergency Medicine Level 1 milestones. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:115-24. [PMID: 27042155 PMCID: PMC4780742 DOI: 10.2147/amep.s97106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND An increasing number of students rank Emergency Medicine (EM) as a top specialty choice, requiring medical schools to provide adequate exposure to EM. The Core Entrustable Professional Activities (EPAs) for Entering Residency by the Association of American Medical Colleges combined with the Milestone Project for EM residency training has attempted to standardize the undergraduate and graduate medical education goals. However, it remains unclear as to how the EPAs correlate to the milestones, and who owns the process of ensuring that an entering EM resident has competency at a certain minimum level. Recent trends establishing specialty-specific boot camps prepare students for residency and address the variability of skills of students coming from different medical schools. OBJECTIVE Our project's goal was therefore to perform a needs assessment to inform the design of an EM boot camp curriculum. Toward this goal, we 1) mapped the core EPAs for graduating medical students to the EM residency Level 1 milestones in order to identify the possible gaps/needs and 2) conducted a pilot procedure workshop that was designed to address some of the identified gaps/needs in procedural skills. METHODS In order to inform the curriculum of an EM boot camp, we used a systematic approach to 1) identify gaps between the EPAs and EM milestones (Level 1) and 2) determine what essential and supplemental competencies/skills an incoming EM resident should ideally possess. We then piloted a 1-day, three-station advanced ABCs procedure workshop based on the identified needs. A pre-workshop test and survey assessed knowledge, preparedness, confidence, and perceived competence. A post-workshop survey evaluated the program, and a posttest combined with psychomotor skills test using three simulation cases assessed students' skills. RESULTS Students (n=9) reported increased confidence in the following procedures: intubation (1.5-2.1), thoracostomy (1.1-1.9), and central venous catheterization (1.3-2) (a three-point Likert-type scale, with 1= not yet confident/able to perform with supervision to 3= confident/able to perform without supervision). Psychomotor skills testing showed on average, 26% of students required verbal prompting with performance errors, 48% with minor performance errors, and 26% worked independently without performance errors. All participants reported: 1) increased knowledge and confidence in covered topics and 2) overall satisfaction with simulation experience. CONCLUSION Mapping the Core EPAs for Entering Residency to the EM milestones at Level 1 identifies educational gaps for graduating medical students seeking a career in EM. Educators designing EM boot camps for medical students should consider these identified gaps, procedures, and clinical conditions during the development of a core standardized curriculum.
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Affiliation(s)
- Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Bryan Wilson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brenda Natal
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roxanne Nagurka
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Correspondence: Roxanne Nagurka, Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07101, USA, Email
| | - Michael Anana
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Harsh Sule
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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