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Karol D, Malik A, Philippopoulos E, Alibhai K, Jones C, Tannenbaum E. Interventions Used to Improve Communication Competencies in Surgical Residencies: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:103284. [PMID: 39388971 DOI: 10.1016/j.jsurg.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/10/2024] [Accepted: 09/06/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE To explore which educational interventions have been used to address communication skill in surgical residents. DESIGN Systematic review. RESULTS Several interventions have been used to improve communication skill in residency, including simulation, standardized patients, and didactic teaching. These interventions vary widely, yet the majority of interventions tend to result in improvement in resident communication skill. CONCLUSIONS Communication is an essential skill for surgical trainees to learn. Integration of communication-focused educational interventions can lead to improved skill development in surgical residents.
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Affiliation(s)
- Dalia Karol
- University of Toronto, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada.
| | - Aleena Malik
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | | | - Kameela Alibhai
- University of Toronto, Department of General Surgery, Toronto, Ontario, Canada
| | - Claire Jones
- University of Toronto, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada; Mount Sinai Hospital, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Toronto, Ontario, Canada
| | - Evan Tannenbaum
- University of Toronto, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada; Mount Sinai Hospital, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada
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Assouly J, Hayes M, Debien B, Roubille C, Jung B. Navigating the challenges: Would onboarding bootcamps enhance comfort and wellbeing of residents in medicine? Eur J Intern Med 2024; 128:141-142. [PMID: 38806371 DOI: 10.1016/j.ejim.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Jonathan Assouly
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, University of Montpellier, Montpellier, France
| | - Margaret Hayes
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Blaise Debien
- Medical Simulation Training Center, Medical School, University of Montpellier and Emergency Department, Lapeyronie Teaching Hospital, University of Montpellier, Montpellier, France
| | - Camille Roubille
- Department of Internal medicine, Lapeyronie Teaching Hospital, University of Montpellier, Montpellier, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, University of Montpellier, Montpellier, France; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; PhyMedExp, University of Montpellier, Montpellier, France.
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Trehan R, Chen C, Bhalla R. Peer review for handoff education in a transition to residency course: A prospective cohort study. Health Sci Rep 2024; 7:e2292. [PMID: 39118671 PMCID: PMC11306289 DOI: 10.1002/hsr2.2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 07/11/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
Background and Aims Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) mandate training in handoff delivery for students and residents. Communication errors, including errors during handoffs of patient care, account for over 2/3 of sentinel events. This study aims to assess the effectiveness of peer-assisted learning (PAL) in handoff education within a longitudinal framework. Methods This study involved the analysis of fourth-year medical students (n = 67) enrolled in a transition to residency program designed to reinforce skills essential for success in internal medicine residencies. We modified the I-PASS handoff rubric for a single-encounter evaluation. Before attending the transitions of care workshop, students submitted one written handoff report. During high-fidelity simulation sessions, peers evaluated the written document as well as verbal handoffs, while faculty evaluated a recorded verbal version. The primary outcome measured was improvement in handoff quality and accuracy over time and secondary outcomes compared peer- and self-evaluations to faculty assessments. Results Overall, students demonstrated a statistically significant improvement in handoff quality and accuracy across all scoring criteria after completing the peer evaluation process. Peer evaluations did not demonstrate statistically significant differences in scores for quality or accuracy questions as compared to faculty. Conclusion Peer evaluators effectively assessed handoff reports using the modified I-PASS checklist yielding outcomes similar to faculty while providing feedback. These findings provide exciting evidence that should prompt training programs to consider incorporating standardized peer review into handoff education for medical students and, potentially, residents. The detailed evaluation of individual handoff events fosters feedback skills essential for ongoing professional growth and clinical excellence.
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Affiliation(s)
- Rajiv Trehan
- Robert Wood Johnson Medical SchoolRutgers UniversityPiscatawayNew JerseyUSA
| | - Catherine Chen
- Department of Medicine, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Raman Bhalla
- Department of Medicine, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
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Donohue K, Davis N, Farber D, Retener N, Dittmar P. An internal medicine residency preparatory curriculum for fourth-year medical students. CLINICAL TEACHER 2024; 21:e13703. [PMID: 38049309 DOI: 10.1111/tct.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/09/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Intern preparation courses are often broad in scope; there are few published specialty-specific programs outside of General Surgery and Obstetrics. We designed an internal medicine (IM) residency preparatory course at the University of Maryland School of Medicine, which aimed to prepare graduating medical students for the rigours of IM residency training, mapped to Entrustable Professional Activities (EPAs). METHODS Fourteen fourth-year medical students who were matriculating into IM residency programs enrolled in a 4-week long residency preparation course. The course was designed to teach skills using case-based learning modules, specialty topic seminars, simulation laboratories, procedure laboratories and clinical practice. Participants were surveyed before and after the course on their perceived knowledge and ability with the skills tested. RESULTS With the exception of 'giving signout to a colleague', there was a significant difference in the participant's perceived ability for each skill taught within the course (P < 0.03 for each), with mean pre-course scores of 1.4-3.7 (SD = 0.5-1.2) and mean post-course scores of 3.2-4.2 (SD = 0.5-1.3). A second survey on course evaluation and perceived impact, completed 3 months after starting intern year, resulted in all respondents reporting that the information learned during the course had directly affected their care of patients on a daily or weekly basis. The modified Ottawa scale was the primary assessment means for the EPAs, with participants approaching entrustment at the conclusion of the course. CONCLUSIONS Implementation of an IM-specific residency preparation course is a useful adjunct in the fourth year of medical school.
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Affiliation(s)
- Katelyn Donohue
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dara Farber
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Norman Retener
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Philip Dittmar
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Wesevich A, De Fer TM, Awad MM, Woodhouse J, Andriole DA, Brunt LM. A Capstone Course for Senior Medical Students: from Innovative Elective to Required Core Curriculum. MEDICAL SCIENCE EDUCATOR 2024; 34:171-180. [PMID: 38510417 PMCID: PMC10948630 DOI: 10.1007/s40670-023-01880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 03/22/2024]
Abstract
We describe our institution's development and implementation of our Capstone course from a small elective course to the only required fourth-year course. The course's structure evolved from mostly didactic to one including various workshops and simulation sessions. Course content has become increasingly specialty-specific. Implementation requires high faculty and resident involvement. Evaluations indicate a positive impact of the course on participants' self-reported confidence and residency preparedness. Assessment remains pass/fail with more specialty-specific questions. As steadily increasing numbers of medical schools are developing transition to residency courses, we share our Capstone course's evolution and lessons learned over the past nine years. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01880-2.
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Affiliation(s)
- Austin Wesevich
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Thomas M. De Fer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Michael M. Awad
- Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Julie Woodhouse
- Office of Education, Washington University School of Medicine, St. Louis, MO USA
| | - Dorothy A. Andriole
- Medical Education Research, Association of American Medical Colleges, Washington, D.C. USA
| | - L. Michael Brunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
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Park YS, Sachdeva AK, Liscum K, Alseidi A, Gesbeck M, Blair PG, Salcedo E, Sullivan M, Bordage G. The American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA): Validity Evidence From a Three-Year National Study. Ann Surg 2023; 277:704-711. [PMID: 34954752 DOI: 10.1097/sla.0000000000005358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To gather validity evidence supporting the use and interpretation of scores from the American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA) Program. SUMMARY AND BACKGROUND DATA ACS ERRA is an online formative assessment program developed to assess entering surgery residents' ability to make critical clinical decisions, and includes 12 clinical areas and 20 topics identified by a national panel of surgeon educators and residency program directors. METHODS Data from 3 national testing administrations of ACS ERRA (2018-2020) were used to gather validity evidence regarding content, response process, internal structure (reliability), relations to other variables, and consequences. RESULTS Over the 3 administrations, 1975 surgery residents participated from 125 distinct residency programs. Overall scores [Mean = 64% (SD = 7%)] remained consistent across the 3 years ( P = 0.670). There were no significant differences among resident characteristics (gender, age, international medical graduate status). The mean case discrimination index was 0.54 [SD = 0.15]. Kappa inter-rater reliability for scoring was 0.87; the overall test score reliability (G-coefficient) was 0.86 (Ф-coefficient = 0.83). Residents who completed residency readiness programs had higher ACS ERRA scores (66% versus 63%, Cohen's d = 0.23, P < 0.001). On average, 15% of decisions made (21/140 per test) involved potentially harmful actions. Variability in scores from graduating medical schools (7%) carried over twice as much weight than from matched residency programs (3%). CONCLUSIONS ACS ERRA scores provide valuable information to entering surgery residents and surgery program directors to aid in development of individual and group learning plans.
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Affiliation(s)
- Yoon Soo Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, IL
| | - Kathy Liscum
- Division of Education, American College of Surgeons, Chicago, IL
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Melissa Gesbeck
- Division of Education, American College of Surgeons, Chicago, IL
| | | | - Edgardo Salcedo
- Department of Surgery, University of California Davis, Sacramento, CA
| | - Maura Sullivan
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Georges Bordage
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL
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Damon A, Lee SJ, Pichelmann M, Nottmeier E, CreveCoeur TS, Clifton W. International Learner Perceptions, Educational Value, and Cost Associated With the Use of Start-to-Finish Surgical Simulation Compared With Cadaveric Models. Oper Neurosurg (Hagerstown) 2023; 24:201-208. [PMID: 36637305 DOI: 10.1227/ons.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Graduate surgical education is highly variable across regions and institutions regarding case volume and degree of trainee participation in each case. Dedicated educational curriculum using cadaveric tissue has been shown to enhance graduate surgical training, however with associated financial and utility burden to the institution. OBJECTIVE To investigate the utility of educational and cost applications of a novel method of combining mixed organic hydrogel polymers and 3-dimensional printed anatomic structures to create a complete "start-to-finish" simulation for resident education in spinal anatomy, instrumentation, and surgical techniques. METHODS This qualitative pilot study investigated 14 international participants on achievement of objective and personal learning goals in a standardized curriculum using biomimetic simulation compared with cadaveric tissue. A questionnaire was developed to examine trainee evaluation of individual anatomic components of the biomimetic simulators compared with previous experience with cadaveric tissue. RESULTS A total of 210 responses were acquired from 14 participants. Six participants originated from US residency education programs and 8 from transcontinental residency programs. Survey results for the simulation session revealed high user satisfaction. Score averages for each portion of the simulation session indicated learner validation of anatomic features for the simulation compared with previous cadaveric experience. Cost analysis resulted in an estimated savings of $10 833.00 for this single simulation session compared with previous cadaveric tissue sessions. CONCLUSION The results of this study indicate a strong potential of establishing biomimetic simulation as a cost-effective and high-quality alternative to cadaveric tissue for the instruction of fundamental spine surgical techniques.
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Affiliation(s)
- Aaron Damon
- Department of Education, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Seung Jin Lee
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Mark Pichelmann
- Department of Neurosurgery, Mayo Clinic Health Systems, Eau ClaiSre, Wisconsin, USA
| | - Eric Nottmeier
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Travis S CreveCoeur
- Department of Neurologic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - William Clifton
- Department of Neurologic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Alnuhait M, Alharbi A, Alanizi A, Alkhudair N, Alshamrani M, Bajnaid E, Alrajhi A, Alnajjar F, Khardaly A. Implementing Oncology Pharmacy Boot Camp for Advanced Pharmacy Practice Experience Students at a Regional Conference in Saudi Arabia. Cureus 2023; 15:e34780. [PMID: 36909037 PMCID: PMC10005846 DOI: 10.7759/cureus.34780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/10/2023] Open
Abstract
Background Upon graduation, pharmacy students are expected to possess a diverse array of knowledge, skills, and attitudes. A subject-specific boot camp may support bridging the gap between the information and skills gained during clerkships, courses required for pharmacy school after graduation, and skills needed for the job market, as well as the gap between pharmacy school and residency. This research aimed to determine whether an integrated boot camp increased Advanced Pharmacy Practice Experience (APPE) student self-confidence and enhanced students' knowledge in oncology pharmacy. Method APPE students who attended the annual meeting of the Saudi Oncology Pharmacy Assembly (SOPA)/International Society of Oncology Pharmacy Practitioners (ISOPP) Regional Conference 2021 were voluntarily enrolled in a three-hour oncology-focused boot camp consisting of interactive lectures. Pre- and post-intervention examinations were used to evaluate student learning outcomes and their experience feedback. Result Of 118 students who attended the boot camp, 80 students who met the criteria were included in the study. The pre- and post-intervention examinations were completed by the 80 APPE students. The pre-intervention test results (mean: 66%, standard deviation (SD): 16%) increased by 21.5% after the boot camp (mean: 87.5%, SD: 12%, p = 0.001). Students scored better on each of the 10 test questions, with nine questions demonstrating a statistically significant result. Conclusion The results of this research showed that interns who participated in an oncology boot camp had a higher level of knowledge and confidence in applying key oncology concepts. Interns were satisfied with the chance to engage in the activity, and they agreed to adding boot camps to future conferences would be valuable. This research shows that it is possible to hold a transitional boot camp during conferences to better prepare students for their fields of study and increase their participation in oncology conferences.
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Affiliation(s)
- Mohammed Alnuhait
- Department of Clinical Pharmacy, Umm Al-Qura University, Makkah, SAU
| | - Atika Alharbi
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, SAU
| | - Abdalrhman Alanizi
- Department of Pharmaceutical Care, King Abdullah bin Abdulaziz University Hospital, Riyadh, SAU
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, SAU
| | - Majed Alshamrani
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, SAU
| | - Eshtyag Bajnaid
- Department of Pharmaceutical Care Services, King Abdullah Medical City, Makkah, SAU
| | - Abdullah Alrajhi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, SAU.,College of Pharmacy, Alfaisal University, Riyadh, SAU
| | - Fouad Alnajjar
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, SAU
| | - Amr Khardaly
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, SAU
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Krishnaswami S, Polites SF, Dekany G, Gaines BA, Nwomeh BC, Huang EY, Finck CM, Lopushinsky SR, Puligandla PS, Feliz A, Mak GZ, Anderson SA, Fairbanks T, Alaish SM. The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions. JOURNAL OF SURGICAL EDUCATION 2023; 80:62-71. [PMID: 36085115 DOI: 10.1016/j.jsurg.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The first transition to fellowship course for incoming pediatric surgery fellows was held in the US in 2018 and the second in 2019. The course aimed to facilitate a successful transition in to fellowship by introduction of the professional, patient care, and technical aspects unique to pediatric surgery training. The purpose of this study was to evaluate the feasibility and effectiveness of the first two years of this course in the US and discuss subsequent evolution of this endeavor. DESIGN This is a descriptive and qualitative analysis of two years' experience with the Association of Pediatric Surgery Training Program Directors' (APSTPD) Transition to Fellowship course. Course development and curriculum, including clinical knowledge, soft skills, and hands-on skills labs, are presented. Participating incoming fellows completed multiple choice, boards-style pre- and post-tests. Scores were compared to determine if knowledge was effectively transferred. Participants also completed post-course evaluations and subsequent 3- or 12-month surveys inquiring on the lasting impact of the course on their transition into fellowship. Standard univariate statistics were used to present results. SETTING The first APSTPD Transition to Fellowship course was held at the Johns Hopkins Hospital in Baltimore, Maryland in 2018, and the second course was held at the Oregon Health and Science University in Portland, Oregon in 2019. PARTICIPANTS All fellows entering ACGME-certified Pediatric Surgery fellowships in the United States were invited to participate. Twenty fellows accepted and attended in 2018, and fourteen fellows participated in 2019. RESULTS There were 34 incoming pediatric surgery fellow participants over 2 years. Faculty represented more than 10 institutions each year. Pre- and post-test scores were similar between years, with a significant improvement of scores after completion of the course (67±10% vs 79±8%, p < 0.001). Feedback from participants was overwhelmingly positive, with skills labs being attendees' favorite component. When asked about usefulness of individual course sessions, more attendees found clinical sessions more useful than soft skills (93% vs 73%, p = 0.011). Almost all (90%) of participants reported the course met its stated purpose and would recommend the course to future fellows. This was further reflected on 3 and 12 month follow up surveys wherein 85% stated they found the course helpful during the first few months of fellowship and 90% would still recommend it. CONCLUSIONS A transition to fellowship course in the US for incoming pediatric surgery fellows is logistically feasible, effective in transfer of knowledge, and highly regarded among attendees. Feedback from each course has been used to improve the subsequent courses, ensuring that it remains a valuable addition to pediatric surgical training in the US.
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Affiliation(s)
- Sanjay Krishnaswami
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon; APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Gabriela Dekany
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara A Gaines
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Eunice Y Huang
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | | | | | - Alexander Feliz
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Grace Z Mak
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Scott A Anderson
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Samuel M Alaish
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Bondzi-Simpson A, Lindo CJ, Hoy M, Lui JT. The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery. J Otolaryngol Head Neck Surg 2022; 51:23. [PMID: 35659365 PMCID: PMC9167522 DOI: 10.1186/s40463-022-00583-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world. DATA SOURCES Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed. REVIEW METHODS Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees. RESULTS A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition. CONCLUSION Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.
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Affiliation(s)
- Adom Bondzi-Simpson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Lindo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
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Ryan MS, Iobst W, Holmboe ES, Santen SA. Competency-based medical education across the continuum: How well aligned are medical school EPAs to residency milestones? MEDICAL TEACHER 2022; 44:510-518. [PMID: 34807793 DOI: 10.1080/0142159x.2021.2004303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Competency-based medical education (CBME) provides a framework for describing learner progression throughout training. However, specific approaches to CBME implementation vary widely across educational settings. Alignment between various methods used across the continuum is critical to support transitions and assess learner performance. The purpose of this study was to investigate alignment between CBME frameworks used in undergraduate medical education (UME) and graduate medical education (GME) settings using the US context as a model. METHOD The authors analyzed content from the core entrustable professional activities for entering residency (Core EPAs; UME model) and residency milestones (GME model). From that analysis, they performed a series of cross-walk activities to investigate alignment between frameworks. After independent review, authors discussed findings until consensus was reached. RESULTS Some alignment was found for activities associated with history taking, physical examination, differential diagnosis, patient safety, and interprofessional care; however, there were far more examples of misalignment. CONCLUSIONS These findings highlight challenges creating alignment of assessment frameworks across the continuum of training. The importance of these findings includes implications for assessment and persistence of the educational gap across UME and GME. The authors provide four next steps to improve upon the continuum of education.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - William Iobst
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Sally A Santen
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Shi J, Li T, Chang P, Wang Z, Hu L. Education curriculum for surgical interns that improves stress management and grit levels. MEDICAL TEACHER 2022; 44:263-266. [PMID: 34608836 DOI: 10.1080/0142159x.2021.1984407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Overwhelming stress or burnout has been observed in medical students, including 69% of surgical interns. This study aimed to assess the stress levels of fifth-year medical students during surgical training. An education curriculum with both clinical and research sessions was evaluated for its effect on the interns' stress and grit levels. METHOD A blinded, prospective study was conducted to evaluate the efficacy of an educational program on the recognition and management of stress. The State-Trait Anxiety Inventory (STAI) was used to assess anxiety. The Grit Scale was used to quantify the interns' grit, conscientiousness, and self-control. RESULTS The STAI survey results showed that the STAI state scores but not the trait scores were significantly lower in the intervention group than in the control group (p < 0.05). Additionally, the postintervention STAI score and the change in the STAI score were both lower in the intervention group (p < 0.05). There was a significant increase in grit among the medical students in the intervention group from baseline to post-intervention (p < 0.001). The scores of the consistency and perseverance subscales of the Grit Scale also increased significantly from baseline to post-intervention (both p < 0.001). CONCLUSION The education curriculum can improve interns' stress management and grit levels. We believe this curriculum needs to be implemented in medical education, and we plan to continue the program.
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Affiliation(s)
- Jianhua Shi
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Li
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pengkang Chang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Wang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangshuo Hu
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Price A, Greene HM, Stem CT, Titus MO. Sticking It Straight: Pediatric Procedure Curriculum Initiative. Pediatr Emerg Care 2022; 38:79-82. [PMID: 33394950 DOI: 10.1097/pec.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Literature demonstrates that pediatric residents are not graduating with procedural confidence and competency. This was confirmed with our own institution's Accreditation Council for Graduate Medical Education and internal surveys. Our primary objective was to improve procedural confidence among pediatric residents with the introduction of a mandatory longitudinal pediatric procedural curriculum, including simulation in combination with online modules. METHODS We performed a quality improvement intervention to increase resident comfort level performing Accreditation Council for Graduate Medical Education-required procedures. This study involved pediatric residents, postgraduation year (PGY) 1-3, at an academic, tertiary care hospital. Between April 2015 and June 2017, the combination of online self-directed learning modules and hands-on simulation curriculum was implemented for pediatric residents. Surveys were administered at 1-year intervals to assess self-reported comfort level on 12 procedures using a Likert scale (1 for "strongly disagree" to 5 for "strongly agree, maximum score of 60 for all procedures). RESULTS Forty (63%) of 63 participant presurveys and 45 (71%) of 63 postsurveys were available for analysis. The mean comfort level for all procedures demonstrated a statistically significant increase from 32.4 to 37.1, or 12.7% (P = 0.005). By PGY level, the score increased from 24.4 to 30.9 (21%) for PGY1, 34.4 to 37.5 (8.3%) for PGY2, and 38.6 to 42.8 (9.8%) for PGY3 (P < 0.005). Overall, pediatric residents rated the simulation experience very favorably. CONCLUSIONS A mandatory longitudinal procedure curriculum improved procedural comfort level among pediatric residents. Iterative curriculum designs found the most productive combination to be deliberate practice within mastery learning simulation sessions with required precourse online modules.
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Affiliation(s)
- Amanda Price
- From the Pediatric Emergency Medicine, Pediatric Simulation, Medical University South Carolina, Charleston, SC
| | - H Michelle Greene
- Pediatric Emergency Medicine and Child Abuse Fellow, Nationwide Children's Hospital, Columbus, OH
| | - Christopher T Stem
- Pediatric Emergency Medicine Fellow, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - M Olivia Titus
- Pediatric Emergency Medicine, Medical University South Carolina, Charleston, SC
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14
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A systematic review of methodological principles and delivery of surgical simulation bootcamps. Am J Surg 2021; 223:1079-1087. [PMID: 34865734 DOI: 10.1016/j.amjsurg.2021.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/27/2021] [Accepted: 10/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The growth of "bootcamp style" simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented that can be applied to all surgical specialities. METHODS To understand the surgical bootcamp principles and delivery mechanisms, we searched peer-reviewed, English language studies published between 2000 and 21. RESULTS From 137 articles, 14 studies with a Medical Education Research Quality Instrument Score of >11.5 were included. Most studies followed the core components; delivery at transition (12), mapping syllabus (13), multimodality delivery (14), and deliberate practice with formative feedback (12) apart from 1:1 training by only 2 studies. CONCLUSIONS Our review suggests that Surgical bootcamp can be an extremely useful education tool for trainees if 5 pillars of a boot camp are respected.
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Sinclair S, Kondejewski J, Jaggi P, Dennett L, Roze des Ordons AL, Hack TF. What Is the State of Compassion Education? A Systematic Review of Compassion Training in Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1057-1070. [PMID: 33830949 PMCID: PMC8231671 DOI: 10.1097/acm.0000000000004114] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To investigate the current state and quality of compassion education interventions offered to health care providers during training or practice, determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, and identify the most common approaches to compassion education. METHOD The MEDLINE, Embase, CINAHL Plus with Full Text, Sociological Abstracts, Web of Science, ERIC, and Education Research Complete databases were searched from inception to March 2020 in this systematic review. Studies that evaluated a compassion education intervention for health care providers or those in training to enhance compassion toward patients and/or families were included. A narrative synthesis of the included studies was performed. The components of each intervention were mapped onto the domains of compassion described in the Patient Compassion Model. RESULTS One hundred eight peer-reviewed publications describing 103 interventions were included. Modalities ranged from establishing curricula and interventions in clinical settings to programs that used humanities-based reflective practices, clinical simulation, role modeling, and contemplative practices, with many education interventions adopting a multimodal approach. Most interventions mapped to the virtuous response domain of the Patient Compassion Model; very few mapped to the other domains of this model. CONCLUSIONS Most interventions were limited as they focused on a single domain of compassion; did not adequately define compassion; were assessed exclusively by self-report; were devoid of a comparator/control group; and did not evaluate retention, sustainability, and translation to clinical practice over time. The authors suggest that compassion education interventions be grounded in an empirically based definition of compassion; use a competency-based approach; employ multimodal teaching methods that address the requisite attitudes, skills, behaviors, and knowledge within the multiple domains of compassion; evaluate learning over time; and incorporate patient, preceptor, and peer evaluations.
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Affiliation(s)
- Shane Sinclair
- S. Sinclair is associate professor and director, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- J. Kondejewski is research assistant, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Priya Jaggi
- P. Jaggi is research coordinator, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Liz Dennett
- L. Dennett is librarian, Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda L. Roze des Ordons
- A.L. Roze des Ordons is clinical associate professor, Department of Critical Care Medicine and Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas F. Hack
- T.F. Hack is professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, and director, Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
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16
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Keilin CA, Farlow JL, Malloy KM, Bohm LA. Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship. Laryngoscope 2021; 131:E2143-E2148. [PMID: 33567132 DOI: 10.1002/lary.29443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/03/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Residency preparation courses (RPCs) have become a widely adopted practice to ease the transition of medical students into residency, but these courses often lack training in skills expected of subspecialty interns. To fill this gap, a simulation-based curriculum in otolaryngology (ORL) was implemented at the University of Michigan Medical School. The curriculum aimed to improve confidence and perceived ability to perform common ORL skills for graduating students prior to internship. STUDY DESIGN Cross-sectional study. METHODS Six basic simulations (tracheostomy, flexible laryngoscopy, otomicroscopy, myringotomy and tube insertion, epistaxis and peritonsillar abscess management) were included in the first course in 2019. The course was expanded in 2020 with the addition of three advanced simulations (ear foreign body extraction, tracheostomy complications, and "cannot intubate, cannot ventilate" situations). Pre- and postsession surveys were collected to assess individual simulations and the course overall. RESULTS A total of 32 students participated in the ORL simulation curriculum in Spring 2019 and 2020. Paired t-tests showed significant improvement in self-perception of ability on every simulation. Qualitative feedback revealed that students particularly valued the opportunity for hands-on learning. Non-ORL students rated their baseline abilities significantly lower than ORL students on five stations, but they achieved statistically equivalent postsession ratings on all but the otomicroscopy station. CONCLUSIONS An ORL-specific curriculum is a valuable addition to procedural RPCs. The curriculum resulted in increased confidence and perceived ability in skill performance for both students pursuing ORL residencies, as well as those pursuing other procedural specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2143-E2148, 2021.
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Affiliation(s)
- Charles A Keilin
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
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Chartrand G, Soucisse M, Dubé P, Trépanier JS, Drolet P, Sideris L. Self-directed learning by video as a means to improve technical skills in surgery residents: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:91. [PMID: 33546679 PMCID: PMC7863545 DOI: 10.1186/s12909-021-02524-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND With their demanding schedules, surgical residents have limited time to practice techniques. The aim is to evaluate the pedagogic model of self-directed learning using video in surgery residents. METHODS Informed consent was obtained from all the participants. A randomized controlled trial was conducted in 2018 at Hôpital Maisonneuve-Rosemont (University of Montreal). Participants were general surgery residents. There were 27 eligible residents; 22 completed the study. They were filmed performing an intestinal anastomosis on cadaveric pig bowel. The self-directed learning by video (SDL-V) group was given an expert video, which demonstrated the technique performed by an experienced surgeon. The control group continued with their regular duties. Three weeks later, participants performed a second filmed anastomosis. Two attending surgeons evaluated the residents' filmed anastomosis using the Objective Structured Assessment of Technical Skills scale. After their second anastomosis, all participants had access to the expert video and completed a survey. RESULTS Score did not differ significantly between groups during the first (control: 23.6 (4.5) vs. SDL-V: 23.9 (4.5), p = 0.99, presented as mean (SD)) or second filmed anastomosis procedure (control: 27.1 (3.9) vs. SDL-V: 29.6 (3.4) p = 0.28). Both groups improved significantly from pre- to post-intervention (mean difference between the two anastomosis procedure with 95% CI for control: 3.5, [1.1; 5.9] and for SDL-V: 5.8, [3.4: 8.2]). Correlation between the evaluators for score was moderate (r = 0.6, 95% CI: [0.3: 0.8]). The pass/fail global evaluation exhibited poor inter-rater reliability (Kappa: 0.105, 95% CI: [- 0.2:0.4]). On the survey, all participants wanted more expert-made videos of specific surgical techniques. CONCLUSIONS Despite a higher final OSATS score for the intervention group, self-directed learning by video failed to produce a statistically significant difference on the overall OSATS scores between the two groups in this small cohort.
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Affiliation(s)
- Geneviève Chartrand
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - Mikael Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Jean-Sébastien Trépanier
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Drolet
- Centre d'acquisition des attitudes et habiletés cliniques, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
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18
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Jochum SB, Venkatramani M, Ritz EM, Favuzza J, Hayden DM, Saclarides TJ, Bhama AR. Surgical Residents' Perspective on Informed Consent-How Does It Compare With Attending Surgeons? J Surg Res 2020; 260:88-94. [PMID: 33333384 DOI: 10.1016/j.jss.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The informed consent discussion (ICD) is a compulsory element of clinical practice. Surgical residents are often tasked with obtaining informed consent, but formal instruction is not included in standard curricula. This study aims to examine attitudes of surgeons and residents concerning ICD. MATERIALS AND METHODS A survey regarding ICD was administered to residents and attending surgeons at an academic medical center with an Accreditation Council for Graduate Medical Education-accredited general surgery residency. RESULTS In total, 44 of 64 (68.75%) residents and 37 of 50 (72%) attending surgeons participated. Most residents felt comfortable consenting for elective (93%) and emergent (82%) cases, but attending surgeons were less comfortable with resident-led ICD (51% elective, 73% emergent). Resident comfort increased with postgraduate year (PGY) (PGY1 = 39%, PGY5 = 85%). A majority of participants (80% attending surgeons, 73% residents) believed resident ICD skills should be formally evaluated, and most residents in PGY1 (61%) requested formal instruction. High percentages of residents (86%) and attendings (100%) believed that ICD skills were best learned from direct observation of attending surgeons. CONCLUSIONS Resident comfort with ICD increases as residents advance through training. Residents acknowledge the importance of their participation in this process, and in particular, junior residents believe formal instruction is important. Attending surgeons are not universally comfortable with resident-led ICDs, particularly for elective surgeries. Efforts for improving ICD education including direct observation between attending surgeons and residents and formal evaluation may benefit the residency curriculum.
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Affiliation(s)
- Sarah B Jochum
- Rush University Medical Center, Department of Surgery, Chicago, Illinois
| | | | - Ethan M Ritz
- Rush University Medical Center, Bioinformatics and Biostatistics Core, Chicago, Illinois
| | - Joanne Favuzza
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Dana M Hayden
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Theodore J Saclarides
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Anuradha R Bhama
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois.
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19
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Cheun TJ, Davies MG. Improving ABSITE scores - A meta-analysis of reported remediation models. Am J Surg 2020; 220:1557-1565. [DOI: 10.1016/j.amjsurg.2020.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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20
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Craig CK, Johnson JE, Holmes JH, Kahn SA, Carter JE. Results From an Evidenced-Based Curriculum Design With Innovative Simulators to Prepare Providers in Caring for Those With Burn Injuries. J Burn Care Res 2020; 41:1267-1270. [PMID: 32516390 DOI: 10.1093/jbcr/iraa089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn care and medical education have undergone dramatic changes. Trauma has over seven courses covering fundamentals, whereas burns has one. Our goal was to develop a course to meet the needs of healthcare professionals requiring more advanced burn management training. A survey was distributed to burn physicians, nurses, therapists, administrators, and survivors, to assess the perceived proficiency of those managing adult and pediatric patients. Procedure simulators were developed, and a course was designed and delivered. An after-course survey of participants captured how this course filled identified knowledge gaps. A total of 188 initial surveys were sent to individuals involved in burn care. A diverse pool of 109 individuals participated (58% response rate). Survey results by providers demonstrated the lowest self-rated proficiency scores at managing large pediatric burns and frostbite. Nonphysicians reported low proficiency in developing wound treatment algorithms, performing escharotomies, and aftercare/reintegration. Following rigorous curriculum development, the course was conducted, and after-course surveys noted students' improved understanding of managing burn injuries, ability to troubleshoot, confidence to manage patients, and their recommending the course to a peer. Providing quality care beyond the initial assessment and stabilization of a burn-injured patient requires additional skills and knowledge. Providers that are uncomfortable or challenged in providing this care may benefit from additional training. Initial data show that a course, such as this one, provides the education necessary to fill the most commonly reported gaps in knowledge and skills. Further work is being invested to develop disaster management skills, assessment components, and further determine course validity.
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Affiliation(s)
- Christopher K Craig
- Department of Surgery, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC
| | - James E Johnson
- Department of Surgery, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC.,Burn Center, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC
| | - James H Holmes
- Department of Surgery, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC.,Department of Surgery/Burn Center, Medical University of South Carolina, Charleston
| | - Steven A Kahn
- Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Jeffery E Carter
- Burn Center, University Medical Center New Orleans, New Orleans, LA
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Abu Dabrh AM, Waller TA, Bonacci RP, Nawaz AJ, Keith JJ, Agarwal A, Merfeld J, Nordin T, Winscott MM, Belda TE, Murad MH, Pantin SAL, Steinkraus LW, Grau TJ, Angstman KB. Professionalism and inter-communication skills (ICS): a multi-site validity study assessing proficiency in core competencies and milestones in medical learners. BMC MEDICAL EDUCATION 2020; 20:362. [PMID: 33054797 PMCID: PMC7560108 DOI: 10.1186/s12909-020-02290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interpersonal and Communication Skills (ICS) and Professionalism milestones are challenging to evaluate during medical training. Paucity in proficiency, direction and validity evidence of assessment tools of these milestones warrants further research. We validated the reliability of the previously-piloted Instrument for Communication skills and Professionalism Assessment (InCoPrA) in medical learners. METHODS This validity approach was guided by the rigorous Kane's Framework. Faculty-raters and standardized patients (SPs) used their respective InCoPrA sub-component to assess distinctive domains pertinent to ICS and Professionalism through multiple expert-built simulated-scenarios comparable to usual care. Evaluations included; inter-rater reliability of the faculty total score; the correlation between the total score by the SPs; and the average of the total score by two-faculty members. Participants were surveyed regarding acceptability, realism, and applicability of this experience. RESULTS Eighty trainees and 25 faculty-raters from five medical residency training sites participated. ICC of the total score between faculty-raters was generally moderate (ICC range 0.44-0.58). There was on average a moderate linear relationship between the SPs and faculty total scores (Pearson correlations range 0.23-0.44). Majority of participants ascertained receiving a meaningful, immediate, and comprehensive patient-faculty feedback. CONCLUSIONS This work substantiated that InCoPrA was a reliable, standardized, evidence-based, and user-friendly assessment tool for ICS and Professionalism milestones. Validating InCoPrA showed generally-moderate agreeability and high acceptability. Using InCoPrA also promoted engaging all stakeholders in medical education and training-faculty, learners, and SPs-using simulation-media as pathway for comprehensive feedback of milestones growth.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
- Integrative Medicine and Health, Department of General Internal Medicine, Mayo clinic, Jacksonville, FL, USA.
| | - Thomas A Waller
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Anem J Nawaz
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Joshua J Keith
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Anjali Agarwal
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - John Merfeld
- Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI, USA
| | - Terri Nordin
- Department of Family Medicine, Mayo Clinic health System, Eau Claire, WI, USA
| | | | | | | | - Sally Ann L Pantin
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Thomas J Grau
- Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI, USA
| | - Kurt B Angstman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Chase T, Shah DK, Parry JP, Bhagavath B, Lindheim SR, Petrozza JC, Pfeifer S, Stetter C, Kunselman A, Estes SJ. Surgical simulation supplements reproductive endocrinology and infertility fellowship training. F S Rep 2020; 1:154-161. [PMID: 34223232 PMCID: PMC8244323 DOI: 10.1016/j.xfre.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 10/26/2022] Open
Abstract
Objective To assess if a surgical boot camp improves laparoscopic skill among reproduction endocrinology and infertility (REI) fellows and increases fellow desire to incorporate surgical skills into practice and to examine whether fellowship in vitro fertilization (IVF) volume correlates with surgical efficiency. Design Prospective evaluation. Setting Simulation Center. Patients Forty REI fellows. Interventions Fellows were timed before and after training in laparoscopic suturing and knot tying and while using virtual simulators. Fellows were surveyed before boot camp on prior experience with IVF and reproductive surgery, and immediately and 1 month after boot camp on their desire to incorporate surgical skills into practice. Main Outcome Measures Efficiency of laparoscopic suturing and knot tying before and after boot camp; likelihood and persistence of incorporating surgical skills into practice immediately and 1 month after boot camp; and correlation between fellowship IVF volume and fellow surgical efficiency. Results Fellows experienced significant improvement in laparoscopic suturing (44 sec), intracorporeal knot tying (82 sec), and extracorporeal knot tying (71 sec). Fellows reported being more likely to incorporate operative hysteroscopy (89%), operative laparoscopy (87%), and laparoscopic suturing (84%) into practice immediately following boot camp with no difference 1 month later. Fifty-four percent of fellows reported being more likely to perform robotic surgery after the boot camp, increasing to 70% 1 month later. There were weak correlations between IVF case volume and efficiency in laparoscopic suturing or hysteroscopic polypectomy (Spearman correlation coefficients, -0.14 and -0.03). Conclusions An intensive surgical boot camp enhances surgical skill among REI fellows.
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Affiliation(s)
- Tess Chase
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Divya K Shah
- Division of Reproductive Endocrinology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bala Bhagavath
- Division of Reproductive Endocrinology and Infertility, University of Wisconsin, Madison, Wisconsin
| | - Steven R Lindheim
- Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Division of Reproductive Endocrinology and Infertility, Wright State University, Dayton, Ohio
| | - John C Petrozza
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Boston, Massachusetts
| | - Samantha Pfeifer
- Division of Reproductive Endocrinology and Infertility, Weill Cornell Medical Center, New York, New York
| | - Christina Stetter
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania
| | - Allen Kunselman
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania
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23
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Graves MT, Castro JR, Anderson DE. Veterinary Intern Program for Entrustable Professional Activities Skills, a.k.a. Intern Boot Camp. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:321-326. [PMID: 31194630 DOI: 10.3138/jvme.0518-066r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The University of Tennessee College of Veterinary Medicine (UTCVM) Department of Large Animal Clinical Sciences has developed an intensive training program that all large animal veterinary interns are required to complete at the onset of their internship year. This program was designed to establish a uniform approach to entrustable professional activity (EPA) skills deemed essential by the large animal faculty. These EPA skills emphasize the clinical approaches and skills that interns should understand and demonstrate competency in early in their internship year. The EPA program, completed over 4 consecutive days, was coined the "Intern Boot Camp" and structured to fuse case-based lecture discussions and hands-on wet labs designed to develop or improve skills and techniques. At the conclusion of the boot camp, participants were given an evaluation survey to provide feedback on the program. The results were overwhelmingly positive, with 90% of the participants giving the program a rating of 5 on a scale ranging from 1 (poor opinion or experience) to 5 (excellent opinion or experience). Nearly 95% of participants stated that they felt more prepared for their internship year after attending the boot camp, and 100% of the participants indicated that they would recommend this program to future candidates. Given the positive outcomes over the past 4 years, the implementation of the Veterinary Intern Entrustable Professional Activities program (Intern Boot Camp) is considered a valuable component of the veterinary intern training program and could readily be adapted to other programs.
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Crannell WC, Boes C, Brasel K, Cook MR. Evaluating the educational effectiveness of an 8-week patient management course for surgical interns: A nine-year analysis. Am J Surg 2020; 219:800-803. [PMID: 32122659 DOI: 10.1016/j.amjsurg.2020.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Our general surgery program mandates an 8-week "intern school" (IS) for matriculating surgery interns. The course consists of a pre-test, didactics, and a post-test. We hypothesized IS exam performance would correlate with American Board of Surgery In Training Examination (ABSITE) scores.∖ METHODS: This was a retrospective analysis of IS pre- and post-tests and ABSITE scores for all OHSU surgery interns from 2010 to 2018. McNemar's, chi-square, and Pearson tests were calculated. RESULTS The pre and post-test pass rate for 293 interns was 26% vs. 86% (p < 0.001). Categorical interns were more likely to pass the pre-test (33% vs 11% p = 0.004), and the post-test (96% vs 83% p = 0.007) than non-designated interns and more likely to pass the post-test than designated preliminary intern (96% vs 80%, p = 0.0014). There was no correlation between IS exams and ABSITE performance. DISCUSSION IS improves exam performance, but IS test scores do not correlate with ABSITE scores, and the program is not a means to identify interns at risk of poor ABSITE performance.
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Affiliation(s)
- W Christian Crannell
- Oregon Health and Science University, Mail Code L223, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Camden Boes
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Karen Brasel
- Oregon Health and Science University, Mail Code L223, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Mackenzie R Cook
- Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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Clifton W, Damon A, Stein R, Pichelmann M, Nottmeier E. Biomimetic 3-Dimensional−Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction. World Neurosurg 2020; 135:308. [DOI: 10.1016/j.wneu.2019.12.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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Len KA, Gavero GC, Savala MC, Hishinuma ES. Multi-Specialty Boot Camp: Enhancing Student Confidence in Residency Preparation. MEDICAL SCIENCE EDUCATOR 2020; 30:187-195. [PMID: 34457658 PMCID: PMC8368114 DOI: 10.1007/s40670-019-00848-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND A "boot camp" or senior preparatory course can help to bridge the gap between knowledge and skills attained in required clerkships and residency expectations. An under-researched area is in interventions across specialties and with student confidence as the outcome. OBJECTIVE A multi-specialty school-wide boot camp for 4th year medical students was evaluated with a curriculum that focused on specialty milestones and entrustable professional activities and the importance of student confidence as an outcome. METHODS A school-wide "boot camp" was developed to help 4th year students become ready for their matched specialty. Faculty resources were pooled to teach students from multiple specialties' common milestone topics. Surveys were collected from 3 academic years (2014-2015 to 2016-2017): pre-boot camp (Pre), immediately post-boot camp (Post 1), and 3 months after starting residency (Post 2). Dependent t-tests were employed to determine pre-post differences. RESULTS Over the 3-year study period, 185 students participated in boot camp, 162 (87.6%) completed the first 2 surveys, and 75 (40.5%) students provided data at all 3 points in time. With more robust findings between Pre and Post 1, students improved their confidence level in communicating with families and most specialty skills, and students felt more prepared to be an intern as a result of the boot camp. CONCLUSIONS The robust increase in student confidence suggested that a multi-specialty, school-wide approach to a capstone curriculum should be considered by medical schools, which will not only benefit students but faculty as well. Future research should examine student competence in achieving specialty skills.
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Affiliation(s)
- Kyra A. Len
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - Gretchenjan C. Gavero
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - Michael C. Savala
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - Earl S. Hishinuma
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
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Walsh DP, Murugappan KR, Oren-Grinberg A, Wong VT, Mitchell JD, Matyal R. Tool to improve qualitative assessment of left ventricular systolic function. Echo Res Pract 2020; 7:1-8. [PMID: 32190341 PMCID: PMC7077518 DOI: 10.1530/erp-19-0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/17/2020] [Indexed: 02/01/2023] Open
Abstract
Interactive online learning tools have revolutionized graduate medical education and can impart echocardiographic image interpretive skills. We created self-paced, interactive online training modules using a repository of echocardiography videos of normal and various degrees of abnormal left ventricles. In this study, we tested the feasibility of this learning tool. Thirteen anesthesia interns took a pre-test and then had 3 weeks to complete the training modules on their own time before taking a post-test. The average score on the post-test (74.6% ± 11.08%) was higher than the average score on the pre-test (57.7% ± 9.27%) (P < 0.001). Scores did not differ between extreme function (severe dysfunction or hyperdynamic function) and non-extreme function (normal function or mild or moderate dysfunction) questions on both the pre-test (P = 0.278) and post-test (P = 0.093). The interns scored higher on the post-test than the pre-test on both extreme (P = 0.0062) and non-extreme (P = 0.0083) questions. After using an online educational tool that allowed learning on their own time and pace, trainees improved their ability to correctly categorize left ventricular systolic function. Left ventricular systolic function is often a key echocardiographic question that can be difficult to master. The promising performance of this educational resource may lead to more time- and cost-effective methods for improving diagnostic accuracy among learners.
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Affiliation(s)
- Daniel P Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kadhiresan R Murugappan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Achikam Oren-Grinberg
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa T Wong
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Mitchell
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Does being in the hot seat matter? Effect of passive vs active learning in surgical simulation. Am J Surg 2020; 220:593-596. [PMID: 32057411 DOI: 10.1016/j.amjsurg.2020.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Participation in simulation can improve future performance, but it is unclear if observation of simulation scenarios can produce an equivalent benefit. METHODS First-year surgical residents were exposed to various simulation scenarios in groups of 4 or 5, either through active participation or passive observation. Residents were individually assessed on 3 of the scenarios. Scores were categorized based on resident level of exposure to the scenario and analyzed using a multivariate analysis. RESULTS 32 residents were enrolled and 28 underwent testing. Previous exposure to the scenario as a participant or observer led to improved performance on medical management and overall performance compared to those who had not been exposed (p < 0.02). However, active participation did not improve performance relative to passive observation (p > 0.1). Previous exposure did not improve communication aspects of the scenarios. CONCLUSION Analyses confirmed the advantage of simulation-based training, but additionally suggest that the benefits for similar in both active participants and passive observers. This supports the idea of group based simulation training which can be more cost and time efficient.
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The Impact of an Introductory Radiation Oncology Curriculum (IROC) for Radiation Oncology Trainees Across the United States and Canada. Int J Radiat Oncol Biol Phys 2020; 107:408-416. [PMID: 32057993 DOI: 10.1016/j.ijrobp.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Despite interest from both radiation oncology residents and program directors, many residency training programs lack a formalized introductory curriculum to orient incoming radiation oncology residents to the specialty. METHODS AND MATERIALS Using the 6-step model for medical education curriculum development, a structured introductory radiation oncology curriculum (IROC) was created for incoming post-graduate year 2 (PGY-2) radiation oncology residents to address foundational concepts including patient simulation, contouring, and plan evaluation. The curriculum was distributed to 55 training programs across the United States and Canada at the start of the 2018 to 2019 and 2019 to 2020 academic years. Feasibility of curriculum dissemination was assessed via a survey of participating program directors. Curriculum effectiveness was assessed using an anonymous survey of participating residents administered pre- and postcurriculum and consisting of both subjective and objective knowledge-based questions. RESULTS A total of 236 residents participated in IROC at the start of the 2018 to 2019 and 2019 to 2020 academic years. Of those, 228 of 236 (97%) completed both the pre- and postcurriculum surveys. Of participating residents, the median residency program size was 10 (range, 2-28), and the median number of residents in each program per year was 3 (range, 1-7). At baseline, most PGY-2s (142 of 228, 62%) reported being "not at all" or "slightly" prepared to function in the radiation oncology clinic, and after IROC most (188 of 228, 82%) felt "moderately," "quite," or "extremely" prepared. Objective knowledge improved pre- to postcurriculum on a multiple-choice test from 70% to 81% (P < .0001) correct, with improvements observed across all question items. Program directors also reported that the curriculum was easier to use and more effective than prior orientation materials. CONCLUSIONS The implementation of an international introductory curriculum for PGY-2 radiation oncology residents is both feasible and effective. Similar strategies should be employed to enhance and standardize radiation oncology educational initiatives across training programs.
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Theodore S, Grant HM, Budrow JJ, Fernandez GL, Tashjian DB, Seymour NE. Boot Camp in a Box: Initial Experience with Pretraining Skills Preparation for New Interns. JOURNAL OF SURGICAL EDUCATION 2019; 76:e225-e231. [PMID: 31471156 DOI: 10.1016/j.jsurg.2019.07.019] [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: 03/23/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE In order to increase selected skills at onset of training, we provided newly matched PGY-1 trainees with materials and instructions to practice these skills, as well as the opportunity to share video-recorded performance and receive feedback based on these videos. METHODS Knot tying and suturing kits, instruments and supplies, and video instructions for task performance were sent to newly matched trainees to our program (n = 10), with instructions to practice 4 tasks (1- and 2-handed knot tying, interrupted and running suturing) until self-assessed comfort with each task was achieved or the 8-week time point before start of training was reached. Each trainee returned a video of each task, which was graded by blinded reviewers for time and errors using an itemized evaluation instrument (12 items for suturing and five items for knot-tying). Feedback (annotations of submitted videos) was provided after grading was completed. Task performance was repeated and reassessed at the time of new intern "Boot Camp" and again 8 weeks after start of training. Performance scores were compared for the 3 time points and with scores of PGY 2-4 residents using ANOVA with posthoc tests. RESULTS Compliance with instruction for practice and return of video recorded tasks in the months before start of PGY-1 training was high, with only 1 of 10 failing to return knot-tying videos. A significant pattern of performance change (p < 0.05) was observed for all tasks with an initial decrease between the pre-employment practice period and the Boot Camp test followed by an increase to the highest level of performance 2 months after start of training. At that point, scores were not significantly different than those of more senior residents. CONCLUSIONS A high level of compliance was achieved with requested skills practice and video documentation of performance. We attribute the consistently lower scores on the tasks during Boot Camp tests to higher stress test environment which was apt to be less favorable than having the trainee choose to submit their best possible preresidency video recording of performance in a low-stress situation. Subsequent achievement of significantly higher performance even compared to more senior residents may have been helped by incentivized pretraining practice.
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Affiliation(s)
- Sheina Theodore
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - Heather M Grant
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - John J Budrow
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - Gladys L Fernandez
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - David B Tashjian
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - Neal E Seymour
- Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts.
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Buist N, Webster CS. Simulation Training to Improve the Ability of First-Year Doctors to Assess and Manage Deteriorating Patients: a Systematic Review and Meta-analysis. MEDICAL SCIENCE EDUCATOR 2019; 29:749-761. [PMID: 34457539 PMCID: PMC8368756 DOI: 10.1007/s40670-019-00755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many simulation courses now exist which aim to prepare first-year doctors for the task of assessing and managing potentially deteriorating patients. Despite the substantial resources required, the degree to which participants benefit from such courses, and which aspects of the simulation training are optimal for learning, remains unclear. A systematic literature search was undertaken across seven electronic databases. Inclusion criteria were that the intervention must be a simulation of a deteriorating patient scenario that would likely be experienced by first-year doctors, and that participants being first-year doctors or in their final year of medical school. Studies reporting quantitative benefits of simulation on participants' knowledge and simulator performance underwent meta-analyses. The search returned 1444 articles, of which 48 met inclusion criteria. All studies showed a benefit of simulation training, but outcomes were largely limited to self-rated or objective tests of knowledge, or simulator performance. The meta-analysis demonstrated that simulation improved participant performance by 16% as assessed by structured observation of a simulated scenario, and participant knowledge by 7% as assessed by written assessments. A mixed-methods analysis found conflicting evidence about which aspects of simulation were optimal for learning. The results of the review indicate that simulation is an important tool to improve first-year doctors' confidence, knowledge and simulator performance with regard to assessment and management of a potentially deteriorating patient. Future research should now seek to clarify the extent to which these improvements translate into clinical practice, and which aspects of simulation are best suited to achieve this.
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Affiliation(s)
- Nicholas Buist
- Department of Emergency Medicine, Whangarei Hospital, Northland District Health Board, Maunu Rd, Private Bag 9742, Whangarei, 0110 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Littell RD, Kumar A, Einstein MH, Karam A, Bevis K. Advanced communication: A critical component of high quality gynecologic cancer care: A Society of Gynecologic Oncology evidence based review and guide. Gynecol Oncol 2019; 155:161-169. [PMID: 31422857 DOI: 10.1016/j.ygyno.2019.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 01/22/2023]
Abstract
Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations. Therefore, training in serious illness communication skills is critically important to gynecologic oncology practice and benefits patients, providers, and the healthcare system. Like surgical skills, communication skills can be learned and improved upon, particularly by making use of communication skills courses and other resources. While the purpose of each conversation will vary based on the medical setting, most communication roadmaps incorporate four basic components: 1) Assess patient knowledge and understanding, 2) inform patient in accordance with her communication preferences, 3) recognize and respond to emotion 4) elicit patient values, and create a plan that aligns with those values. Improved patient outcomes associated with addressing patient emotions underscore a critical need to recognize and address emotional cues during difficult conversations. We present strategies for delivering serious news, and for discussing prognosis and goals of care. In each strategy, we highlight skills for recognizing and responding to patient and family emotional cues.
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Affiliation(s)
- Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA, United States of America
| | - Amanika Kumar
- Mayo Clinic, Rochester, MN, United States of America
| | - M Heather Einstein
- University of Connecticut Health Center School of Medicine, Hartford, CT, United States of America
| | - Amer Karam
- Stanford University, Palo Alto, CA, United States of America
| | - Kerri Bevis
- University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Corbetta L, Arru LB, Mereu C, Pasini V, Patelli M. Competence and training in interventional pulmonology. Panminerva Med 2018; 61:203-231. [PMID: 30394710 DOI: 10.23736/s0031-0808.18.03562-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.
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Affiliation(s)
- Lorenzo Corbetta
- Unit of Interventional Pulmonology, Department of Experimental and Clinical Medicine, University Hospital of Careggi, University of Florence, Florence, Italy -
| | - Luigi B Arru
- Council of Health of the Region Sardinia, Cagliari, Italy
| | - Carlo Mereu
- Unit of Pneumology, ASL 2 Savonese, Savona, Italy
| | - Valeria Pasini
- Interventional Pulmonary Program, University of Florence, Florence, Italy
| | - Marco Patelli
- Unit of Interventional Pulmonology, University of Florence and Bologna, Florence, Italy
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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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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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Acosta D, Castillo-Angeles M, Garces-Descovich A, Watkins AA, Gupta A, Critchlow JF, Kent TS. Surgical Practical Skills Learning Curriculum: Implementation and Interns' Confidence Perceptions. JOURNAL OF SURGICAL EDUCATION 2018; 75:263-270. [PMID: 28827182 DOI: 10.1016/j.jsurg.2017.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide an overview of the practical skills learning curriculum and assess its effects over time on the surgical interns' perceptions of their technical skills, patient management, administrative tasks, and knowledge. DESIGN An 84-hour practical skills curriculum composed of didactic, simulation, and practical sessions was implemented during the 2015 to 2016 academic year for general surgery interns. Totally, 40% of the sessions were held during orientation, whereas the remainder sessions were held throughout the academic year. Interns' perceptions of their technical skills, administrative tasks, patient management, and knowledge were assessed by the practical skills curriculum residents' perception survey at various time points during their intern year (baseline, midpoint, and final). Interns were also asked to fill out an evaluation survey at the completion of each session to obtain feedback on the curriculum. SETTING General Surgery Residency program at a tertiary care academic institution. PARTICIPANTS 20 General Surgery categorical and preliminary interns. RESULTS Significant differences were found over time in interns' perceptions on their technical skills, patient management, administrative tasks, and knowledge (p < 0.001 for all). The results were also statistically significant when accounting for a prior boot camp course in medical school, intern status (categorical or preliminary), and gender (p < 0.05 for all). Differences in interns' perceptions occurred both from baseline to midpoint, and from midpoint to final time point evaluations (p < 0.001 for all). Prior surgical boot camp in medical school status, intern status (categorical vs. preliminary), and gender did not differ in the interns' baseline perceptions of their technical skills, patient management, administrative tasks, and knowledge (p > 0.05 for all). CONCLUSIONS Implementation of a Practical Skills Curriculum in surgical internships can improve interns' confidence perception on their technical skills, patient management skills, administrative tasks, and knowledge.
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Affiliation(s)
- Danilo Acosta
- Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, New York
| | | | | | - Ammara A Watkins
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alok Gupta
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan F Critchlow
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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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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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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Hosny SG, Johnston MJ, Pucher PH, Erridge S, Darzi A. Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study. J Surg Res 2017; 220:419-426.e2. [PMID: 28844460 DOI: 10.1016/j.jss.2017.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/22/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite evidence demonstrating the advantages of simulation training in general surgery, it is not widely integrated into surgical training programs worldwide. The aim of this study was to identify barriers and facilitators to the implementation and uptake of surgical simulation training programs. METHODS A multinational qualitative study was conducted using semi-structured interviews of general surgical residents and experts. Each interview was audio recorded, transcribed verbatim, and underwent emergent theme analysis. All data were anonymized and results pooled. RESULTS A total of 37 individuals participated in the study. Seventeen experts (Program Directors and Surgical Attendings with an interest in surgical education) and 20 residents drawn from the United States, Canada, United Kingdom, France, and Japan were interviewed. Barriers to simulation-based training were identified based on key themes including financial cost, access, and translational benefit. Participants described cost (89%) and access (76%) as principal barriers to uptake. Common facilitators included a mandatory requirement to complete simulation training (78%) and on-going assessment of skills (78%). Participants felt that simulation training could improve patient outcomes (76%) but identified a lack of evidence to demonstrate benefit (38%). There was a consensus that simulation training has not been widely implemented (70%). CONCLUSIONS There are multiple barriers to the implementation of surgical simulation training programs, however, there is agreement that these programs could potentially improve patient outcomes. Identifying these barriers enable the targeted use of facilitators to deliver simulation training programs.
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Affiliation(s)
- Shady G Hosny
- Department of Academic Surgery, Imperial College London, London, UK.
| | | | - Philip H Pucher
- Department of Academic Surgery, Imperial College London, London, UK
| | - Simon Erridge
- Department of Academic Surgery, Imperial College London, London, UK
| | - Ara Darzi
- Department of Academic Surgery, Imperial College London, London, UK
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Perone JA, Anton NE, Gardner AK, Steinemann S. Simulation Training in Surgical Education. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0182-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Starr M, Sawyer T, Jones M, Batra M, McPhillips H. A Simulation-based Quality Improvement Approach to Improve Pediatric Resident Competency with Required Procedures. Cureus 2017; 9:e1307. [PMID: 28690941 PMCID: PMC5493469 DOI: 10.7759/cureus.1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Pediatric residents report a lack of confidence and competence with procedural skills at graduation. Training programs could benefit from improved approaches to target these needs. Using the Institute for Healthcare Improvement (IHI) Model for Improvement and three Plan-Do-Study-Act (PDSA) cycles, we examined the impact of a procedure simulation boot camp on self-reported procedural confidence and competence as well as the longitudinal impacts of these sequential interventions on Accreditation Council for Graduate Medical Education (ACGME) Graduating Resident Survey (GRS) results. METHODS Three rapid cycle interventions were performed in successive academic years. The interventions included 1) increased awareness of available procedural experiences, 2) institution of procedural educational conferences, and 3) implementation of a senior resident procedure boot camp. Senior resident self-reported procedural confidence was measured before and after the boot camp. Procedural competence was measured using the ACGME GRS. Results: Thirty-two of 34 senior residents (94%) completed the 2016 ACGME GRS, similar to the response rates of 2014 (92%) and 2015 (94%), and 30 of 34 third-year residents participated in the procedure boot camp (88%). Resident confidence and competence with procedural skills improved after the institution of the quality improvement intervention. ACGME GRS-reported competency increased in bag and mask ventilation (77% to 94%), neonatal endotracheal intubation (39% to 69%), peripheral IV placement (10% to 50%), and umbilical catheter placement (35% to 53%). CONCLUSION A quality improvement intervention with three rapid PDSA cycles was successful in improving senior pediatric resident confidence and competence with ACGME required procedural skills.
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Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education. Plast Reconstr Surg 2017; 138:730e-738e. [PMID: 27673543 DOI: 10.1097/prs.0000000000002558] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.
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Ceresnak SR, Axelrod DM, Sacks LD, Motonaga KS, Johnson ER, Krawczeski CD. Advances in Pediatric Cardiology Boot Camp: Boot Camp Training Promotes Fellowship Readiness and Enables Retention of Knowledge. Pediatr Cardiol 2017; 38:631-640. [PMID: 28161811 DOI: 10.1007/s00246-016-1560-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
We previously demonstrated that a pediatric cardiology boot camp can improve knowledge acquisition and decrease anxiety for trainees. We sought to determine if boot camp participants entered fellowship with a knowledge advantage over fellows who did not attend and if there was moderate-term retention of that knowledge. A 2-day training program was provided for incoming pediatric cardiology fellows from eight fellowship programs in April 2016. Hands-on, immersive experiences and simulations were provided in all major areas of pediatric cardiology. Knowledge-based examinations were completed by each participant prior to boot camp (PRE), immediately post-training (POST), and prior to the start of fellowship in June 2016 (F/U). A control group of fellows who did not attend boot camp also completed an examination prior to fellowship (CTRL). Comparisons of scores were made for individual participants and between participants and controls. A total of 16 participants and 16 control subjects were included. Baseline exam scores were similar between participants and controls (PRE 47 ± 11% vs. CTRL 52 ± 10%; p = 0.22). Participants' knowledge improved with boot camp training (PRE 47 ± 11% vs. POST 70 ± 8%; p < 0.001) and there was excellent moderate-term retention of the information taught at boot camp (PRE 47 ± 11% vs. F/U 71 ± 8%; p < 0.001). Testing done at the beginning of fellowship demonstrated significantly better scores in participants versus controls (F/U 71 ± 8% vs. CTRL 52 ± 10%; p < 0.001). Boot camp participants demonstrated a significant improvement in basic cardiology knowledge after the training program and had excellent moderate-term retention of that knowledge. Participants began fellowship with a larger fund of knowledge than those fellows who did not attend.
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Affiliation(s)
- Scott R Ceresnak
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
| | - David M Axelrod
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Loren D Sacks
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Kara S Motonaga
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Emily R Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Catherine D Krawczeski
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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Patel M, Pleass H. Teaching urology to medical students: 'is this as good as it gets'? ANZ J Surg 2017; 87:7-8. [PMID: 28156073 DOI: 10.1111/ans.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Manish Patel
- Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.,Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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Hoffmann H, Oertli D, Mechera R, Dell-Kuster S, Rosenthal R, Reznick R, MacDonald H. Comparison of Canadian and Swiss Surgical Training Curricula: Moving on Toward Competency-Based Surgical Education. JOURNAL OF SURGICAL EDUCATION 2017; 74:37-46. [PMID: 27697404 DOI: 10.1016/j.jsurg.2016.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/23/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Quality of surgical training in the era of resident duty-hour restrictions (RDHR) is part of an ongoing debate. Most training elements are provided during surgical service. As exposure to surgical procedures is important but time-consuming, RDHR may affect quality of surgical training. Providing structured training elements may help to compensate for this shortcoming. DESIGN This binational anonymous questionnaire-based study evaluates frequency, time, and structure of surgical training programs at 2 typical academic teaching hospitals with different RDHR. SETTING Departments of Surgery of University of Basel (Basel, Switzerland) and the Queen's University (Kingston, Ontario, Canada). PARTICIPANTS Surgical consultants and residents of the Queen's University Hospital (Kingston, Ontario, Canada) and the University Hospital Basel (Basel, Switzerland) were eligible for this study. RESULTS Questionnaire response rate was 37% (105/284). Queen's residents work 80 hours per week, receiving 7 hours of formal training (8.8% of workweek). Basel residents work 60 hours per week, including 1 hour of formal training (1.7% of working time). Queen's faculty and residents rated their program as "structured" or "rather structured" in contrast to Basel faculty and residents who rated their programs as "neutral" in structure or "unstructured." Respondents identified specific structured training elements more frequently at Queen's than in Basel. Two-thirds of residents responded that they seek out additional surgical experiences through voluntary extra work. Basel participants articulated a stronger need for improvement of current surgical training. Although Basel residents and consultants in both institutions fear negative influence of RDHR on the training program, this was not the case in Queen's residents. CONCLUSIONS Providing more structured surgical training elements may be advantageous in providing optimal-quality surgical education in an era of work-hour restrictions.
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Affiliation(s)
- Henry Hoffmann
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
| | - Daniel Oertli
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Robert Mechera
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Salome Dell-Kuster
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Rachel Rosenthal
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Richard Reznick
- Department of Surgery, Queen׳s University, Kingston, Ontario, Canada
| | - Hugh MacDonald
- Department of Surgery, Queen׳s University, Kingston, Ontario, Canada
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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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Morgan H, Skinner B, Marzano D, Fitzgerald J, Curran D, Hammoud M. Improving the medical school-residency transition. CLINICAL TEACHER 2016; 14:340-343. [PMID: 27878956 DOI: 10.1111/tct.12576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In response to calls to improve the continuum between undergraduate and graduate medical education, many medical schools are creating electives designed to prepare students for residency training. There is a need for data that link improvements from these residency preparation courses to residency itself. Data is needed that links improvements from these residency preparation courses to residency OBJECTIVE: To examine senior medical student performance on the Association of Professors of Gynecology and Obstetrics (APGO) Preparation for Residency Knowledge Assessment before and after an obstetrics and gynaecology residency preparation elective, and to determine whether the knowledge improvements persisted to the start of the residency. METHODS All 13 students enrolled in the course completed the APGO knowledge assessment on the first and last day of the elective. Three months later, the students were asked to re-take the assessment immediately prior to the start of their residency. RESULTS There was improvement in mean scores from the pre-test score of 66.4 per cent to the post-test score of 77.4 per cent. At the time of the pre-test, three of the 13 students (23%) had passing scores (70% or greater), and at the time of the post-test, 11 of the 13 (85%) had passing scores. Nine of the 13 students (69%) completed the APGO knowledge assessment immediately prior to the start of their residency. Those nine students had a mean pre-residency score of 76.4 per cent. Eight of the nine students (89%) passed the pre-residency test. CONCLUSIONS Our data support the value of residency preparation electives for improving knowledge, and suggest that senior medical school electives can help to bridge the continuum between undergraduate and graduate medical education.
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Affiliation(s)
- Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Learning Health Services, University of Michigan, Ann Arbor, Michigan, USA
| | - Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Marzano
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - James Fitzgerald
- Department of Learning Health Services, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana Curran
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Learning Health Services, University of Michigan, Ann Arbor, Michigan, USA
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A pilot study examining experiential learning vs didactic education of abdominal compartment syndrome. Am J Surg 2016; 214:358-364. [PMID: 27771036 DOI: 10.1016/j.amjsurg.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Current surgical education relies on simulated educational experiences or didactic sessions to teach low-frequency clinical events such as abdominal compartment syndrome (ACS). The purpose of this pilot study was to evaluate if simulation would improve performance and knowledge retention of ACS better than a didactic lecture. METHODS Nineteen general surgery residents were block randomized by postgraduate year level to a didactic or a simulation session. After 3 months, all residents completed a knowledge assessment before participating in an additional simulation. Two independent reviewers assessed resident performance via audio-video recordings. RESULTS No baseline differences in ACS experience were noted between groups. The observational evaluation demonstrated a significant difference in performance between the didactic and simulation groups: 9.9 vs 12.5, P = .037 (effect size = 1.15). Knowledge retention was equivalent between groups. CONCLUSIONS This pilot study suggests that simulation-based education may be more effective for teaching the basic concepts of ACS.
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