Medical student satisfaction and confidence in simulation-based learning in Rwanda - Pre and post-simulation survey research

Nursing and midwifery simulation training with a newly developed low-cost high-fidelity placenta simulator: a collaboration between Italy and Ethiopia

BACKGROUND

Simulation training provides safe environment for skill acquisition and retention. This study addresses a critical challenge in Africa - umbilical cord and placenta management after childbirth - aiming to bridge theoretical learning with practical experiences through simulation. We realized a new low-cost high-fidelity simulator of placenta and umbilical cord. We conducted a needs-based training course for nursing and midwifery students at St. Luke Hospital of Wolisso, Ethiopia, to validate our new simulator and compare its acceptability and teaching effectiveness with other two simulators (conventional low-fidelity model and human placenta).

METHODS

We surveyed St. Luke Hospital medical experts to obtain their feedback on the new simulator's face, content, and usability. We carried out a simulation training course for 67 students who received theoretical lectures and simulation courses being divided into three groups according to the simulator used. We assessed the simulators' user acceptability using the Technology Acceptance Model (TAM) and compared the final objective evaluations by tutors between groups.

RESULTS

Experts confirmed the new simulator's fidelity, material quality, and usability. Students training on the new simulator demonstrated higher objective scores and perceived it as more useful and user-friendly compared to human placenta, while there was no difference between conventional simulator and human placenta in the TAM items.

CONCLUSION

We validated a new high-fidelity simulator developed by the Sant'Anna School of Advanced Studies in Pisa, Italy, using the TAM scale and robust statistical methods, thanks to a successful collaboration with St. Luke's Hospital in a simulation training course where students achieved higher objective scores and perceived the simulator as more useful and easier to use than a real human placenta, suggesting significant educational benefits and potential for future research.

A LUMP MODEL FOR MEDICAL STUDENTS' CLINICAL EVALUATION

Introduction

Soft tissue masses are commonly encountered in surgical and general medical practice. The graduating medical student should therefore be competent in the physical examination of a lump. Paucity of real patients makes it paramount that models be used for teaching and evaluation. This study purposed to describe the perception of graduating medical students to the use of a low-cost lump model for Objective Structured Clinical Examination (OSCE).

Methods

This was a cross-sectional survey of final year medical students who participated in a surgery OSCE utilizing an innovative low-cost lump model.

Results

One hundred and sixty students undertook the OSCE examination while 130 (81.3%) students completed the survey questionnaire. One hundred and forty students (87.5%) passed (score 3 5) the skills assessment using the lump model. The median age of the students who completed the questionnaire was 25 (range 24-27) years. There were more males N=84 (65.6%) than females N= 44 (34.4%). Two thirds (67.2%; n=84) of the students said the model simulated a true lump. Nearly all the students agreed that the signs of site (97.6%; n=127), size (97.6%; n=127), shape (95.4%; n=124) and transillumination (95.4%; n=124) were clearly demonstrable with the model. A lower proportion of agreements were seen with signs such as tenderness (64.6%; n=82), attachment (77.7%; n=80) and warmth (58.6%; n=75) while more students disagreed with pulsatility (51.5%; n=67).

Conclusion

The medical students had a positive perception to the use of the model. However, further refinements would be needed for more signs to be demonstrable.

The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review

Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.

The Development of an Innovative Crowdsourced Resident Procedure Team Model to Improve Bedside Procedural Proficiency in the Inpatient Setting

Background Bedside procedures are a necessary skill for many residents. Practice changes, including the discontinuation of a minimum number of procedures required by the American Board of Internal Medicine, may have resulted in decreased incentive for residents to seek procedural opportunities. Objective To improve residents' procedural output and confidence in abdominal paracentesis, arterial and central venous line placement, nasogastric intubation, and ultrasound-guided peripheral intravenous catheter insertions (USPIV). Methods A novel Resident Procedure Team (RPT) model was created using crowdsourced proficient (having completed ≥5 procedures) near-peers in combination with peer-led USPIV simulation workshops to increase the number of supervising residents available. Procedure logs and the number of residents who became qualified to perform and supervise procedures were tracked from July 2018 to June 2022 and compared before and after the implementation of the RPT in July 2020. Results Implementing the novel RPT model significantly increased the number of procedures performed (1875 procedures post-RPT vs 1292 pre-RPT; P=.02). Abdominal paracentesis increased from 411 to 482 (17.3%), central venous line placement increased from 344 to 401 (16.6%), USPIV increased from 318 to 389 (22.3%), arterial line placement increased from 189 to 360 (90.5%), and nasogastric intubation increased from 30 to 243 (710.0%). Resident confidence levels increased significantly after RPT-led USPIV workshops (P<.05 for all). Conclusions Implementation of a novel, crowdsourced, resident-led procedure team and peer-led USPIV workshops helped increase the number of procedures performed by residents.

Developing a Surgical Simulation Curriculum for the Rwandan Context

OBJECTIVE

We report on the development and implementation of a surgical simulation curriculum for undergraduate medical students in rural Rwanda.

DESIGN

This is a narrative report on the development of scenario and procedure-based content for a junior surgical clerkship simulation curriculum by an interdisciplinary team of simulation specialists, surgeons, anesthesiologists, medical educators, and medical students.

SETTING

University of Global Health Equity, a new medical school located in Butaro, Rwanda.

PARTICIPANTS

Participants in this study consist of simulation and surgical educators, surgeons, anesthesiologists, research fellows and University of Global Health Equity medical students enrolled in the junior surgery clerkship.

RESULTS

The simulation training schedule was designed to begin with a 17-session simulation-intensive week, followed by 8 sessions spread over the 11-week clerkship. These sessions combined the use of high-fidelity mannequins with improvised, bench-top surgical simulators like the GlobalSurgBox, and low-cost gelatin-based models to effectively replace resource intensive options.

CONCLUSIONS

Emphasis on contextualized content generation, low-cost application, and interdisciplinary design of simulation curricula for low-income settings is essential. The impact of this curriculum on students' knowledge and skill acquisition is being assessed in an ongoing fashion as a substrate for iterative improvement.

A digital literacy model to narrow the digital literacy skills gap

The concept of digital literacy is increasingly prevalent in the 21st century. Growing demands from the work sector for individuals to be digitally literate has prompted targeted interventions and innovations from the education sector to instil digital skills into the future workforce. However, despite efforts the digital skills gap remains visible globally. This paper explores the prominent educational frameworks and models, their advantages and limitations in 21st-century learning and teaching. Furthermore, a new innovative digital literacy model has been proposed to be integrated into the existing and future education frameworks and models to assist educationists in narrowing the digital skills gaps and preparing graduates for the work sector. The digital literacy model consists of two components: (1) the digital literacy framework- South Pacific Digital Literacy Framework (SPDLF) and (2) the digital literacy tool. The SPDLF reflects six major literacies identified for the 21st-century while the digital literacy tool--digilitFJ consists of a digital literacy measuring scale and an online intervention program. The exploratory factor analysis showed that the SPDLF was valid. On the other hand, heuristics, student attitude, and satisfaction and effectiveness of the digital literacy tool were also evaluated from the student's perspective to reflect its usefulness. The survey results also showed a positive attitude and perception of the use of the tool. Additionally, Cohen's d value showed that the digital literacy tool was effective. Therefore, if the tool is implemented and adopted, it can narrow the existing digital skills gap in the South Pacific.

The utility of a gross dissection anatomical model for simulation-based learning in pathology

INTRODUCTION

The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators.

METHODS

Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3).

RESULTS

The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8).

CONCLUSIONS

This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.

Evaluation of simulation skills of healthcare workers at a tertiary care center: A perspective towards coronavirus disease 2019 (COVID-19) third wave preparation

BACKGROUND:

Simulation-based training for healthcare providers was established as an efficacious training tool to sharpen the performance skills of nontechnical team as necessary for the prevention of errors and adverse events in the pandemic. To tackle this third wave, our institute started preparations with a faculty development course of simulation-based learning to evaluate participants' knowledge and skills and their attitudes and feedback.

MATERIALS AND METHODS:

As part of the simulation workshop, a module was developed to train the staff on recognizing and responding to acute coronavirus disease 2019 affecting adults and children. Case-based scenarios were provided in the application. Pretest and posttest questionnaires were administered to all trainees. The questionnaires included questions on knowledge, skills confidence and attitude marked on a 5-point Likert scale. Data were entered and analyzed using the Microsoft Excel 2018. Qualitative variables were expressed as percentages, whereas mean and standard deviations were computed for quantitative variables. Paired t-test was used to test the difference between pre and post test scores; P < 0.05 was taken as significant value.

RESULTS:

A total of 296 participants were included in the study. A statistically significant increase in knowledge and skills confidence scores was found from pre-test to post-test. The most significant improvement was found in the assessment of pediatric hemodynamic status and the management of fluid and electrolytes. The most interesting benefit to the participants was the acquisition of knowledge about the proper use of technology after the faculty development course.

CONCLUSIONS:

Such workshops play a crucial role in training healthcare workers, especially as preparation for the pandemic. Most participants suggested that there should be such workshops at regular intervals to enhance their skills confidence in handling emergency situations in the clinical settings.

Deciphering Learning Motivation in Open Distance Learning towards Sustainable Medical Education

Open distance learning has become a new norm in medical education since the COVID-19 pandemic. The abrupt shift from conventional medical education to fully virtual learning deserves a reflection on how it affected the learning motivation among medical students. Hence, this study aimed to investigate the effect of open distance learning on their learning motivation during this pandemic period, with suggestions to improve through reflections and recommendations. This qualitative study involved 152 medical students undertaking the Doctor of Medicine program in Universiti Kebangsaan Malaysia, Malaysia, during the COVID-19 pandemic. All data were collected through a validated questionnaire. We found that medical students portrayed intrinsic motivation—mainly self-motivation, self-discipline, and self-adaptation—in open distance learning during the pandemic period. Feedback from medical students also showed that they advocated a better internet connection, innovative teaching, and learning, as well as new appropriate assessment methods and strengthening of the learning management system for a sustainable open distance learning outcome. Hence, medical educators should be creative in making use of open distance learning as an attractive complementary platform in medical education to ensure life-long learning.

179 A Cross-Sectional Study on the Effectiveness of Simulation-Based Learning in Emergency Medicine for Medical Undergraduates in a Low-Middle Income Country During the COVID-19 Pandemic

Learning emergencies is a challenge during COVID-19 pandemic for medical students. Managing a real patient in an emergency exposes the medical students and patients to risks now more than ever before. Simulation-based learning (SBL) is a proven safer teaching method to improve technical and non-technical medical knowledge, skills, and to enhance confidence in high-income countries. There is limited literature on the effectiveness of SBL in low-middle income countries (LMICs)

This study evaluates final-year medical undergraduates’ knowledge, skills and confidence improvement through a novel SBL in an LMIC during the COVID-19 pandemic.

Four simulation scenarios were conducted by an instructor to a small group of five to six participants. The instructors were Emergency Medicine Senior Registrars or Registrars, who had prior knowledge in teaching techniques through a formal instructor development course elsewhere. The simulation sessions were based on four scenarios. A high-fidelity mannequin, basic airway devices, IV access, monitoring devices and a defibrillator were used. Pendleton Model

Final-year medical students of the University of Colombo were trained on medical emergency care skills and subsequently they were given the opportunity to apply skills in simulation. This course was conducted twice a week, 4-hour sessions, for 6 weeks in March and April 2021. There were four skills stations, including ABCDE assessment, airway management, defibrillation with BLS and non-technical skills. A pre- and post-MCQ was used to assess improvement of knowledge and confidence level on performing each skill. Likert-scale questionnaires were administered before and after each simulation session to assess the level of confidence in performing each task of the simulated scenario. The normal distribution of data was tested with the Shapiro–Wilk test. If the distribution of data was not normal, Wilcoxon signed-rank test was used to compare pre- and post-test scores. Paired sample t-test was used to compare pre- and post-test data if the distribution of data is normal.

All 42 participants experienced SBL for the first time ever. Post-test MCQ score significantly improved compared with pre-test score (p < 0.001). Confidence in skills increased in all 17 domains following the skills sessions in all participants. Confidence to manage cardiac arrest increased in all 10 tasks of the cardiac arrest simulation and the total average confidence score rose from 17.1 (±4.7) to 32.0 (±7.7) after the simulation-based intervention (p < 0.001). Confidence increased significantly in all 12 domains of asthma and anaphylaxis management with the total average confidence score rising from 21.4 (±0.8) to 39.2 (±2.1) (p < 0.001). Satisfaction and attitudes towards simulation-based learning were very positive.

The course has shown a statistically significant improvement of students’ knowledge and confidence in skills with a high level of satisfaction. Therefore, SBL is an effective, safe and feasible alternative to train emergency medicine for the students of LMICs during COVID-19 pandemic.