1
|
Heidemann LA, Rustici M, Buckvar-Keltz L, Anderson A, Plant J, Morgan HK, Goforth J, Atkins KM. Transition to Residency Courses: Recommendations for Creation and Implementation. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231225009. [PMID: 38304278 PMCID: PMC10832425 DOI: 10.1177/23821205231225009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
Transition to Residency (TTR) courses help ease the critical transition from medical school to residency, yet there is little guidance for developing and running these courses. In this perspective, the authors use their expertise as well as a review of the literature to provide guidance and review possible solutions to challenges unique to these courses. TTR courses should be specialty-specific, allow for flexibility, and utilize active learning techniques. A needs assessment can help guide course content, which should focus on what is necessary to be ready for day one of residency. The use of residents in course planning and delivery can help create a sense of community and ensure that content is practical. While course assessments are largely formative, instructors should anticipate the need for remediation, especially for skills likely to be performed with limited supervision during residency. Additionally, TTR courses should incorporate learner self-assessment and goal setting; this may be valuable information to share with learners' future residency programs. Lastly, TTR courses should undergo continuous quality improvement based on course evaluations and surveys. These recommendations are essential for effective TTR course implementation and improvement.
Collapse
Affiliation(s)
| | | | | | - Andrea Anderson
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Jon Goforth
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katharyn M. Atkins
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Heidemann LA, Kempner S, Jones E, Kobernik E, Stricklen A, Ross R, Wixson M, Kim GJ, Morgan HK. Easing the Transition From Medical School to Residency: Using Deliberate Practice to Improve Senior Medical Students' Performance Responding to Urgent Pages From Registered Nurses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S130. [PMID: 37838863 DOI: 10.1097/acm.0000000000004885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Lauren A Heidemann
- Author affiliation: L.A. Heidemann, S. Kempner, E. Jones, E. Kobernik, A. Stricklen, R. Ross, M. Wixson, G.J. Kim, H.K. Morgan, University of Michigan
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Shaw RD, Lamb CR, Carroll MC, Wong SL, Rosenkranz KM. Implementation of a Standardized Sub-Intern Curriculum Improves Confidence for those Entering a Surgical Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:1402-1412. [PMID: 35868970 DOI: 10.1016/j.jsurg.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Medical students often feel underprepared entering surgical residency. We have previously reported the results of a sub-intern needs assessment (SINA) which informed the creation of a standardized sub-internship curriculum. We aimed to determine if implementation of this curriculum into students' scheduled rotations would improve student confidence in their abilities related to the AAMC Core Entrustable Professional Activities for Entering Residency (CEPAERs). DESIGN We surveyed 4th year medical students during their surgery sub-internship. Sub-interns participated in a weekly series of 2-hour didactic sessions. We utilized interactive lectures and case scenarios addressing the pertinent topics identified in our previous needs assessment. The surveys were administered before and after the rotation and linked using unique identifiers. The surveys assessed confidence in each of the CEPAERs as well as the top 25 topics prioritized by our needs assessment. Self-reported confidence in each of the topics was measured using Likert scales (CEPAER scale 1-5, SINA scale 1-6). Pre- and post-curriculum confidence on a variety of topics were compared using paired t-tests. SETTING Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Medical Center, a tertiary-care academic medical center. PARTICIPANTS Fourth year medical students participating in their general surgery sub-internship. RESULTS Twelve medical students participated in general and thoracic surgery sub-internships over the course of the study period. Ten (83%) participated in the didactic curriculum and they all completed both the pre- and postsurvey. 100% of the respondents agreed that the curriculum provided a useful supplement to their clinical experience. With respect to the CEPAERs, students reported improved confidence in 77% of the areas, with statistically significant increases occurring in the following areas: ability to prioritize a differential diagnosis (average Likert rating improved from 3.7 to 4.1, p = 0.04), comfort entering and discussing orders (2.9-3.8, p = 0.007), and overall preparedness to be a surgical intern (3.2-3.8, p = 0.02). Students also reported improvement in confidence in 92% of the basic intern responsibility topics, with statistically significant increases in maintenance fluid calculations (Likert rating 3.5-4.5, p = 0.001), repleting electrolytes (3.8-4.6, p = 0.01), interpretation of chest and abdominal x-rays (4-5, p = 0.02; 3.6-4.5, p=0.004, respectively), management of oliguria (3.2-3.8, p = 0.02), and time management/organization skills (4.5-5.4, p = 0.04). CONCLUSIONS Implementation of a standardized sub-intern curriculum improved student confidence in 33 of the 38 basic intern responsibilities, core Entrustable Professional Activities, and overall preparedness to be a surgical intern. While limited by a single institution design, we believe these results offer a new avenue for educating and preparing medical students for residency within their existing sub-internships.
Collapse
Affiliation(s)
- Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Casey R Lamb
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Matthew C Carroll
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| |
Collapse
|
4
|
Nair K, Muehlschlegel C, Borgas P. Letter to the Editor on "Feedback Methods in an Interprofessional Mock Paging Program". MEDICAL SCIENCE EDUCATOR 2022; 32:585-586. [PMID: 35528298 PMCID: PMC9055002 DOI: 10.1007/s40670-022-01505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Kalyani Nair
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, N18 1QX UK
| | - Charlotte Muehlschlegel
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, N18 1QX UK
| | - Pia Borgas
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, N18 1QX UK
| |
Collapse
|
5
|
Mutter MK, Pedersen K, Cunningham T, Martindale JR. Feedback Methods in an Interprofessional Mock Paging Program. MEDICAL SCIENCE EDUCATOR 2021; 31:2001-2005. [PMID: 34956710 PMCID: PMC8651872 DOI: 10.1007/s40670-021-01445-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many medical schools offer a culminating internship readiness experience. Curricula focus on particular knowledge and skills critical to internship, such as answering urgent nursing pages. Studies have shown student performance improvement with mock paging education programs, but the role of feedback versus self-regulated practice has not been studied. DESIGN AND METHODS The interprofessional mock paging program included 156 medical students enrolled in a 4th-year internship readiness course and 44 master's level direct entry nursing students. Medical students were randomized to receive verbal feedback immediately after each of the three phone calls (intervention group) or delayed written feedback (control group) after the third phone call only. Specialty-specific case scenarios were developed and a single checklist for all scenarios was developed using the communication tool ISBAR. Medical students and nursing students had separate training sessions before the pages commenced. The nursing students administered the phone calls and evaluated the medical students by ISBAR checklist. An interrater reliability measure was obtained with physician observation of a selection of phone calls. RESULTS After adjusting for the case effects (different case scenarios for different specialties), students showed no statistically significant differences on checklist scores for case 1 (first case, F = 1.491, df = 1, p = .224), but did show statistically significant differences on checklist scores for case 3 (final case, F = 12.238, df = 1, p = .001). Strong interrater reliability was found between the faculty physician and observed nursing students (ICC = .89). CONCLUSIONS Immediate feedback significantly improves student checklist scores with a mock paging program. This finding suggests that coaching with feedback may have advantages above self-regulated learning.
Collapse
Affiliation(s)
- M. Kathryn Mutter
- Department of Emergency Medicine, University of Virginia, 1215 Lee St, PO Box 800699, Charlottesville, VA 22908 USA
| | | | - Tim Cunningham
- Practice & Innovation, Emory Healthcare, Atlanta, GA USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA USA
| | | |
Collapse
|
6
|
Lamb CR, Shaw RD, Hilty BK, Wong SL, Rosenkranz KM. A Targeted Needs Assessment for the Development of a Surgical Sub-internship Curriculum. JOURNAL OF SURGICAL EDUCATION 2021; 78:e121-e128. [PMID: 34362707 DOI: 10.1016/j.jsurg.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/18/2021] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Medical students often feel inadequately prepared for the responsibilities of surgical internship because of insufficient exposure to resident responsibilities prior to starting residency. This lack of preparation may contribute to burnout and attrition early in residency. Sub-internships should provide these experiences. Significant variation, however, exists in the structure of these rotations. We conducted a targeted needs assessment to inform the development of a didactic curriculum to address gaps in the surgical sub-internship experience and better prepare students for general surgery residency. DESIGN A 25-item needs assessment survey was developed and distributed to senior medical students in their surgical sub-internship, current junior residents, and prior students (alumni) from the past 4 years who matched into general surgery residencies at other institutions. SETTING Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Medical Center, a tertiary-care academic medical center. PARTICIPANTS Nine senior medical students; 12 current residents and 14 alumni, including 9 PGY-1, 13 PGY-2, and 4 PGY-3 residents. RESULTS The topics rated most important by medical students were floor management topics, specifically lines, tubes, and drains, hypotension, post-operative fever, chest pain, oliguria, and post-operative pain. In contrast, there was a wider variety of topics rated highly by residents. Residents emphasized non-technical communication and documentation skills. Residents at every training level rated presenting patients on rounds as the most important skill for incoming interns to acquire, whereas only one-third of medical students considered this to be an essential topic. CONCLUSIONS Medical students rank management of common clinical problems as the most critical aspect in their preparation for residency. Residents recognized these topics as important, but also placed high emphasis on non-technical communication and documentation skills. The findings from this need's assessment can be used to guide content structure for a sub-intern curriculum.
Collapse
Affiliation(s)
- Casey R Lamb
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bailey K Hilty
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| |
Collapse
|
7
|
Rao A, Heidemann L, Morgan H, Fitzgerald J, Allen B, Schiller J, Kempner S. Improving Interprofessional Communication Skills for Senior Medical Students Pursuing Pediatrics. Acad Pediatr 2021; 21:1297-1299. [PMID: 33991714 DOI: 10.1016/j.acap.2021.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Aditi Rao
- University of Michigan Medical School (A Rao), Ann Arbor, Mich.
| | - Lauren Heidemann
- Department of Internal Medicine, Michigan Medicine (L Heidemann), Ann Arbor, Mich
| | - Helen Morgan
- Department of Obstetrics and Gynecology, Michigan Medicine (H Morgan and S Kempner), Ann Arbor, Mich
| | - James Fitzgerald
- Department of Learning Health Sciences, University of Michigan Medical School (J Fitzgerald), Ann Arbor, Mich
| | - Brittany Allen
- Department of Pediatrics, Michigan Medicine (B Allen and J Schiller), Ann Arbor, Mich
| | - Jocelyn Schiller
- Department of Pediatrics, Michigan Medicine (B Allen and J Schiller), Ann Arbor, Mich
| | - Samantha Kempner
- Department of Obstetrics and Gynecology, Michigan Medicine (H Morgan and S Kempner), Ann Arbor, Mich
| |
Collapse
|
8
|
Mack JA, Morgan HK, Fitzgerald JT, Walford EC, Heidemann LA. The Development of a Video Intervention to Improve Senior Medical Students' Performance on Outpatient Telephone Encounters: a Delphi Analysis and Randomized Controlled Trial. MEDICAL SCIENCE EDUCATOR 2021; 31:1429-1439. [PMID: 34178421 PMCID: PMC8216674 DOI: 10.1007/s40670-021-01331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
Introduction Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs. Materials and Methods We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement. Results The Delphi yielded 34 important skills with the highest focus on communication (n = 13) and triage (n = 6). Seventy-two students completed assessments (Control, n = 41; Intervention, n = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention. Conclusions This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01331-w.
Collapse
Affiliation(s)
- Jacob A. Mack
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, UH South F4323, 1500 E. Medical Center Drive, 48109 Ann Arbor, MI, USA
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - James T. Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Eric C. Walford
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Lauren A. Heidemann
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, UH South F4323, 1500 E. Medical Center Drive, 48109 Ann Arbor, MI, USA
| |
Collapse
|
9
|
Chen T, Stapleton S, Babcock M, Kelley MN, Frallicciardi A. Handoffs and Nurse Calls: Overnight Call Simulation for Fourth-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11138. [PMID: 33816798 PMCID: PMC8015711 DOI: 10.15766/mep_2374-8265.11138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Interns must be able to give and receive handoffs and use handoff information to respond to calls from nursing staff regarding patient concerns. Medical students may not receive adequate instruction in these tasks and often feel unprepared in this aspect of transitioning to residency. This program simulated an overnight call experience for fourth-year medical students emphasizing handoffs, nurse calls, and medical emergency response. METHODS The program utilized a combination of traditional didactics and simulated handoffs, nurse calls, and patient scenarios to allow groups of fourth-year medical students to independently manage a simulated overnight call. The program was designed for students as part of a larger Transition to Residency capstone course. RESULTS We ran four sessions over 3 years, with a total of 105 medical student participants. All students reported increased confidence or comfort in their ability to manage handoffs and respond to nurse calls. Students reported that the sessions were helpful and realistic. DISCUSSION This program provided fourth-year medical students with a realistic and useful opportunity to simulate handoffs and response to nurse calls, which increased their confidence and comfort. Minor changes were made between iterations of the course with continued positive feedback from medical students. The course is generalizable and can be adapted to the needs and resources of different institutions.
Collapse
Affiliation(s)
- Tina Chen
- Assistant Professor, Division of Emergency Medicine, Saint Louis University School of Medicine
| | - Stephanie Stapleton
- Assistant Professor, Department of Emergency Medicine, Boston University School of Medicine
| | - Matthew Babcock
- Assistant Professor, Department of Emergency Medicine, University of Connecticut School of Medicine
| | - Mariann Nocera Kelley
- Assistant Professor, Departments of Pediatrics and Emergency Medicine/Traumatology, Division of Pediatric Emergency Medicine, University of Connecticut School of Medicine and Connecticut Children's Medical Center; Director of Simulation Education, University of Connecticut School of Medicine
| | - Alise Frallicciardi
- Associate Professor, Department of Emergency Medicine, University of Connecticut School of Medicine; Emergency Department Medical Director, University of Connecticut John Dempsey Hospital
| |
Collapse
|
10
|
Heidemann LA, Kempner S, Walford E, Chippendale R, Fitzgerald JT, Morgan HK. Internal medicine paging curriculum to improve physician-nurse interprofessional communication: a single center pilot study. J Interprof Care 2020:1-4. [PMID: 32297818 DOI: 10.1080/13561820.2020.1743246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
Effective physician-nurse communication is critical to patient safety, yet internal medicine trainees are rarely given feedback on this skill. In order to address this gap, we developed a 4-week simulated paging curriculum for senior medical students. Standardized Registered Nurses administered five acute inpatient paging cases to students via telephone and scored communication on a 10-point global scale (1 = highly ineffective to 10 = highly effective) and seven communication domains using a 5-point Likert-type scale. The domains included precision/clarity, instructive, directing, assertive, ability to solicit information, engaged, and structured communication. Students received verbal and written feedback from the nurses on communication skills and clinical decision-making. Our primary goal was to determine if student-nurse communication improved throughout the curriculum. Data were analyzed using multivariate ANOVAs with repeated measures. Twenty-seven students participated. Global communication scores increased significantly from case 1 to case 5 (7.1 to 8.7, p < .01). The following communication domains increased significantly: precision (3.8 to 4.4, p < .01), instructive (3.6 to 4.7, p < .01), directing (4.0 to 4.6, p = .02), assertiveness (4.0 to 4.7, p = .04), engaged (4.1 to 4.7, p < .01). In conclusion, this curriculum can be an innovative approach to improve physician-nurse communication using standardized registered nurses to deliver structured feedback to medical trainees.
Collapse
Affiliation(s)
- Lauren A Heidemann
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samantha Kempner
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eric Walford
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ryan Chippendale
- Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - James T Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Rosasco J, McCarroll ML, Gothard MD, Myers J, Hughes P, Schwartz A, George RL, Ahmed RA. Medical Decision-Making in the Physician Hierarchy: A Pilot Pedagogical Evaluation. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520925061. [PMID: 32656357 PMCID: PMC7333496 DOI: 10.1177/2382120520925061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. METHODS The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjusted z tests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set at P < .05. Effect sizes were determined and reported to inform future studies. RESULTS A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant (P = .002) interaction for total simulation time between groups RP: 6.2 minutes (±1.58); MP: 8.7 minutes (±2.46); and AP: 10.3 minutes (±2.78). The AP MJM scores, 12.3 (±2.66), for the RC simulation were significantly (P = .010) lower than the RP 14.7 (±1.15) and MP 14.7 (±1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups (P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. CONCLUSIONS Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.
Collapse
Affiliation(s)
- John Rosasco
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Michele L McCarroll
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | | | - Jerry Myers
- HRP Cross Cutting Computational Modeling Project, NASA John H. Glenn Research Center, Cleveland, OH, USA
| | - Patrick Hughes
- Department of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Alan Schwartz
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard L George
- Department of Surgery, Trauma Program, Summa Health System —Akron Campus, Akron, OH, USA
- Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Rami A Ahmed
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
| |
Collapse
|
13
|
Griffith PB, Kelly MM, Becker D. On-call simulation for adult gerontology acute care nurse practitioner students: A comparative descriptive study. J Am Assoc Nurse Pract 2019; 33:429-440. [PMID: 31868822 DOI: 10.1097/jxx.0000000000000355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is now commonplace for acute care nurse practitioners (ACNPs) to work in positions that include an on-call component or management of emergent concerns through telephone. There are no published reports on the inclusion of an on-call component in ACNP clinical preparation of students; novice ACNPs feel unprepared to competently and confidently manage emergent patient situations and on-call responsibilities. PURPOSE To examine ACNP student perception of stress, necessary skills, confidence, and benefit of participating in a simulated on-call experience. METHODS Using simulated faculty callers as nurses, ACNP students participated in a simulated on-call experience that included receiving two calls, eliciting key information from the nurse, diagnosing and managing the patient, and submitting documentation of the encounter. Students completed preparticipation and postparticipation perception surveys, and they were evaluated by the simulated nurse (faculty) using standardized evaluation tools. RESULTS Acute care nurse practitioner students rated the simulated on-call experience as educationally valuable. High levels of anxiety before participation were notably improved after participation. Students identified critical thinking, clear communication, and knowledge with the specific disease as the most important skills needed to manage nurse calls successfully. Students reported marked improvement in their confidence and were receptive to accepting an nurse practitioner position with call/triage responsibilities after their on-call experience. IMPLICATIONS FOR PRACTICE Inclusion of a simulated on-call experience in the final semester of an ACNP program is both feasible and relevant to ACNP student development. On-call exposure within the clinical practicum is inconsistent and, therefore, should be added through simulation.
Collapse
Affiliation(s)
- Patricia B Griffith
- Adult Gerontology Acute Care Nurse Practitioner Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Pediatric Nurse Practitioner Program, Villanova University, Villanova, Pennsylvania
| | - Deborah Becker
- Adult Gerontology Acute Care Nurse Practitioner Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| |
Collapse
|
14
|
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: 1] [Impact Index Per Article: 0.2] [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.
Collapse
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
| |
Collapse
|
15
|
|
16
|
Hvolbek AP, Nilsson PM, Sanguedolce F, Lund L. A prospective study of the effect of video games on robotic surgery skills using the high-fidelity virtual reality RobotiX simulator. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:627-634. [PMID: 31616197 PMCID: PMC6699361 DOI: 10.2147/amep.s199323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/15/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Robot-assisted surgery is a growing field. Prior video game experience might give advantage to novice robotic surgeons. AIM Assessing if prior video gaming experience gives advantage in performing high-fidelity virtual reality (VR)-simulated robotic surgery. METHODS In this observational study, 30 medical students and 2 interns (17 females; 15 males) with median age 25 years (range, 24-26 years) were recruited and subsequently divided into groups according to prior gaming experience; gamers (≥6 video game hours/week) vs nongamers (<6 video game hours/week). Participants performed VR-simulated urethrovesical anastomosis on RobotiX Mentor, which measured performance parameters. Participants answered a questionnaire for demographics and gaming experience. Groups were compared using Mann-Whitney U and multiple regression. RESULTS Gamers significantly outperformed nongamers in 3 of 24 performance metrics (p<0.05), and there was a trend toward better results for 7 of the 21 remaining metrics. Males outperformed females in 5 of 24 metrics (p<0.05) but were overrepresented among gamers. CONCLUSION Prior video game experience >6 hrs/week might give advantage in simulated robotic surgery. We recommend future studies testing this hypothesis to develop simulator programs for certification of robotic surgeons.
Collapse
Affiliation(s)
| | - Philip Mørkeberg Nilsson
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | | | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Lars LundDepartment of Urology, Odense University Hospital, J.B. Winsloew Vej 4, Entrance 20, Penthouse, 2. Floor, OdenseC DK-5000, DenmarkTel +45 5 140 8982Email
| |
Collapse
|
17
|
Heidemann LA, Fitzgerald JT, Hartley S. Are medical students trained in cross-cover? CLINICAL TEACHER 2018; 16:214-219. [PMID: 29947072 DOI: 10.1111/tct.12803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the current state of cross-cover education in undergraduate medical education and intern perceived readiness to provide cross-cover. METHODS An electronic survey was distributed to 126 incoming interns in surgery, internal medicine, family medicine and paediatrics residencies at a single academic centre. Information regarding prior cross-cover training, experience, confidence, and responses to a sample cross-cover case were obtained. RESULTS The survey response rate was 69.8% (88 of 126), which included both partial and complete responses. Fifty-seven interns out of 85 (67.1%) had no formal training and 51 (60.0%) had no experience performing cross-cover. They reported feeling unprepared to provide cross-cover, with an average score of 1.8 on a 5-point Likert scale (1, not at all confident; 5, extremely confident). Interns had more confidence in performing cross-cover tasks if they had prior direct cross-cover experience (p = 0.001), and were the least confident in performing the initial evaluation and management of urgent issues (Likert score = 1.6). Scores on the sample case were correlated with the amount of prior experience with patients (p = 0.06). Only 77.7% of interns indicated that they would notify their senior resident in two urgent scenarios. Those who reported higher confidence in knowing when to ask for help were more likely to appropriately notify their senior colleague (p = 0.005). We identified gaps in cross-cover training and in the preparedness of incoming interns CONCLUSIONS: We identified gaps in cross-cover training and in the preparedness of incoming interns. This has important implications for the first day of residency, when interns are often asked to perform cross-coverage, yet feel unprepared to do so and express the greatest concern in urgent cross-cover scenarios. Addressing this curricular gap is crucial in assuring safe cross-cover care.
Collapse
Affiliation(s)
- Lauren A Heidemann
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - James T Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.,Geriatric Research Education and Clinical Center, Arbor VA Medical Center, Ann Arbor, Michigan, USA
| | - Sarah Hartley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
18
|
Tischendorf J, O'Connor C, Alvarez M, Johnson S. Mock Paging and Consult Curriculum to Prepare Fourth-Year Medical Students for Medical Internship. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10708. [PMID: 30800908 PMCID: PMC6342441 DOI: 10.15766/mep_2374-8265.10708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/13/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Internship preparation should include curricula to hone key skills such as acute medical management and communication with consulting and interprofessional providers. METHODS To enhance these skills, we developed an interprofessional mock paging and consult curriculum incorporating direct observation and peer, faculty, and nursing feedback for fourth-year medical students entering medical internships. Our brief mock paging and consult curriculum was designed as part of a larger 2-week internship preparation course. Our curriculum was delivered in two 2-hour sessions by physician and nurse educators. Sessions were conducted in small groups, offering the opportunity for direct observation and feedback from faculty, nurse educators, and peers. Our curriculum was expanded from a pilot for 10-15 students to 60 students after 2 years of a successful pilot. RESULTS Mock paging and consult sessions were highly rated by medical students and resulted in significantly enhanced self-assessment of preparedness in key intern skills such as returning pages, interprofessional communication, calling a consult, and managing acute issues for cross-cover patients. DISCUSSION We have demonstrated the effectiveness of a brief, interprofessional mock paging and consult curriculum incorporating faculty, nurse educator, and peer feedback. The tenets of our curriculum can be widely adopted for other learner groups.
Collapse
Affiliation(s)
| | - Clare O'Connor
- Fellow, Endocrinology, McGaw Medical Center of Northwestern University
| | - Madelyn Alvarez
- Fellow, Women's Health, William S. Middleton Memorial VA Hospital
| | - Sara Johnson
- Assistant Professor, Division of Hematology/Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
- Fellowship Director, Palliative Medicine Fellowship, University of Wisconsin School of Medicine and Public Health
- Course Co-Director, Fourth-Year Medical Student Internship Preparation Course, University of Wisconsin School of Medicine and Public Health
| |
Collapse
|
19
|
Naik ND, Abbott EF, Gas BL, Murphy BL, Farley DR, Cook DA. Personalized video feedback improves suturing skills of incoming general surgery trainees. Surgery 2018; 163:921-926. [DOI: 10.1016/j.surg.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
|
20
|
Kalet A, Zabar S, Szyld D, Yavner SD, Song H, Nick MW, Ng G, Pusic MV, Denicola C, Blum C, Eliasz KL, Nicholson J, Riles TS. A simulated "Night-onCall" to assess and address the readiness-for-internship of transitioning medical students. Adv Simul (Lond) 2017; 2:13. [PMID: 29450014 PMCID: PMC5806245 DOI: 10.1186/s41077-017-0046-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic "night on call" experience for near graduating students and build measurements of students' readiness for this transition framed by the Association of American Medical College's Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.
Collapse
Affiliation(s)
- Adina Kalet
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Sondra Zabar
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Demian Szyld
- Department of Emergency Medicine, Center for Medical Simulation, Institute for Medical Simulation, Harvard Medical School, Boston, MA USA
| | - Steven D Yavner
- Department of Journalism, Central Connecticut State University, New Britain, CT USA
| | - Hyuksoon Song
- Department of Education, Georgian Court University, Lakewood, NJ USA
| | - Michael W Nick
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Grace Ng
- New York Simulation Center for the Health Sciences, New York, New York USA
| | - Martin V Pusic
- Department of Emergency Medicine, NYU School of Medicine, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
| | - Christine Denicola
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Cary Blum
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
| | - Kinga L Eliasz
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Joey Nicholson
- Health Science Library, NYU School of Medicine, New York, New York USA
| | - Thomas S Riles
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
| |
Collapse
|
21
|
Ahmed RA, McCarroll ML, Schwartz A, Gothard MD, Atkinson SS, Hughes PG, Cepeda Brito JR, Assad L, Myers JG, George RL. Development, Validation, and Implementation of a Medical Judgment Metric. MDM Policy Pract 2017; 2:2381468317715262. [PMID: 30288425 PMCID: PMC6125013 DOI: 10.1177/2381468317715262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 02/23/2017] [Indexed: 01/10/2023] Open
Abstract
Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM), a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987) as well as their evaluation of the expected patient outcome (Fleiss’s Kappa 0.791 to 0.906). For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen’s Kappa 0.851 to 0.880). Discussion: The MJM demonstrated preliminary evidence of reliability and validity.
Collapse
Affiliation(s)
- Rami A Ahmed
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Michele L McCarroll
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Alan Schwartz
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - M David Gothard
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - S Scott Atkinson
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Patrick G Hughes
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Jose Ramon Cepeda Brito
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Lori Assad
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Jerry G Myers
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| | - Richard L George
- Summa Health, Akron, Ohio (RAA, MLM, SSA, PGH, JRCB, LA, RLG).,Northeast Ohio Medical University, Rootstown, Ohio (RAA, MLM, RLG).,University of Illinois at Chicago, Chicago, Illinois (AS).,Biostats, Inc., East Canton, Ohio (MDG).,NASA Glenn Research Center, Cleveland, Ohio (JGM)
| |
Collapse
|
22
|
Mock Pages Are a Valid Construct for Assessment of Clinical Decision Making and Interprofessional Communication. Ann Surg 2017; 265:116-121. [DOI: 10.1097/sla.0000000000001575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
"Surgery interrupted": The effect of multitasking on cognitive and technical tasks in medical students. Am J Surg 2016; 213:268-272. [PMID: 27839688 DOI: 10.1016/j.amjsurg.2016.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Today's medical learners are Millennials, and reportedly, multitasking pros. We aim to evaluate effect of multitasking on cognitive and technical skills. MATERIALS AND METHODS 16 medical students completed a mock page and laceration closure separately on day 1 and day 13, and in parallel on day 14. Suturing was graded using GRS and mock pages scored. Total time, suturing and loading times, and percent correct on mock page were compared. RESULTS Percent correct on mock page improved from days 1-13 and 14 (p < 0.01 and 0.04). GRS improved from days 1-13 and 14 (p = 0.04 and <0.01). Total time suturing was similar on all days. However, time suturing during the mock page on day 14 was prolonged compared to before mock page (p = 0.01). CONCLUSIONS Medical students can complete cognitive and technical tasks in parallel, without compromising acceptability. However, multitasking results in longer times to complete the complex component of the technical task.
Collapse
|
24
|
|
25
|
Sugand K, Mawkin M, Gupte C. Validating Touch Surgery™: A cognitive task simulation and rehearsal app for intramedullary femoral nailing. Injury 2015; 46:2212-6. [PMID: 26094504 DOI: 10.1016/j.injury.2015.05.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/11/2015] [Accepted: 05/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of simulation in orthopaedic surgical training is becoming increasingly evident, as simulation allows repeated sustained practice in an environment that does not harm the patient. Previous studies have shown that the cognitive aspects of surgery are of equal if not greater importance in developing decision making than the practical aspects. AIM To observe construct, content and face validity of four IFN modules on a cognitive simulator, Touch Surgery™. METHODS 39 novices and 10 experts were recruited to complete four simulation modules on surgical decision-making that represented the procedural steps of preparing the patient and equipment, inserting and locking an intramedullary femoral nail. Real-time objective performance metrics were obtained, stored electronically and analysed using median and Bonett-Price 95% confidence intervals from the participant's primary attempt to assess for construct validity. The median score of a post-study questionnaire using 5-point Likert scales assessed face and content validity. Data was confirmed as non-parametric by the Kolmogorov-Smirnov test. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value<0.05. RESULTS Experts significantly outperformed novices in all four modules to demonstrate construct validity (p<0.001). Specifically, experts scored 32.5% higher for patient positioning and preparation (p<0.0001), 31.5% higher for femoral canal preparation (p<0.0001), 22.5% higher for proximal locking (p<0.0001) and 17% higher scores for distal locking and closure (p<0.001). Both cohorts either agreed or strongly agreed that the graphics, simulated environment and procedural steps were realistic. Also, both cohorts agreed that the app was useful for surgical training and rehearsal, should be implemented within the curriculum and would want to use it to learn other surgical procedures. CONCLUSION IFN on the Touch Surgery app demonstrated construct, face and content validity. Users can demonstrate cognitive competencies prior to performing surgical procedures in the operating room. The application is an effective adjunct to traditional learning methods and has potential for curricular implementation.
Collapse
Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK.
| | - Mala Mawkin
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK.
| | - Chinmay Gupte
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK.
| |
Collapse
|
26
|
Wade TJ, Lorbeer K, Awad MM, Woodhouse J, DeClue A, Brunt LM. Outcomes of a proficiency-based skills curriculum at the beginning of the fourth year for senior medical students entering surgery. Surgery 2015; 158:962-9; discussion 969-71. [PMID: 26283204 DOI: 10.1016/j.surg.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesized that a proficiency-based curriculum administered early in the fourth year to senior medical students (MS4) would achieve outcomes comparable to a similar program administered during surgical internship. METHODS MS4 (n = 18) entering any surgical specialty enrolled in a proficiency-based skills curriculum at the beginning of the fourth year that included suturing/knot-tying, on-call problems, laparoscopic, and other skills (urinary catheter, sterile prep/drape, IV placement, informed consent, electrosurgical use). Assessment was at 4-12 weeks after training by a modified Objective Structured Assessment of Technical Skills (OSATS). Suturing and knot tying tasks were assessed by time and OSATS technical proficiency (TP) scores (1 [novice], 3 [proficient], 5 [expert]). Outcomes were compared with PGY-1 residents who received similar training at the beginning of internship and assessment 4-12 weeks later. Data are presented as mean values ± standard deviation; statistical significance was assessed by Student's t test. RESULTS Fifteen of 18 MS4 (83%) reached proficiency on all 15 tasks, and 2 others were proficient on all but 1 laparoscopic task. Compared with PGY-1s, MS4 were significantly faster for 3 of 5 suturing and tying tasks and total task time (547 ± 63 vs 637 ± 127 s; P < .05). Mean TP scores were similar for both groups (MS4, 3.4 ± 0.5 vs PGY-1, 3.1 ± .57; P = NS). MS4 OSATS scores were higher for IV placement, informed consent, and urinary catheter placement, but lower for prep and drape and for management of on-call problems. CONCLUSION MS4 who participate in a proficiency-based curriculum taught early in the fourth year are able to meet proficiency targets in a high percentage of cases. This approach should better prepare MS4 for surgical internship.
Collapse
Affiliation(s)
- Thomas J Wade
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Karly Lorbeer
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Michael M Awad
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Julie Woodhouse
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Angela DeClue
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|