Use of mobile learning module improves skills in chest tube insertion

Microlearning: A Concept Analysis

With an overall rise in technology adoption, the information-seeking behaviors of today have become instant and single-focused, and demand convenience for learning and the acquisition of knowledge. Digital technologies expand the reach of learning and allow for the development of innovative and creative methods of teaching. The use of microlearning has been gaining popularity in academic and professional development settings and corporate training. Currently, there is no standardized definition of microlearning. Using Walker and Avant's method of concept analysis, a comprehensive overview of microlearning is provided through identifying the concept and describing its uses, attributes, exemplary cases, antecedents, consequences, and empirical referents. Seven attributes associated with microlearning are single focus, bite-sized, asynchronistic, accessibility, flexibility, interactivity, and multimodal delivery. A proposed definition is a self-directed, on-demand, teaching strategy where small single-focused interactive content is presented to learners asynchronously, using technologies that accommodate multimodal delivery, and access where and when convenient for the learner. This analysis will assist informatics and nursing educators in understanding how microlearning, as a strategy, fits into the electronic learning landscape, is supported by digital technologies, and adds portability to leverage in an on-demand asynchronous way providing targeted learning for use in all areas of clinical practice.

Teaching Chest Tube Insertion by Blended Learning: A Multi-Dimensional Analysis

BACKGROUND

Emerging technologies are being incorporated in surgical education. The use of such technology should be supported by evidence that the technology neither distracts nor overloads the learner and is easy to use. To teach chest tube insertion, we developed an e-learning module, as part of a blended learning program delivered prior to in-person hands-on simulation. This pilot study was aimed to assess learning effectiveness of this blended learning, and cognitive load and the usability of e-learning.

METHODS

The interactive e-learning module with multimedia content was created following learning design principles. In advance of the standard simulation, 13 first-year surgical residents were randomized into two groups: 7 received the e-learning module and online reading materials (e-learning group); 6 received only the online reading materials (controls). Knowledge was evaluated by pre-and post-tests; technical performance was assessed using a Global Rating Scale by blinded assessors. Cognitive load and usability were evaluated using rating scales.

RESULTS

The e-learning group showed significant improvement from baseline in knowledge (P = .047), while controls did not (P = .500). For technical skill, 100% of residents in the e-learning group reached a predetermined proficiency level vs 60% of controls (P = .06). The addition of e-learning was associated with lower extrinsic and greater germane cognitive load (P = .04, .03, respectively). Usability was evaluated highly by all participants in e-learning group.

CONCLUSION

Interactive e-learning added to hands-on simulation led to improved learning and desired cognitive load and usability. This approach should be evaluated in teaching of other procedural skills.

Implementation of a novel thoracostomy tube trainer with real-time feedback

Objectives

Simulation-based training leads to improved clinical performance but may be influenced by quality and frequency of training. Within simulation training, chest tube insertion remains a challenge as one of the main pitfalls of insertion is a controlled pleural entry. This study evaluates the efficacy of a novel training model with real-time pressure monitoring, the average force to pleural entry in a model and the utility of audio and visual feedback.

Methods

This proprietary training model comprised a modified Kelly clamp device with three force sensors at the index finger (sensor 1) and two finger loops (sensors 2 and 3), and a manikin with a replaceable chest wall pad. Standard force values (Newtons (N)) were obtained by experts; expert data revealed that 3-5 s was an acceptable time range to complete the chest tube insertion. Participant level ranged from Post-graduate Year (PGY)-1 to PGY-6 with 13 total participants. Each individual was provided an introduction to the procedure and chest tube trainer. Force (N) and time (ms) measurements were obtained from entry through dermis to pleural space puncture. A significant pressure drop suggested puncturing through the chest wall (completion of the procedure).

Results

Force data were captured during each phase of the procedure-linear, plateau, and drop. Linear phase (~3000 ms) was from start of procedure to point of maximum force (<30 N). Plateau phase was from maximum force to just before a drop in pressure. Drop phase was a drop in pressure by 5+ N in a span of 150 ms signaling completion of procedure. All participants were able to complete the task successfully. Force for pleural entry ranged from 17 N to 30 N; time to pleural entry ranged from 7500 to 15 000 ms. There was variability in use of all three sensors. All participants used the index sensor, however there was variability in the use of the loop sensors depending on the handedness of the participant. Left-handed users relied more on sensors 1 and 3 while right-handed users relied more on sensors 1 and 2. Given this variability, only force measurements from sensor 1 were used for assessment.

Conclusions

This novel force-sensing chest tube trainer with continuous pressuring monitoring has a wide range of applications in simulation-based training of emergency surgical tasks. Next steps include evaluating its impact on accuracy and efficiency. Applications of real-time feedback measuring force are broad, including vascular access, trocar placement and other common procedures.

Level of evidence

Level IV, prospective study.

Digital Education in General Thoracic Surgery: A Narrative Review

BACKGROUND

Since advanced technologies were introduced into surgical education, a variety of new programs have been developed. However, a comprehensive review of digital education in general thoracic surgery has not been performed. This narrative review was conducted was to identify the current applications of digital education in general thoracic surgery.

METHODS

A literature search was performed using keywords related to general thoracic surgery and digital education, including e-learning and virtual simulation, up to September 2021. Studies published in English investigating the effect of digital education in general thoracic surgery were included.

RESULTS

Thirteen studies met the criteria. The settings were in undergraduate (n = 6) and postgraduate education (residency) (n = 5) and mixed audience with other disciplines (n = 2). Theoretical knowledge (n = 5), technical skills (n = 4), and both knowledge and technical skills (n = 4) were the stated educational objectives for the studies. The didactic materials were transferred to hardware, software, or online platforms and delivered with multimedia materials. Technical skills training for bronchoscopy and chest tube insertion (n = 5) were offered using virtual reality and computer-based simulations. Subjective evaluation was done in 10 studies. Although after the digital education training there was observed improvement in knowledge or skills in 8 studies, studies were not designed to test for superiority compared with controls through randomized controlled studies.

CONCLUSIONS

This review summarizes the current applications of digital education in general thoracic surgery and helps establish the needs for future studies in this field.

Use of Videos by Health Care Professionals for Procedure Support in Acute Cardiac Care: A Scoping Review

BACKGROUND

Cardiology procedures are often life-saving and time-critical, but some are so infrequent that health care staff may have rarely encountered them in practice or need to refresh their skills rapidly. Videos demonstrating procedures have the potential to assist health care professionals and support safe patient care. This scoping review explores the research literature involving the use of video by health care professionals in hospitals.

AIM

To identify what is known from research regarding the use of video to support clinical procedures in hospitals or health care facilities.

METHOD

The Joanna Briggs Institute Scoping review methodology guided our systematic search of peer-reviewed evidence related to video use to support procedures in a hospital or health care facility. Data sources included the electronic databases: ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Excerpta Medica dataBASE (EMBASE), Scopus, and PubMed.

FINDINGS

Seventeen (17) studies that met the inclusion criteria were included in the review, all published between 2012 and 2022. Since 2005, YouTube has become the dominant platform for publishing or sourcing videos related to clinical procedures. Studies to date can be summarised under five themes: 1) video content and purpose, 2) target audience, 3) video hosting site-internal websites versus YouTube, 4) curated versus original 'homegrown' video content, and 5) video development process.

DISCUSSION/CONCLUSION

Research on the development and utility of videos to support clinical procedures is emerging, with the ability to host videos on platforms such as YouTube becoming more accessible in recent years. All videos were designed to enhance health care professionals' existing knowledge and skills within their scope of practice. The available literature suggests that video can be a valuable clinical resource for both simple and skilled procedures. Video resources can help clinicians perform or assist with rare procedures, providing 'just in time' patient safety prompts and information.

Technology-enhanced trauma training in low-resource settings: A scoping review and feasibility analysis of educational technologies

BACKGROUND

Lack of training contributes to the burden of trauma-related mortality and morbidity in low- and lower-middle-income countries (LMICs). Educational technologies present a unique opportunity to enhance the quality of trauma training. Therefore, this study reviews current technologies used in trauma courses and evaluates their feasibility for LMICs.

METHODS

We conducted a scoping review evaluating the learning outcomes of technology-enhanced training in general trauma assessment, team skills or any procedures covered in the 2020 Advanced Trauma Life Support® program. Based on the Technology-Enhanced Learning criteria, we created and applied a feasibility analysis tool to evaluate the technologies for use in LMICs.

RESULTS

We screened 6471 articles and included 64. Thirty-four (45%) articles explored training in general trauma assessment, 28 (37%) in team skills, and 24 (32%) in procedures. The most common technologies were high-fidelity mannequins (60%), video-assisted debriefing (19%), and low-fidelity mannequins (13%). Despite their effectiveness, high-fidelity mannequins ranked poorly in production, maintenance, cost, and reusability categories, therefore being poorly suited for LMICs. Virtual simulation and digital courses had the best feasibility scores, but still represented a minority of articles in our review.

CONCLUSION

To our knowledge, this is the first study to perform a feasibility analysis of trauma training technologies in the LMIC context. We identified that the majority of trauma courses in the literature use technologies which are less suitable for LMICs. Given the urgent need for pediatric trauma training, educators must use technologies that optimize learning outcomes and remain feasible for low-resource settings.

LEVEL OF EVIDENCE

IV.

Advances in e-learning in undergraduate clinical medicine: a systematic review

BACKGROUND

E-learning is recognised as a useful educational tool and is becoming more common in undergraduate medical education. This review aims to examine the scope and impact of e-learning interventions on medical student learning in clinical medicine, in order to aid medical educators when implementing e-learning strategies in programme curricula.

METHODS

A systematic review compliant with PRISMA guidelines that appraises study design, setting and population, context and type of evaluations. Specific search terms were used to locate articles across nine databases: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus and Google Scholar. Only studies evaluating e-learning interventions in undergraduate clinical medical education between January 1990 and August 2021 were selected. Of the 4,829 papers identified by the search, 42 studies met the inclusion criteria.

RESULTS

The 42 studies included varied in scope, cognitive domain, subject matter, design, quality and evaluation. The most popular approaches involved multimedia platforms (33%) and case-based approaches (26%), were interactive (83%), asynchronous (71%) and accessible from home (83%). Twelve studies (29%) evaluated usability, all of which reported positive feedback. Competence in use of technology, high motivation and an open attitude were key characteristics of successful students and preceptors.

CONCLUSIONS

Medical education is evolving consistently to accommodate rapid changes in therapies and procedures. In today's technologically adept world, e-learning is an effective and convenient pedagogical approach for the teaching of undergraduate clinical medicine.

Formative Feedback with In-Class Question Bank Utilization Improves Resident Satisfaction with General Surgery Didactics

BACKGROUND

Formative feedback provides low-stakes opportunities for educational improvement. To enrich our basic science didactics, formative feedback measures were incorporated into our didactics using mobile devices.

MATERIALS AND METHODS

Lecture changes included institutional paid access to a commercial question bank, a 5-item in-class pre-didactic quiz curated from the question bank and taken on the resident's mobile device, and group discussion of quiz topics. An anonymous survey was sent to participating residents.

RESULTS

Overall response rate was 71% among residents. All reported that the new lecture format was a valuable addition to the basic science curriculum (100% Agree/Strongly Agree), and formative assessments provided valuable feedback about the progress of their learning (Strongly Agree = 42%, Agree =58%). All residents reported that in-class use of their mobile device for quizzes was convenient, with majority (84%) preferring it over paper printouts. Residents were more motivated to study before lecture (Strongly Agree = 42%, Agree =42%), with majority also reporting the new format helped identify weaknesses in their knowledgebase (Strongly Agree = 58%, Agree =33%). While majority of residents agreed that quizzes motivated them to study more after lecture, a large portion disagreed (42%). Majority of senior residents reported that the process of composing quizzes prior to lecture enriched their own learning (57%) and helped them find gaps in their knowledge (71%).

CONCLUSION

Incorporating a commercial question bank within didactics gives general surgery residents formative feedback and encourages learning outside the classroom, leading to improved satisfaction with basic science didactics.

Just-in-time clinical video review improves successful placement of Sengstaken-Blakemore tube by emergency medicine resident physicians: A randomized control simulation-based study

OBJECTIVE

Successful completion of life-saving procedures may benefit from a concise just-in-time (JIT) intervention. Video is an optimal medium for JIT training, but currently available video-based references are not optimized for a JIT format, especially in time-pressured situations prior to high-risk clinical contexts. We aimed to create and evaluate the efficacy of a brief video review of emergent Sengstaken-Blakemore tube (SBT) insertion for acutely decompensating variceal hemorrhage when used just prior to clinical performance in a simulated setting.

METHODS

We created a less than 3-minute audio-optional JIT training video on SBT insertion. We recruited emergency medicine resident physicians to participate in a simulation scenario in which they had to quickly place an SBT. Participants were randomized to either a 3-minute procedure review by any media they chose (control) or review of the JIT video (intervention). Performance on a checklist created by a multidisciplinary group of SBT experts (passing score > 18 and maximum = 28) served as the primary outcome. We analyzed performance in checklist scores controlling level of training through a one-way analysis of covariance (ANCOVA). We analyzed rates of passing scores via a chi-square analysis.

RESULTS

We randomized 32 participants to media review (control) or JIT video (intervention). The intervention group had an overall mean (±SD) performance of 19.8 (±9.0) and the control group had a mean (±SD) score of 6.6 (±7.4). After adjusting for postgraduate year, we found a significant difference in final checklist scores between the two groups (mean difference = 12.8, 95% confidence interval [CI] = 7.6 to 18.0). Percentages of participants reaching a minimum passing score were two of 16 (12.5%) in the control group and 10 of 16 (62.5%) in the intervention group (odds ratio = 11.7, 95% CI = 9.9 to 13.5). Cohen's kappa indicated substantial agreement (κ = 0.714) between reviewer scores.

CONCLUSIONS

A readily available, focused, audio-optional JIT video increased performance for SBT insertion in a simulated setting. Future work may include testing of this format for more commonly performed emergency procedures and determination of effect on bedside performance in the clinical setting.

Multidisciplinary simulation-based trauma team training with an emphasis on crisis resource management improves residents' non-technical skills

BACKGROUND

Non-technical skills impact trauma resuscitation time. Crisis resource management teaches non-technical skills required for effective teamwork in a crisis. We developed a simulation-based multidisciplinary trauma team training, with an emphasis on crisis resource management and a goal of improving residents' non-technical skills.

METHODS

Twenty-five post-graduate year-1 general surgery and emergency medicine residents were divided into multidisciplinary teams with embedded nurse participants. Teams underwent 3 trauma resuscitation scenarios followed by a crisis resource management debrief. Additionally, a Just-In-Time crisis resource management didactic was delivered before 1 scenario. Teams' non-technical skills in each scenario were assessed by expert raters using non-technical skills scale for trauma and scenario scores before and after the Just-In-Time didactic were compared. Multiple linear-regression calculating the impact of clinical scenario, case order, and timing relative to the Just-In-Time didactic on a teams' non-technical skills scale for trauma score was performed.

RESULTS

Seventy-four team T-NOTECHS ratings were completed. T-NOTECHS total score was significantly higher on the third training case regardless of clinical scenario or timing relative to the Just-In-Time didactic (pre = 15.58 vs post = 18.11, P = .117). Teams scored an average of 15.44 on the first scenario of the day, 16.63 on the second, and 19.04 on the last (P < .001).

CONCLUSION

Crisis resource management-focused multidisciplinary team training significantly improves residents' non-technical skills in the simulated environment. Case repetition followed by crisis resource management focused debriefings outweighed the effect of a single Just-In-Time crisis resource management didactic.

Instructing Ultrasound-guided Examination Techniques Using a Social Media Smartphone App

Social media applications on smartphones allow for new avenues of instruction in sports medicine and exercise sciences. This study tested the feasibility of instructing health care personnel through videos of ultrasound vascular measurements distributed by a social media messenger application. After two training sessions with an ultrasound device, voluntary physicians (n=10) and nurses (n=10) received a video for the performance of an ultrasound-guided determination of intima-media-thickness and diameter of the femoral arteries via a social media messenger application. All participants examined the same healthy human subject. There was no significant difference between the groups regarding overall time of performance, measurements of the femoral arteries, or a specifically designed "assessment of mobile imparted arterial ultrasound determination" score. The physicians group achieved significantly higher scores in the established "objective structured assessment of ultrasound skills" score (p=0.019). Approval of the setting was high in both groups. Transmission of videos via social media applications can be used for instructions on the performance of ultrasound-guided vascular examinations in sports medicine, even if investigators' performances differ depending on their grade of ultrasound experience. In the future, the chosen approach should be tested in practical scientific examination settings.

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Purpose

During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR.

Methods

European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important).

Results

In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively].

Conclusion

This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR.

Electronic supplementary material

The online version of this article (10.1007/s10029-020-02270-y) contains supplementary material, which is available to authorized users.

A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents

PURPOSE

Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation.

METHOD

The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children's Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months.

RESULTS

Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]).

CONCLUSIONS

Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents' intubation performance on airway trainers with sustained improvement at three months.

Attitude towards Mobile Learning in English Language Education

Mobile devices, especially smart phones, are the most frequently used technological devices for daily routines. Mobile devices can be used for various purposes to meet different needs. Since education is a core requirement for human beings, smart phones are being integrated into education. However, it remains to be seen whether they have an impact on learning or not. Consequently, integration of these technologies, or “mobile learning”, has become a popular research study in the field of instructional technology. It is important to investigate the impact of smart phones in language education since students today use them frequently. This attitudinal study aims to investigate the attitude of students in higher education towards smart phone use in the context of foreign language learning. In particular, it gathers information about how smart phones are used for language learning. Participants of the study were 294 prep school students from a well-known university in Turkey. Descriptive study was selected as a research method and mixed-method was the research design for the study. The findings of the study showed that participants care about instant and easy access to information in language learning. In addition to drawing attention to the ease of information access, participants provided suggestions about future applications of smartphones in language learning.

Optimizing Residents' Performance of Lumbar Puncture: An RCT Comparing the Effect of Preparatory Interventions on Performance and Self-Confidence

BACKGROUND

Lumbar puncture is often associated with uncertainty and limited experience on the part of residents; therefore, preparatory interventions can be essential. There is growing interest in the potential benefit of videos over written text. However, little attention has been given to whether the design of the videos impacts on subsequent performance.

OBJECTIVE

To investigate the effect of different preparatory interventions on learner performance and self-confidence regarding lumbar puncture (LP).

DESIGN

Randomized controlled trial in which participants were randomly assigned to one of three interventions as preparation for performing lumbar puncture: 1) goal- and learner-centered video (GLV) presenting procedure-specific process goals and learner-centered information; 2) traditional video (TV) providing expert-driven content, but no process goals; and 3) written text (WT) with illustrations.

PARTICIPANTS AND MAIN MEASURES

Participants were PGY-1 doctors without LP experience. After the preparatory intervention, participants performed an LP in a simulated setting with a standardized patient and an assistant. Two content experts, blinded to participant group allocation, assessed video recordings of the performance using the Lumbar Puncture Assessment Tool (LumPAT) and an overall global rating. Participants rated their self-confidence immediately prior to performing the procedure. The primary outcome was the difference in LumPAT scores among groups.

KEY RESULTS

A total of 110 PGY-1 doctors were included. Results demonstrated significant differences in LumPAT mean scores among the three groups: GLV, 42.8; TV, 40.6; WT, 38.1 (p = 0.01). The global rating scores were highest in the GLV group (p = 0.026). Self-confidence scores differed significantly among the three groups (p = 0.003), with the TV group scoring the highest. There were no significant correlations between self-confidence scores and performance scores in any of the groups.

CONCLUSION

A video designed with procedure-specific process goals and learner-centered information resulted in better subsequent LP performance than a traditionally designed video or written text. Participants' self-confidence was not predictive of their actual performance.

Utilization of just-in-time training for nursing education using the LA Phonospirometry asthma tool

OBJECTIVE

Just-in-time training (JITT) has been used to teach and re-teach known medical techniques, but has not been used to teach novel techniques. We aimed to assess the performance retention of JITT on a novel asthma exacerbation severity assessment technique known as Los Angeles (LA) Phonospirometry.

METHODS

This was a prospective cohort study using a convenience sample of pediatric emergency department registered nurses (RNs) who were asked to watch a brief instructional digital video on LA Phonospirometry, and then asked to practice the technique on a research assistant (RA). A checklist was used to evaluate proficiency with the primary outcome being the number correct on the checklist. The secondary outcome included whether or not they could identify a common error demonstrated by the RA. RNs were re-tested after 4-6 months to assess skill retention.

RESULTS

Forty RNs were enrolled in the study and six were lost to follow-up. The mean time from the first to second testing was 5.4 months ± 0.5 months. The mean score of the first part of the checklist on the initial testing was 4.6 ± 0.7 and on second testing was 3.8 ± 1.5 (p = 0.008). This represented a drop in scores and thus minimal knowledge decay of 18% (from 91% to 73%). The mean values for number of errors picked up for the first test and second test were 1.3 and 1.5, respectively (p = 0.2).

CONCLUSIONS

JITT demonstrated feasibility as a rapid instructional tool for RNs, with a limited decay in cognitive knowledge surrounding the LA Phonospirometry technique.

Enhancing the connection between the classroom and the clinical workplace: A systematic review

INTRODUCTION

Although medical students are increasingly exposed to clinical experiences as part of their training, these often occur parallel with, rather than connected to, their classroom-based learning experiences. Additionally, students seem to struggle with spontaneously making the connection between these spheres of their training themselves. Therefore, this systematic review synthesized the existing evidence about educational interventions that aim to enhance the connection between learning in the classroom and its application in the workplace.

METHODS

Electronic databases (AMED, CINAHL, EMBASE, ERIC, Medline, RDRB, PsycINFO and WoS) were screened for quantitative and qualitative studies investigating educational interventions that referenced a connection between the classroom and workplace-based experiences within undergraduate, graduate or postgraduate medical education.

RESULTS

Three types of interventions were identified: classroom to workplace interventions, workplace to classroom interventions, and interventions involving multiple connections between the two settings. Most interventions involved a tool (e. g. video, flow chart) or a specific process (e. g. linking patient cases with classroom-based learning content, reflecting on differences between what was learned and how it works in practice) which aimed to enhance the connection between the two settings.

DISCUSSION

Small-scale interventions can bring classroom learning and workplace practice into closer alignment. Such interventions appear to be the necessary accompaniments to curricular structures, helping bridge the gap between classroom learning and workplace experience. This paper documents examples that may serve to assist medical educators in connecting the classroom and the workplace.

Development and Assessment of an Advanced Pediatric Airway Management Curriculum With Integrated Intubation Videos

OBJECTIVES

Opportunities to learn advanced airway management skills on pediatric patients in the emergency department are limited. Current strategies have focused largely on traditional didactics coupled with procedural skills training using simulation. However, these approaches are limited in their exposure to anatomic variation and realism. Here, we describe the development and assessment of an advanced airway curriculum that integrates videolaryngoscopic recordings obtained during actual patient intubations into a series of interactive educational sessions.

METHODS

Trainees and attending physicians were surveyed anonymously to assess the impact of participation in the curriculum. A mixed methods approach to statistical analysis was used. Rating questions were used to evaluate the relative impact of this approach over other traditional strategies and recurrent themes within open-ended questions were identified.

RESULTS

Participants reported this to be a highly effective means of learning about pediatric laryngoscopy and endotracheal intubation and regarded it more highly than other traditional educational approaches. Identified benefits included repetitive exposure, approaches to laryngoscopy, the realism of teaching using real and varied anatomy, and the opportunities to identify and troubleshoot difficulty in a learning environment.

CONCLUSIONS

An advanced pediatric airway curriculum that integrates intubation videos obtained during videolaryngoscopy was highly regarded by pediatric emergency medicine providers. Content emphasis can be shifted to meet the needs of pediatric emergency medicine providers with all levels of skill and experience.

Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video

OBJECTIVE

Splinting is a multistep procedure that is seldom performed by primary care physicians. Just-in-time training (JITT) is an emerging teaching modality and can be an invaluable asset for infrequently performed procedures or in locations where teaching resources and trained professionals are limited. Our objective was to determine the utility of JITT for teaching medical students the short-arm (SA) volar splinting technique.

METHODS

This was a prospective randomized controlled pilot study. An instructional video on SA volar splinting was produced. Students viewed the video or had access to standard medical textbooks (control group) immediately before applying an SA volar splint. The students were assessed for the quality of the splint via a standard 6-point skills checklist. The times required for presplinting preparation and for completion of the splint were also measured.

RESULTS

Just-in-time training group students scored higher on the splint checklist (mean [SD], 5.45 [1.06]; 95% confidence interval [CI], 4.99-5.92 vs mean [SD], 1.58 [1.12]; 95% CI, 1.04-2.12; P < 0.0001), had higher pass rates (73%; 95% CI, 53%-93% vs 0%; P < 0.0001), and required less time (minutes) for presplinting preparation (mean [SD], 7.86 [2.45]; 95% CI, 6.78-8.94 vs mean [SD], 9.89 [0.46]; 95% CI, 9.67-10.12; P < 0.0001) compared with the control group. No difference was seen in the time required to complete a splint, successful or not.

CONCLUSIONS

In comparison with reading standard textbooks, watching a brief JITT instructional video before splinting yielded faster learning times combined with more successful procedural skills. The use of a JITT instructional video may have potential applications, including globally, as an alternative resource for teaching and disseminating procedural skills, such as SA volar splinting.

Systematic review of e-learning for surgical training

BACKGROUND

Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training.

METHODS

A systematic literature search of bibliographical databases was performed up to August 2015. Studies were included if they were RCTs assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared with no intervention or another method of training.

RESULTS

From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising medical students (52 studies), trainees (51 studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies) and non-technical (8 studies) skills. Tool features included multimedia (84 studies), interactive learning (60 studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies) and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared with both no intervention (29 and 4 studies respectively) and non-e-learning interventions (29 and 22 studies respectively).

CONCLUSION

Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.

Direct ophthalmoscopy on YouTube: analysis of instructional YouTube videos' content and approach to visualization

Background

Direct ophthalmoscopy is well-suited for video-based instruction, particularly if the videos enable the student to see what the examiner sees when performing direct ophthalmoscopy. We evaluated the pedagogical effectiveness of instructional YouTube videos on direct ophthalmoscopy by evaluating their content and approach to visualization.

Methods

In order to synthesize main themes and points for direct ophthalmoscopy, we formed a broad panel consisting of a medical student, junior and senior physicians, and took into consideration book chapters targeting medical students and physicians in general. We then systematically searched YouTube. Two authors reviewed eligible videos to assess eligibility and extract data on video statistics, content, and approach to visualization. Correlations between video statistics and contents were investigated using two-tailed Spearman’s correlation.

Results

We screened 7,640 videos, of which 27 were found eligible for this study. Overall, a median of 12 out of 18 points (interquartile range: 8–14 key points) were covered; no videos covered all of the 18 points assessed. We found the most difficulties in the approach to visualization of how to approach the patient and how to examine the fundus. Time spent on fundus examination correlated with the number of views per week (Spearman’s ρ=0.53; P=0.029).

Conclusion

Videos may help overcome the pedagogical issues in teaching direct ophthalmoscopy; however, the few available videos on YouTube fail to address this particular issue adequately. There is a need for high-quality videos that include relevant points, provide realistic visualization of the examiner’s view, and give particular emphasis on fundus examination.

Ultrasound Tutorials in Under 10 Minutes: Experience and Results

OBJECTIVE

The objective of the present study was to validate the use of web-based tutorials to teach technical skills in pediatric ultrasound.

MATERIALS AND METHODS

A series of 10 video tutorials, each of which was less than 10 minutes long, was created to improve the education of radiology trainees in terms of their ultrasound technique. Pediatric radiology fellow trainees from our institution in the United States and radiology resident trainees from our partner institution in Ethiopia were invited to participate in the study. Validation of the video tutorials was performed using two learning modules that focused on the renal bladder and the right upper quadrant (RUQ). Pretest and posttest skill and confidence assessments were also conducted. After watching the tutorials, the trainees completed questionnaires that assessed the reach, appeal, and learning effectiveness of the modules.

RESULTS

Ten fellow trainees and eight resident trainees participated in the study. The fellows were invited to evaluate both the RUQ and the renal bladder learning modules, whereas the residents evaluated the RUQ module only. Before reviewing the RUQ module, the fellows had performed a median of four RUQ ultrasound examinations, whereas the residents had performed a median of 400 RUQ ultrasound examinations. After the trainees viewed the learning module, the median skills test scores of the fellows increased from 20 to 37.5 (highest possible score, 45) (p < 0.01), and those of the residents increased from 38 to 40 (highest possible score, 40) (p = 0.04). With a total possible score of 15, the median confidence score improved from 8 to 11 for fellows (p < 0.01) and from 13.5 to 14.5 for residents (p = 0.04). After the fellows viewed the renal bladder learning module, their median skills test scores increased from 20 to 37.5 (highest possible score, 40) (p < 0.01), and their median confidence score increased from 8.5 to 11 (highest possible score, 15) (p = 0.01). Trainees gave the tutorials positive ratings overall.

CONCLUSION

Radiology fellow trainees and resident trainees with disparate backgrounds in ultrasound showed significant improvement in their technical skills in pediatric ultrasound and confidence after viewing the tutorials. The web-based design of the tutorials allows integration of international pediatric radiology training communities.

Development and initial evaluation of a point-of-care educational app on medical topics in orthogeriatrics

INTRODUCTION

Research by AOTrauma's orthogeriatrics education taskforce identified ongoing educational needs for surgeons and trainees worldwide regarding the medical management of older adults with a fracture. To address practicing surgeons' preference for increased use of mobile learning, a point-of-care educational app was planned by a committee of experienced faculty. The goals were to deliver the app to surgeons, trainees, and other healthcare professionals, to measure usage, and to evaluate the impact on patient care.

MATERIALS AND METHODS

The committee of geriatricians and surgeons designed and developed four modules on osteoporosis, delirium, anticoagulation, and pain based on published evidence and the content was programmed into mobile app formats. A registration form was integrated and a 14-question online evaluation survey was administered to users.

RESULTS

The AOTrauma Orthogeriatrics app was installed by 17,839 users worldwide between September 2014 and October 2015: Android smartphones (44%), iPhones (32%), iPads (15%), Android tablets (9%). 920 users registered and 100 completed the online evaluation: orthopedic/trauma surgeons (67%), residents/fellows (20%), and other professionals (13%). Ratings for all aspects were 4 or higher on a 1-5 Likert scale (5 = Excellent). 80% of evaluation respondents found the answer to their question or educational need on their last visit, and 26 of 55 respondents (47%) reported making a change in an aspect of their management of patients as a result of their learning from the app.

CONCLUSION

The orthogeriatrics app reached its intended audiences and was rated highly as a method of providing education to help improve patient care. Content input by experienced faculty and app improvements based on user feedback were key contributors to successful implementation.

Mobile spaced education for surgery rotation improves National Board of Medical Examiners scores

BACKGROUND

Use of mobile devices for medical education is increasing. The aim of this study was to describe the implementation of a spaced education-based app study program in a third year medical school surgery rotation and examine its effects on National Board of Medical Examiners (NBME) examination performance.

MATERIALS AND METHODS

Case-based questions were created and distributed to students on a voluntary basis via a mobile app. Questions were repeated in a spaced based manner until mastered. Students completed surveys regarding study habits and app use. NBME examination scores and prior academic measures were obtained. Users of the app were compared to non-users of the app and the previous years' class.

RESULTS

One hundred fifty-two students were offered the app; 121 (80%) used it. App users had a final NBME score of 77.5% compared with 68.8% (P < 0.01) in non-users, although their prior academic achievement was better. Categorizing them by their academic achievement and intensity of app use demonstrated significantly higher scores in regular users of the app as compared with casual and non-users in mid (78 versus 75 versus 71.2%, P < 0.01) and low-achieving students (71.4 versus 70 versus 64.6, P < 0.01), but not high-achieving students (85.3 versus 81.1 versus 79.7, P = 0.09). Stepwise linear regression modeling revealed intensity of app use accounted for 6% of the variance in NBME scores.

CONCLUSIONS

Use of the app-based program was an effective tool associated with higher scores on standardized tests in lower level achieving students.

Mobile Technologies for the Surgical Pathologist

Recent advances in hardware and computing power contained within mobile devices have made it possible to use these devices to improve and enhance pathologist workflow. This article discusses the possible uses ranging from basic functions to intermediate functions to advanced functions. Barriers to implementation are also discussed.

Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism

Background

Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students’ use of personal smartphones for clinical work.

Objective

The intent of the study was to examine final-year medical students’ experience with and attitudes toward using personal mobile technology in the clinical environment, with respect to the perceived impact on patient confidentiality and provider professionalism.

Methods

Cross-sectional surveys were completed by final-year medical students at the University of Toronto. Respondents were asked about the type of personal mobile phone they use, security features on their personal phone, experiences using their personal phone during clinical rotations, and attitudes about using their personal phone for clinical work purposes.

Results

The overall response rate was 45.4% (99/218). Smartphone ownership was prevalent (98%, 97/99) with the majority (86%, 85/99) of participants using their personal phones for patient-related communication during clinical rotations. A total of 26% (26/99) of participants reported not having any type of security feature on their personal phone, 94% (90/96) of participants agreed that using their personal phone for clinical work makes them more efficient, and 86% (82/95) agreed that their personal phone allows them to provide better patient care. Although 68% (65/95) of participants believe that the use of personal phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information, 22% (21/96) of participants still use their personal phone to text or email identifiable patient data to colleagues.

Conclusions

Our findings suggest that the use of personal smartphones for clinical work by medical students is prevalent. There is a need to more fully address the threat to patient confidentiality posed by the use of unsecured communication devices such as smartphones.

Investigating the use of smartphones for learning purposes by Australian dental students

Background

Mobile Internet devices and smartphones have at present a significant potential as learning tools and the development of educational interventions based on smartphones have attracted increasing attention.

Objective

The objective of this study was to obtain a deeper insight in the nature of students’ use of smartphones, as well as their attitudes towards educational use of mobile devices in order to design successful teaching interventions.

Method

A questionnaire was designed, aiming to investigate the actual daily habitual use, as well as the attitudes of dental students towards smartphones for their university education purposes. The survey was used to collect data from 232 dental students.

Results

Of the 232 respondents, 204 (87.9%) owned a smartphone, and 191 (82.3%) had access to third generation (3G) mobile carriers. The most popular devices were the iPhone and Android. Most of the respondents had intermediate smartphone skills and used smartphones for a number of learning activities. Only 75/232 (32.3%) had specific educational applications installed, while 148/232 (63.7%) used smartphones to access to social media and found it valuable for their education (P<.05). Students accessing social media with their smartphones also showed significantly more advanced skills with smartphones than those who did not (P<.05). There was no significant association between age group, gender, origin, and smartphone skills. There was positive correlation between smartphone skills and students' attitudes toward improving access to learning material (r=.43, P<.05), helping to learn more independently (r=.44, P<.05), and use of smartphones by teaching staff (r=.45, P<.05).

Conclusion

The results in this study suggest that students use smartphones and social media for their education even though this technology has not been formally included in the curriculum. This might present an opportunity for educators to design educational methods, activities, and material that are suitable for smartphones and allow students to use this technology, thereby accommodating students’ current diverse learning approaches.

Identifying pitfalls in chest tube insertion: improving teaching and performance

OBJECTIVE

Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies.

DESIGN

In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion. Next, we developed and tested a 14-item checklist, modeled after key skills in the module. Participants, defined as "novice" (fewer than 10 chest tubes placed) or "expert" (10 or more placed), were assigned to either the video or control group. A trained clinician used the checklist to rate participants while they inserted a chest tube on a TraumaMan simulator.

SETTING

University of Miami, Miller School of Medicine, a tertiary care academic institution.

PARTICIPANTS

Current medical students, residents, and the United States Army Forward Surgical Team members rotating through the institution. One hundred twenty-eight subjects entered and finished the study.

RESULTS

One hundred twenty-eight subjects enrolled in the study; 86 (67%) were residents or US Army Forward Surgical Team members, 66 (77%) were novices, and 20 (23%) were experts. Novices most frequently connected the tube to suction (91%), adequately dissected the soft tissue (82%), and scrubbed or anesthetized appropriately (80%). They least frequently completed full finger sweeps (33%), avoided the neurovascular bundle (35%), and performed a controlled pleural puncture (39%). Comparing the novice video group with the novice control group, the video group was more likely to correctly perform a finger sweep (42%, p<0.001) and clamp the distal end of the chest tube (42%, p<0.001). Of all the steps, experts least frequently completed full finger sweeps (70%) and avoided the neurovascular bundle (75%). Comparing the expert video group with the expert control group, the video group was more likely to correctly perform finger sweeps, the incision, and clamping the distal chest tube (20%, p = not significant).

CONCLUSIONS

Avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are most often performed incorrectly among novices. This information can help instructors to emphasize key didactic steps, possibly easing trainees' learning curve.