1
|
Gupta S, Zheng K, Panisko D, Tsien C. Recommendations for the Effective Orientation of Clinical Fellows. J Grad Med Educ 2024; 16:261-263. [PMID: 38882419 PMCID: PMC11173021 DOI: 10.4300/jgme-d-23-00541.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Affiliation(s)
- Sarang Gupta
- is a PGY-4 Gastroenterology Fellow, Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Katina Zheng
- is a PGY-3 Internal Medicine Resident, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Panisko
- is Co-Director, Department of Medicine, Master Teacher Program, Gladstone and Maisie Chang Chair, and Professor of Medicine, University of Toronto, and General Internist, Toronto Western Hospital, Toronto, Ontario, Canada; and
| | - Cynthia Tsien
- is Program Director, Royal College of Physicians and Surgeons of Canada Area of Focused Competence in Solid Organ Transplant, Transplant Hepatologist, University Health Network, and Assistant Professor of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Shaffrey EC, Zeng W, Nicksic PJ, Eftekari SC, Frank JM, Dingle AM, Poore SO. Perforator Dissection Porcine Abdominal Model: A Novel Simulator to Improve Microsurgical Training. J Reconstr Microsurg 2024. [PMID: 38395058 DOI: 10.1055/s-0044-1779719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as microsurgical training models, significant drawbacks limit their use. We recently developed a latex-perfused, nonliving, porcine abdomen perforator dissection simulation and described its anatomic similarity to the human deep inferior epigastric artery flap. The purpose was to assess the change in resident confidence in performing key operative steps of flap elevation and perforator dissection and obtain feedback on model realism and utility. METHODS Seventeen plastic and reconstructive surgery resident physicians (postgraduate years 1-6) at a single institution participated in a perforator dissection session utilizing the simulation model. Each resident completed pre- and postactivity surveys to assess interval change in confidence in operating. The postactivity survey also asked residents to answer questions regarding their perception of the model's anatomic and surgical realism and utility in microsurgical training. RESULTS Following a practice session using the latex-perfused, nonliving porcine abdomen, resident confidence was significantly increased in performing all key operative steps and the procedure overall (p = 0.001). All residents (n = 17, 100%) believed the model would improve "trainees' ability to perform perforator dissection in the operating room." Perforator, fascial, and pedicle anatomy were reported to be "Very" similar to human anatomy, with a median Likert score (MLS) of 4. Additionally, six out of the eight surgical steps were noted to be "Very" realistic, with only "Flap Design" and "Fascial Closure" found to be "Moderately" realistic with an MLS of 3. CONCLUSION The latex-infused porcine abdominal model is a novel, realistic simulation for microsurgical trainee perforator dissection practice. This model offers a suitable substitute for perforator dissection practice, as its implementation within a microsurgery training course improves resident comfort and confidence.
Collapse
Affiliation(s)
- Ellen C Shaffrey
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sahand C Eftekari
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer M Frank
- Department of Animal and Dairy Sciences, UW-Madison CALS, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
3
|
Ackermann J, Pape J, Vogler F, Pahls J, Baumann J, Holthaus B, Noé GK, Anapolski M, Ruchay Z, Westermann A, Günther V, Andresen K, Allahqoli L, Moawad G, Neymeyer J, Brügge S, Maass N, Mettler L, Alkatout I. The Feasibility of Practical Training in Minimally Invasive Surgery at Medical School-A Prospective Study on the Pelvitrainer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:159. [PMID: 38256419 PMCID: PMC10819215 DOI: 10.3390/medicina60010159] [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: 11/30/2023] [Revised: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises (p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.
Collapse
Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Felix Vogler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, 49401 Damme, Germany;
| | - Günter Karl Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Kristin Andresen
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran;
| | - Gaby Moawad
- Department of Obstetrics and Gynaecology, The George Washington University Hospital, Washington, DC 20037, USA;
| | - Jörg Neymeyer
- Clinic of Urology, Charité—Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany;
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| |
Collapse
|
4
|
Anand A, Jensen R, Korndorffer JR. More is not better: A scoping review of simulation in transition to residency programs. Surgery 2023; 174:1340-1348. [PMID: 37852830 DOI: 10.1016/j.surg.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Transition to residency programs frequently use simulation to promote clinical skills but place limited emphasis on non-clinical skills. We conducted a scoping review to determine how simulation is being used in transition to residency programs and the key non-clinical skills addressed by simulation activities and tools in these programs. METHODS We searched PubMed, Scopus, and Embase to identify articles addressing transition to residency, simulation, and non-clinical skills/attributes. Two authors independently screened all abstracts and full-text articles and identified non-clinical attributes elicited in each study. Using descriptive statistics, we characterized the simulation activities and tools and the number and type of non-clinical attributes captured in the programs. Using analysis of variance, we compared the number of non-clinical attributes elicited based on the number of simulation activities used and compared the number of non-clinical attributes elicited based on the number of simulation tools used. RESULTS We identified 38 articles that met the study criteria. We characterized simulation activities as mock paging (37%), case-based scenarios (74%), and/or procedural skills training (39%). We found that the most common simulation tools were standardized patients (64.8%), and the most elicited non-clinical attributes were communication skills, critical thinking, and teamwork. Using more simulation activity categories or simulation tools did not increase the number of non-clinical skills elicited. CONCLUSION Simulation is used broadly in transition to residency programs but provides training in a few of the non-clinical skills required for a successful transition. Incorporating more simulation activities or tools does not increase the number of non-clinical attributes elicited, illustrating the importance of developing more targeted simulation activities to promote non-clinical skills more effectively.
Collapse
Affiliation(s)
- Ananya Anand
- Department of Surgery, Stanford University, Stanford, CA.
| | - Rachel Jensen
- Department of Surgery, Stanford University, Stanford, CA. https://twitter.com/GSEC_Surgery
| | - James R Korndorffer
- Department of Surgery, Stanford University, Stanford, CA. https://twitter.com/StanfordSurgery
| |
Collapse
|
5
|
Park YS, Sachdeva AK, Liscum K, Alseidi A, Gesbeck M, Blair PG, Salcedo E, Sullivan M, Bordage G. The American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA): Validity Evidence From a Three-Year National Study. Ann Surg 2023; 277:704-711. [PMID: 34954752 DOI: 10.1097/sla.0000000000005358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To gather validity evidence supporting the use and interpretation of scores from the American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA) Program. SUMMARY AND BACKGROUND DATA ACS ERRA is an online formative assessment program developed to assess entering surgery residents' ability to make critical clinical decisions, and includes 12 clinical areas and 20 topics identified by a national panel of surgeon educators and residency program directors. METHODS Data from 3 national testing administrations of ACS ERRA (2018-2020) were used to gather validity evidence regarding content, response process, internal structure (reliability), relations to other variables, and consequences. RESULTS Over the 3 administrations, 1975 surgery residents participated from 125 distinct residency programs. Overall scores [Mean = 64% (SD = 7%)] remained consistent across the 3 years ( P = 0.670). There were no significant differences among resident characteristics (gender, age, international medical graduate status). The mean case discrimination index was 0.54 [SD = 0.15]. Kappa inter-rater reliability for scoring was 0.87; the overall test score reliability (G-coefficient) was 0.86 (Ф-coefficient = 0.83). Residents who completed residency readiness programs had higher ACS ERRA scores (66% versus 63%, Cohen's d = 0.23, P < 0.001). On average, 15% of decisions made (21/140 per test) involved potentially harmful actions. Variability in scores from graduating medical schools (7%) carried over twice as much weight than from matched residency programs (3%). CONCLUSIONS ACS ERRA scores provide valuable information to entering surgery residents and surgery program directors to aid in development of individual and group learning plans.
Collapse
Affiliation(s)
- Yoon Soo Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, IL
| | - Kathy Liscum
- Division of Education, American College of Surgeons, Chicago, IL
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Melissa Gesbeck
- Division of Education, American College of Surgeons, Chicago, IL
| | | | - Edgardo Salcedo
- Department of Surgery, University of California Davis, Sacramento, CA
| | - Maura Sullivan
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Georges Bordage
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
6
|
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
|
7
|
Martini ML, Shrivastava RK, Kellner CP, Morgenstern PF. Evaluation of a Role for Virtual Neurosurgical Education for Medical Students Over 2 Years of a Global Pandemic. World Neurosurg 2022; 166:e253-e262. [PMID: 35803566 DOI: 10.1016/j.wneu.2022.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Subinternships are critical experiences for medical students applying into neurosurgery to acquire knowledge of the field and network with colleagues. During the coronavirus disease 2019 pandemic, in-person rotations were suspended for 2020 and reduced for 2021. In 2020, our department developed a neurosurgical course to address this need. The course was continued in 2021, enabling assessment of student perceptions as the pandemic progresses. METHODS The virtual course consisted of weekly 1-hour seminars over a 3- to 4-month period. Prior to starting, participants were sent a comprehensive survey assessing their backgrounds, experiences, and confidences in core concepts across neurosurgical subdisciplines. Participants also completed postcourse surveys assessing the course's value and their confidence in the same topics. Responses from students completing both precourse and postcourse surveys were included, analyzed in pairwise fashion, and compared across course years. RESULTS Students shared similar baseline characteristics in terms of demographics, educational background, and exposure to neurosurgery prior to the course. In the 2020 and 2021 cohorts, quality ratings for presentations were favorable for all seminars, and participants reported significantly increased confidence in core topics across all neurosurgical disciplines after the course (2020: 3.36 ± 0.26, P < 0.0001; 2021: 3.56 ± 0.93, P = 0.005). Most participants felt the course would remain useful following the pandemic in both the 2020 (96.9%) and 2021 (100.0%) cohorts. CONCLUSIONS Survey results suggest that the course adds value for students seeking a basic didactic curriculum to supplement their education, and perhaps, an online curriculum for medical students would still be beneficial going forward as in-person rotations resume.
Collapse
Affiliation(s)
- Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Peter F Morgenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
8
|
How Prepared Are They? Pediatric Boot Camps and Intern Performance. Acad Pediatr 2022; 22:1237-1245. [PMID: 35577284 DOI: 10.1016/j.acap.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether participation in a pediatric boot camp during medical school was associated with higher intern performance. Secondary objectives were to determine whether participation in general boot camps, pediatric subinternships or pediatric electives was associated with higher performance. METHODS Intern surveys and faculty performance assessments during early internship were collected from a convenience sample of pediatric residency programs. Interns completed a survey regarding participation in medical school boot camps, pediatric subinternships and pediatric electives. Faculty assessed intern performance on selected Milestone-based subcompetencies on a 5-point scale following each intern's initial inpatient rotation and results were compared between groups. RESULTS Seventeen pediatric residency programs participated. Two hundred eighty-seven interns completed the survey (69%), and faculty completed assessments on 71% of these interns. Of interns with complete faculty assessments (n = 198), 25% participated in 5 or more days of pediatric boot camp, 30% in general boot camp, and 45% in no boot camp. There were no educationally significant associations between participation in 5 or more days of pediatric boot camp, general boot camp, subinternships, or electives and intern performance. Interns completing at least 10 days of pediatric boot camp (n = 25) had slightly higher ratings for incorporating feedback and engaging in help-seeking behavior during June and July only. CONCLUSIONS Participation in pediatric boot camps, general boot camps, pediatric subinternships or electives was not associated with substantially higher intern performance as measured by selected Milestone subcompetencies. Pediatric educators should carefully consider boot camp curricula and anticipated outcomes associated with boot camp participation.
Collapse
|
9
|
Bains M, Kaliski DZ, Goei KA. Effect of self-regulated learning and technology-enhanced activities on anatomy learning, engagement, and course outcomes in a problem-based learning program. ADVANCES IN PHYSIOLOGY EDUCATION 2022; 46:219-227. [PMID: 35113679 DOI: 10.1152/advan.00039.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Problem-based learning (PBL) offers advantages for teaching anatomy and physiology for physical therapy students as clinical cases provide a scaffold for a comprehensive review of body systems. Although the utilization of interactive anatomy software greatly contributes to an active learning environment and efficient use of time, simply providing textbook readings, access to anatomy software, and models is not enough to engage students to become active in reaching their learning goals. Time constraints, meaningful technology implementation, resource abundance, and unfamiliarity are challenges that decrease the effectiveness of both facilitating and learning anatomy. The present study investigated the use of three supplemental learning tools to support anatomy instruction in a self-regulated manner. Friedman test results demonstrated significant differences for perceived engagement [χ2(2) = 15.74, P < 0.001, W = 0.23] but not for perceived learning. Survey responses demonstrated that perceived engagement was greatest with the nondigital supplemental learning tool compared with the two technology-enhanced learning tools (iBooks Author + SoftChalk and SoftChalk alone). Multivariate regression analyses demonstrated statistically significant relationships between the nondigital supplemental learning tool and anatomy practical scores (P < 0.001). The technology-enhanced supplemental learning tools did not further increase learning outcomes as measured by practical scores compared with nondigital learning tools. Incorporation of instructor-created instructional materials independent of technology is an efficient method to drive self-regulated learning, enhance engagement, and improve anatomy course outcomes and may overcome barriers associated with a purely self-directed PBL model.
Collapse
Affiliation(s)
- Mona Bains
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| | - Debora Z Kaliski
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| | - Kathleen A Goei
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| |
Collapse
|
10
|
McLean ME, Cotarelo AA, Huls TA, Husain A, Hillman EA, Cygan LD, Archer LO, Beck-Esmay J, Burke SM, Carrick AI, Chen AS, Hyde RJ, Karalius VP, Lee E, Park JC, Pugliese AM, Wilbanks MD, Young A, Kulkarni ML. UME-to-GME PandEMonium in COVID-19: Large-Scale Implementation of a Virtual ACGME Milestone-Based Curriculum for Senior Medical Students Matched Into Emergency Medicine. J Grad Med Educ 2021; 13:848-857. [PMID: 35070098 PMCID: PMC8672831 DOI: 10.4300/jgme-d-21-00620.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/17/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic displaced newly matched emergency medicine "pre-interns" from in-person educational experiences at the end of medical school. This called for novel remote teaching modalities. OBJECTIVE This study assesses effectiveness of a multisite Accreditation Council for Graduate Medical Education (ACGME) sub-competency-based curricular implementation on Slack during the first wave of the COVID-19 pandemic in the United States. METHODS Emergency medicine residency programs were recruited via national organization listservs. Programs designated instructors to manage communications and teaching for the senior medical students who had matched to their programs (pre-interns) in spring/summer 2020. Pre- and post-surveys of trainees and instructors assessed perceived preparedness for residency, perceived effectiveness of common virtual educational modalities, and concern for the pandemic's effects on medical education utilizing a Likert scale of 1 (very unconcerned) to 5 (very concerned). Data were analyzed using descriptive statistics and the t test. RESULTS Of 276 possible residency programs, 28 enrolled. Of 324 possible pre-interns, 297 (91.7%) completed pre-surveys in April/May and 249 (76.9%) completed post-surveys in June/July. The median weeks since performing a physical examination was 8 (IQR 7-12), since attending in-person didactics was 10 (IQR 8-15) and of rotation displacement was 4 (IQR 2-6). Perceived preparedness increased both overall and for 14 of 21 ACGME Milestone topics taught. Instructors reported higher mean concern (4.32, 95% CI 4.23-4.41) than pre-interns (2.88, 95% CI 2.74-3.02) regarding the pandemic's negative effects on medical education. CONCLUSIONS Pre-interns reported improvements in residency preparedness after participating in this ACGME sub-competency-based curriculum on Slack.
Collapse
Affiliation(s)
- Mary E. McLean
- Mary E. McLean, MD, is Assistant Residency Director, Department of Emergency Medicine, St. John's Riverside Hospital
| | - Adrian A. Cotarelo
- Adrian A. Cotarelo, MD, MHS, is a Resident Physician, Department of Emergency Medicine, St. John's Riverside Hospital
| | - Thomas A. Huls
- Thomas A. Huls, MD, is Associate Physician, Department of Emergency Medicine, Kaiser Permanente Modesto Medical Center
| | - Abbas Husain
- Abbas Husain, MD, is Associate Program Director, Department of Emergency Medicine, Staten Island University Hospital, Northwell Health
| | - Emily A. Hillman
- Emily A. Hillman, MD, MHPE, is Associate Program Director, Department of Emergency Medicine, University of Missouri
| | - Lukasz D. Cygan
- Lukasz D. Cygan, DO, is Assistant Residency Director, Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital
| | - Linette O. Archer
- Linette O. Archer, MD, is Program Director, Department of Emergency Medicine, Memorial Health System
| | - Jennifer Beck-Esmay
- Jennifer Beck-Esmay, MD, is Assistant Residency Director, Department of Emergency Medicine, Mount Sinai Morningside-Mount Sinai West
| | - Shannon M. Burke
- Shannon M. Burke, MD, is a Resident Physician, Department of Emergency Medicine, University of Wisconsin-BerbeeWalsh
| | - Angela I. Carrick
- Angela I. Carrick, DO, is Associate Program Director, Department of Emergency Medicine, Norman Regional Health System
| | - Angela S. Chen
- Angela S. Chen, MD, is Assistant Program Director, Department of Emergency Medicine, Mount Sinai Hospital
| | - Robert J. Hyde
- Robert J. Hyde, MD, MA, is Clerkship Director, Department of Emergency Medicine, Mayo Clinic
| | - Vytas P. Karalius
- Vytas P. Karalius, MD, MPH, MA, is a Resident Physician, Department of Emergency Medicine, McGaw Medical Center of Northwestern University
| | - Eric Lee
- Eric Lee, MD, is Assistant Clerkship Director, Department of Emergency Medicine, Maimonides Medical Center
| | - Joel C. Park
- Joel C. Park, MD, MS, is Attending Physician, Department of Emergency Medicine, St. John's Riverside Hospital, Yonkers
| | - Angela M. Pugliese
- Angela M. Pugliese, MD, is Associate Residency Director, Department of Emergency Medicine, Wayne State University School of Medicine-Henry Ford Hospital
| | - Morgan D. Wilbanks
- Morgan D. Wilbanks, MD, is Interim Director of UME and M3 Elective Director, Department of Emergency Medicine, Medical College of Wisconsin
| | - Amanda Young
- Amanda Young, MD, is Assistant Residency Program Director, Department of Emergency Medicine, University of Arkansas for Medical Sciences
| | - Miriam L. Kulkarni
- Miriam L. Kulkarni, MD, is Residency Program Director, Department of Emergency Medicine, St. John's Riverside Hospital
| |
Collapse
|
11
|
Winter K, Quinn KR, Helmer SD, McBoyle MF. Residency Prep Course Instills Confidence in Interns. Kans J Med 2021; 14:149-152. [PMID: 34178245 PMCID: PMC8222100 DOI: 10.17161/kjm.vol1414919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Physicians entering surgical residency often feel unprepared for tasks expected of them beginning July 1, including responding to pages, writing orders, doing procedures independently, and a multitude of other requirements. Our aim was to design a surgical boot camp to help graduating senior medical students feel more confident entering residency. Methods A two-week intensive surgery residency prep course was conducted in the spring of 2019 at an Accreditation Council for Graduate Medical Education-accredited General Surgery residency program. The course was designed combining aspects from existing prep courses and innovative ideas tailored to resources available at our institution. Medical students participated in the Surgery Residency Prep Course as an elective at the end of their fourth year of medical school. An anonymous survey was given pre- and post-prep course completion evaluating confidence in medical knowledge, clinical skills, and surgical skills. Data were compared using Wilcoxon Signed-Rank Test. Results Six students completed the course as a medical elective. Students felt more confident at course completion in most aspects, were significantly more confident in all areas of surgical skills taught and evaluated, and nearly all areas of medical knowledge. Subjectively, students felt as though the course was beneficial and helped them feel more prepared for starting internship. Conclusions This course designed at our institution was successful in helping prepare and instill confidence in graduating medical students prior to starting their internship.
Collapse
Affiliation(s)
- Kelly Winter
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Karson R Quinn
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Stephen D Helmer
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Medical Education, Ascension Via Christi Hospital Saint Francis, Wichita, KS
| | - Marilee F McBoyle
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| |
Collapse
|
12
|
The Impact of Surgical Boot Camp and Subsequent Repetitive Practice on the Surgical Skills and Confidence of Residents. World J Surg 2021; 44:3607-3615. [PMID: 32632643 PMCID: PMC7527321 DOI: 10.1007/s00268-020-05669-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Boot camp can enable residents to acquire surgical skills and confidence, but they can lose these skills over time if they do not use them. The purpose of this study was to explore whether boot camp and subsequent repetitive practice could strengthen residents’ clinical skills and self-confidence. Methods This is a comparative study of surgical residents who were enrolled in our institution from 2016 to 2017. The residents in the experimental group (enrolled in 2017) received boot camp training and a year of repetitive practice. The control group (enrolled in 2016) only received routine residency training. The rotation assessment pass rates of the two groups during the first year of the residency training were compared. A survey was conducted at different points in time to investigate the influence of boot camp and repetitive practice on the confidence of the residents. Results The assessment pass rate of the experimental group was significantly higher than that of the control group (p < 0.05). The residents’ confidence in themselves improved significantly after the boot camp, and it was comparable to that of the residents in the control group after their first year of residency. The level of self-confidence of the experimental group was further improved after repetitive practice. Finally, residents in the experimental group received better evaluations by their colleagues than the control group received. Conclusions This study showed that boot camp can improve the surgical skills and confidence of residents and that repetitive practice can further strengthen them. Residents in the experimental group developed their self-confidence in boot camp, and it increased after repetitive practice.
Collapse
|
13
|
Martini ML, Yaeger KA, Kellner CP, Hadjipanayis C, Shrivastava R, Mocco J, Morgenstern PF. Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic. World Neurosurg 2021; 152:e250-e265. [PMID: 34058356 PMCID: PMC8412498 DOI: 10.1016/j.wneu.2021.05.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022]
Abstract
Background Before the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format. Methods The virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included. Results An average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001). Conclusions Feedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.
Collapse
Affiliation(s)
- Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter F Morgenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
14
|
Lee-Riddle GS, Sigmon DF, Newton AD, Kelz RR, Dumon KR, Morris JB. Surgical Boot Camps Increases Confidence for Residents Transitioning to Senior Responsibilities. JOURNAL OF SURGICAL EDUCATION 2021; 78:987-990. [PMID: 32928699 DOI: 10.1016/j.jsurg.2020.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical boot camps enhance the confidence of medical students and surgical interns. The impact of boot camps on the confidence of post-graduate year (PGY) 2 residents is unknown. We hypothesized that a postinternship boot camp would improve the confidence of PGY-2 residents in managing their newfound responsibilities. We also hypothesized that the effect of a tailored high-impact boot camp would persist over time. DESIGN A 2-hour boot camp at our simulation center was implemented for PGY-2 residents in 2016 and 2017. Confidence in handling boot camp scenarios was measured on a 1 to 5 Likert scale before and after the boot camp. Three-month follow-up was assessed in the 2017 cohort. PARTICIPANTS Thirty-one PGY-2 residents (n = 16 in 2016, n = 15 in 2017) completed the boot camp. RESULTS Residents reported increased confidence in placing central lines (p < 0.001), placing chest tubes (p = 0.01), managing emergency airways (p < 0.001), running a code (p = 0.03), and fulfilling the role of in-house senior resident (p < 0.001). Three-month follow-up in 2017 (n = 10) demonstrated no difference in confidence compared to postboot camp results. CONCLUSIONS Boot camps can durably improve confidence in skills expected of PGY-2 residents assuming in-house senior resident responsibilities.
Collapse
Affiliation(s)
- Grace S Lee-Riddle
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David F Sigmon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew D Newton
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
15
|
Alabi O, Hill R, Walsh M, Carroll C. Introduction of an ENT emergency-safe boot camp into postgraduate surgical training in the Republic of Ireland. Ir J Med Sci 2021; 191:475-477. [PMID: 33686568 PMCID: PMC7938879 DOI: 10.1007/s11845-021-02581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
Background Otolaryngology (ENT) is a craft surgical specialty, which presents significant challenges for the novice surgical trainee (NST), when managing patients with potentially life-threatening conditions. We assess current evidence behind intensive, simulation-rich training programmes or “boot camps”. We outline an ENT emergency-safe boot camp for NSTs and the impact this can have on trainees’ competence when dealing with ENT emergencies. Methods We designed a standardized “ENT emergency-safe boot camp”, aimed at NSTs with a view to up-skilling them in the management of 3 critical clinical scenarios namely post-thyroidectomy haematoma, post-tonsillectomy haemorrhage and epistaxis. All core surgical trainees (CSTs) (n = 54) on the National Surgical Training programme at the Royal College of Surgeons (RCSI) were enrolled on the boot camp. A pre- and post-boot camp anonymised self-assessment was completed by all participants. Results Trainees’ self-assessment demonstrated an increase in median competence scores from 3/5 to 4/5 for management of post-thyroidectomy haematoma and epistaxis. There was a greater increase in self-assessed competence scores from 2/5 to 4/5 for the management of post-tonsillectomy haemorrhage. Ninety-two percent of respondents said the course added to their previous knowledge, 70% of respondents said it improved their technical skills and 85% of participants said the course gave them more confidence with handling ENT related on-call problems. Conclusion Study participants expressed an increase in confidence when dealing with specific ENT emergencies, following boot camp training. This correlates with published data. Patient safety should be enhanced, as a result of participation in this dedicated ENT emergency-safe boot camp.
Collapse
Affiliation(s)
- Oludare Alabi
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland. .,Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland.
| | - Rhodri Hill
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.,Ireland University Hospital Waterford, Waterford, Ireland
| | - Michael Walsh
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.,Health Service Executive, Dublin, Ireland
| | - Camilla Carroll
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.,Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland
| |
Collapse
|
16
|
Loftus TJ, Filiberto AC, Upchurch GR, Hall DJ, Mira JC, Taylor J, Shaw CM, Tan SA, Sarosi GA. Performance Improvement With Implementation of a Surgical Skills Curriculum. JOURNAL OF SURGICAL EDUCATION 2021; 78:561-569. [PMID: 32888847 PMCID: PMC7462643 DOI: 10.1016/j.jsurg.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/23/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the efficacy of an intern surgical skills curriculum involving a boot camp for core open and laparoscopic skills, self-guided practice with positive and negative incentives, and semiannual performance evaluations. DESIGN Longitudinal cohort study. SETTING Academic tertiary care center. PARTICIPANTS Intervention group (n = 15): residents who completed the intern surgical skills curriculum and had performance evaluations in fall of intern year, spring of intern year, and fall of second year. Control group (n = 8): second-year residents who were 1 year ahead of the intervention group in the same residency program, did not participate in the curriculum, and had performance evaluations in fall of second year. RESULTS In fall of second year of residency, the intervention group had better performance (presented as median values with interquartile ranges) than the control group on one-hand ties (left hand: 9.1 [6.3-10.1] vs 14.6 [13.5-15.4] seconds, p = 0.007; right hand: 8.7 [8.5-9.6] vs 11.5 [9.9-16.8] seconds, p = 0.039). The intervention group also had better performance on all open suturing skills, including mattress suturing (vertical: 33.4 [30.0-40.0] vs 55.8 [50.0-67.6] seconds, p = 0.001; horizontal: 28.7 [27.3-39.9] vs 52.7 [40.7-57.8] seconds, p = 0.003), and a water-filled glove clamp, divide, and ligate task (28.0 [25.0-31.0] vs 59.1 [53.0-93.0] seconds, p < 0.001). Finally, the intervention group had better performance on all laparoscopic skills, including peg transfer (66.0 [59.0-82.0] vs 95.2 [87.5-101.5] seconds, p = 0.018), circle cut (82.0 [69.0-124.0] seconds vs 191.8 [155.5-231.5] seconds, p = 0.002), and intracorporeal suturing (195.0 [117.0-200.0] seconds vs 359.5 [269.0-450.0] seconds, p = 0.002). CONCLUSIONS Implementation of a comprehensive surgical skills curriculum was associated with improved performance on core open and laparoscopic skills. Further research is needed to understand and optimize motivational factors for deliberate practice and surgical skill acquisition.
Collapse
Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Amanda C Filiberto
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - David J Hall
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Juan C Mira
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Janice Taylor
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Christiana M Shaw
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Sanda A Tan
- Department of Surgery, University of Florida Health, Gainesville, Florida
| | - George A Sarosi
- Department of Surgery, University of Florida Health, Gainesville, Florida.
| |
Collapse
|
17
|
Keilin CA, Farlow JL, Malloy KM, Bohm LA. Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship. Laryngoscope 2021; 131:E2143-E2148. [PMID: 33567132 DOI: 10.1002/lary.29443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/03/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Residency preparation courses (RPCs) have become a widely adopted practice to ease the transition of medical students into residency, but these courses often lack training in skills expected of subspecialty interns. To fill this gap, a simulation-based curriculum in otolaryngology (ORL) was implemented at the University of Michigan Medical School. The curriculum aimed to improve confidence and perceived ability to perform common ORL skills for graduating students prior to internship. STUDY DESIGN Cross-sectional study. METHODS Six basic simulations (tracheostomy, flexible laryngoscopy, otomicroscopy, myringotomy and tube insertion, epistaxis and peritonsillar abscess management) were included in the first course in 2019. The course was expanded in 2020 with the addition of three advanced simulations (ear foreign body extraction, tracheostomy complications, and "cannot intubate, cannot ventilate" situations). Pre- and postsession surveys were collected to assess individual simulations and the course overall. RESULTS A total of 32 students participated in the ORL simulation curriculum in Spring 2019 and 2020. Paired t-tests showed significant improvement in self-perception of ability on every simulation. Qualitative feedback revealed that students particularly valued the opportunity for hands-on learning. Non-ORL students rated their baseline abilities significantly lower than ORL students on five stations, but they achieved statistically equivalent postsession ratings on all but the otomicroscopy station. CONCLUSIONS An ORL-specific curriculum is a valuable addition to procedural RPCs. The curriculum resulted in increased confidence and perceived ability in skill performance for both students pursuing ORL residencies, as well as those pursuing other procedural specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2143-E2148, 2021.
Collapse
Affiliation(s)
- Charles A Keilin
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
18
|
LaFemina J, Ahuja V, Alseidi A, Balters M, Brasel K, Clark C, Delman KA, Farley D, Lindeman B, Relles D, Shabahang M, Sohn V, Harrington D. APDS Consensus Statement: Ideal Senior Medical Student Experiences for Preparedness for General Surgery Internship. JOURNAL OF SURGICAL EDUCATION 2021; 78:69-75. [PMID: 32737002 DOI: 10.1016/j.jsurg.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Guide optimal standards on ideal senior medical student experiences for preparedness for general surgery internship DESIGN: Work product of task force, approved by the Association of Program Directors in Surgery CONCLUSION: General surgery rotations should mirror the learning and working environment of a surgical intern. Opportunities should mimic the next phase of learning to help guide informed decisions regarding entrustability for entry into residency training. These opportunities will also help identify students who may have an aptitude for pursuing a general surgery internship. Students should achieve entrustability in Association of American Medical Colleges Core Entrustable Professional Activities (EPAs); curricula should align Core EPAs and modified American Board of Surgery EPAs to guide essential general surgery components. Experiences should include required night, holiday, and/or weekend shifts, a dedicated critical care experience, and a resident preparatory curriculum focusing on nontechnical and essential technical skills. We encourage the opportunity for additional surgical mentorship and subspecialty experience through Surgical Interest Groups or Surgical Honors or Specialty Tracks.
Collapse
Affiliation(s)
- Jennifer LaFemina
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Vanita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, California
| | - Marcus Balters
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska
| | - Karen Brasel
- Department of Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Clarence Clark
- Department of Surgery, Morehouse University, Atlanta, Georgia
| | - Keith A Delman
- Department of Surgery, Emory University, Atlanta, Georgia
| | - David Farley
- Department of Surgery, Mayo Clinic-Rochester, Rochester, Minnesota
| | | | - Daniel Relles
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Mohsen Shabahang
- Department of Surgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
| | - Vance Sohn
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; Department of Surgery, Uniformed Services University, Tacoma, Washington
| | - David Harrington
- Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| |
Collapse
|
19
|
Abstract
Background: Pulmonary and critical care medicine (PCCM) fellowship requires a high degree of medical knowledge and procedural competency. Gaps in fellowship readiness can result in significant trainee anxiety related to starting fellowship training. Objective: To improve fellowship readiness and alleviate anxiety for PCCM-bound trainees by improving confidence in procedural skills and cognitive domains. Methods: Medical educators within the American Thoracic Society developed a national resident boot camp (RBC) to provide an immersive, experiential training program for physicians entering PCCM fellowships. The RBC curriculum is a 2-day course designed to build procedural skills, medical knowledge, and clinical confidence through high-fidelity simulation and active learning methodology. Separate programs for adult and pediatric providers run concurrently to provide unique training objectives targeted to their learners’ needs. Trainee assessments include multiple-choice pre- and post-RBC knowledge tests and confidence assessments, which are scored on a four-point Likert scale, for specific PCCM-related procedural and cognitive skills. Learners also evaluate course material and educator effectiveness, which guide modifications of future RBC programs and provide feedback for individual educators, respectively. Results: The American Thoracic Society RBC was implemented in 2014 and has grown annually to include 132 trainees and more than 100 faculty members. Mean knowledge test scores for participants in the 2019 RBC adult program increased from 55% (±14% SD) on the pretest to 72% (±11% SD; P < 0.001) after RBC completion. Similarly, mean pretest scores for pediatric course attendees increased from 54% (±13% SD) to 62% (±19% SD; P = 0.17). Specific content domains that improved by 10% or more between pre- and posttests included airway management, bronchoscopy, pulmonary function testing, and code management for adult course participants, and airway management, pulmonary function testing, and extracorporeal membrane oxygenation for pediatric course participants. Trainee confidence also significantly improved across all procedural and cognitive domains for adult trainees and in 10 of 11 domains for pediatric course attendees. Course content for the 2019 RBC was overwhelmingly rated as “on target” for the level of learner, with <4% of respondents indicating any specific session was “much too basic” or “much too advanced.” Conclusion: RBC participation improved PCCM-bound trainee knowledge, procedural familiarity, and confidence. Refinement of the RBC curriculum over the past 7 years has been guided by educator and course evaluations, with the ongoing goal of meeting the evolving educational needs of rising PCCM trainees.
Collapse
|
20
|
Ellis R, Ellerington C, Henry ML. Urology boot camp for medical students: improving knowledge and confidence in preparation for clinical practice. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820975306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Undergraduate exposure to urology is limited and junior doctors often feel underprepared for managing urological problems. We therefore established a one-day urology teaching course which covered the entire British Association of Urological Surgeons curriculum. Methods: Graduates of a teaching hospital undertook a survey regarding their practical skills and knowledge in urology ( n=20), with responses compared to a sample of students who attended the boot camp ( n=24). Results: Forty per cent of graduates thought they knew most of the curriculum and 0% knew the entire curriculum, increasing to 79.4% and 8.3%, respectively, in the post-boot camp cohort. Forty per cent felt ‘mostly prepared’ for final examinations, increasing to 70.8%; 35% rated their knowledge as ‘good’, increasing to 50%, with a further 12.5% feeling it was ‘excellent’; 0% were ‘very confident’ in examination skills, increasing to 20.8%. One hundred per cent of students thought the boot camp helped in preparation for medical finals, 70.8% felt it better prepared them for foundation training. All course candidates thought the course increased their knowledge and skills in urology. Conclusion: This urology boot camp improves medical students’ skills and knowledge. This course would benefit medical students nationally, providing comprehensive, standardised training in urology and preparing students for final examinations and foundation years. Level of evidence: Not applicable.
Collapse
Affiliation(s)
- Ricky Ellis
- Urology Department, University Hospitals of Derby and Burton, UK
| | | | - Mei-Ling Henry
- Urology Department, University Hospitals of Derby and Burton, UK
| |
Collapse
|
21
|
McMillan R, Redlich PN, Treat R, Goldblatt MI, Carver T, Dodgion CM, Peschman JR, Davis CS, Alizadegan S, Grushka J, Olson L, Krausert T, Lewis B, Malinowski MJ. Incoming residents’ knot-tying and suturing skills: Are medical school boot camps sufficient? Am J Surg 2020; 220:616-619. [DOI: 10.1016/j.amjsurg.2020.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
|
22
|
Jacobs KG, Kugler J, Chi J, Stuart E, Bereknyei Merrell S, Rassbach C. A Mixed Methods Approach to Understanding Curricular Impact of a Capstone Course on the Self-Efficacy of Fourth-Year Medical Students. Cureus 2020; 12:e9537. [PMID: 32905172 PMCID: PMC7465827 DOI: 10.7759/cureus.9537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Capstone, or bootcamp, courses have been shown to increase the knowledge, skills, and self-efficacy of students prior to starting intern year and have been recommended by the Alliance for Clinical Education (ACE) to be incorporated into the fourth-year medical school curricula. However, a paucity of research exists regarding the exploration of the student perspective on critical curricular content and teaching strategies in a capstone course. Self-efficacy, one's subjective task-specific judgment of capability, has served in the literature as a framework for capstone outcomes and is derived from four sources of experiences: practice, observation of others, feedback, and one's emotional reaction to difficult situations. Utilizing this framework, we aimed to evaluate the impact of our capstone curriculum on students' self-efficacy and to identify critical curricular content and teaching strategies that affected students' self-efficacy and their transition into residency. Methods We designed a mixed methods study of our institution's capstone course in May 2019. Students were invited to participate in the retrospective pre- and post- self-efficacy survey and focus group immediately after the capstone and in semi-structured interviews four months after they began the intern year. Themes were identified via qualitative analysis using inductive coding to allow participants' voices to guide code development and deductive analysis using codes derived from the self-efficacy framework. Results Nine enrolled students participated in the study (surveys n=8, focus group n=7, follow-up interview n=6). Students reported the capstone was a very valuable educational experience (median 4.5 [interquartile range, or IQR 4-5]), increased their preparedness for intern year (median 5 [IQR 4.25-5]) and increased self-efficacy in multiple domains. Qualitative analysis revealed the critical curricular elements that most impacted students' self-efficacy were practical and communication skills to which students previously had limited exposure, in particular managing acute clinical needs, overnight cross-cover pages, inpatient pharmacology, daily intern communication (handoffs, consults, consenting), and end-of-life communication (goals of care, code status, pronouncing death). While all four sources contributed to self-efficacy, students reported that instructor and peer feedback were fundamental to providing context and substance to their performance. Students preferred practice-based learning via high-fidelity simulation and small groups for familiar tasks (daily intern communication, overnight pages, pharmacology) and observation of peers for new tasks (end-of-life communication and acute clinical deterioration). Conclusions This is the first study describing students' perspectives on critical curricular content and teaching strategies for a capstone course derived from qualitative analysis. Practical and communication skills with previously limited clerkship exposure and task-specific learning strategies increased the students' self-efficacy. Constructive feedback provided an important source of self-efficacy for all tasks, augmenting the benefits of practice and observation. This data provides preliminary groundwork for future research as multi-institutional studies are necessary to better understand students' needs around the curriculum to address residency transition.
Collapse
Affiliation(s)
| | - John Kugler
- Internal Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Jeffrey Chi
- Internal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Elizabeth Stuart
- Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
| | | | - Caroline Rassbach
- Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
| |
Collapse
|
23
|
Monday LM, Gaynier A, Berschback M, Gelovani D, Kwon HY, Ilyas S, Shaik AN, Levine DL. Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship. Cureus 2020; 12:e8558. [PMID: 32670695 PMCID: PMC7357344 DOI: 10.7759/cureus.8558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Changes in medical education and health care delivery have limited the ability of fourth-year medical students to perform the role of an intern prior to graduating from medical school. To address this issue, many schools have instituted residency preparation courses (sometimes referred to as boot camps) particularly for students entering surgical fields. Courses for students entering nonprocedural fields are less common and most assess increases in self-reported confidence without providing objective evidence of a gain in knowledge or skills improvement. Materials and Methods We used a Plan, Do, Study, Act (PDSA) model to develop and pilot cycle 1 of a nonprocedural internship preparation elective in 2019. Feedback was used to refine the course and map sessions to core competencies outlined by the Accreditation Council of Graduate Medical Education (ACGME) for PDSA cycle 2. The curriculum was adapted for remote synchronous delivery due to the coronavirus pandemic in spring 2020 using a combination of didactic lectures containing embedded polls and case-based role play responses using a chat box. Students completed anonymous surveys assessing self-perceived levels of confidence, as well as an objective comprehensive assessment after course completion. Results A total of 89 students participated in the course. Pre-session confidence was lowest for transfusion medicine, handling pages from nursing while on call, and knowledge of the role of a chief resident. A statistically significant increase in median scores for self-reported knowledge or confidence was seen in all sessions. The percentage of students reporting that they were either confident or extremely confident also increased significantly after each session (p<0.001 for all). All sessions analyzed were rated as useful or extremely useful by more than half of the students, and 94% of the students scored 70% or higher on the comprehensive course assessment. Conclusions An online virtual synchronous boot camp increased students' confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. We were able to adapt our curriculum to a remote model and will likely keep several sessions in an online format in the future.
Collapse
Affiliation(s)
- Lea M Monday
- Internal Medicine, Detroit Medical Center, Detroit, USA.,Internal Medicine, John D. Dingell VA Medical Center, Detroit, USA
| | - Anthony Gaynier
- Medical Education, Wayne State University School of Medicine, Detroit, USA
| | | | - David Gelovani
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Henry Y Kwon
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Sahrish Ilyas
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA.,Internal Medicine, Detroit Medical Center, Detroit, USA
| | - Asra N Shaik
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Diane L Levine
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
| |
Collapse
|
24
|
Bains M, Kaliski DZ. An anatomy workshop for improving anatomy self-efficacy and competency when transitioning into a problem-based learning, Doctor of Physical Therapy program. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:39-49. [PMID: 31855453 DOI: 10.1152/advan.00048.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
First-year Doctor of Physical Therapy (DPT) students entering a problem-based learning (PBL) program are faced with a number of pedagogical challenges, including the development of self-directed learning skills, resource unfamiliarity, and group dynamics. These challenges can make learning anatomy in a self-directed manner less efficient. Prematriculation introduction of strategies to improve anatomy learning may help prepare students for a rigorous DPT program and improve anatomy learning efficiency. The present study describes a 2-day anatomy workshop offered to incoming students before a DPT program was initiated. Knowledge acquired during both days of the workshop resulted in statistically significant improvements in anatomy postquiz scores for each corresponding prequiz (P < 0.001 for lower and upper limb quizzes). Workshop participants survey responses demonstrated that anatomy confidence and PBL preparedness increased at distinct intervals following the workshop and was significantly higher than controls after the first semester (P < 0.01 for anatomy confidence and PBL preparedness). Multivariate regression analyses demonstrated statistically significant relationships between semester anatomy practical scores and workshop participation (P = 0.03 for practical 1 and P = 0.049 for practical 2) and undergraduate grade point average (P < 0.001 for practical 1 and P = 0.03 for practical 2). First-year DPT students reported the anatomy workshop to be a valuable experience for learning strategies to improve anatomy self-efficacy. An introductory anatomy workshop is an effective strategy to improve self-directed anatomy learning efficiency before the start of a rigorous DPT program.
Collapse
Affiliation(s)
- Mona Bains
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| | - Debora Z Kaliski
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| |
Collapse
|
25
|
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
|
26
|
Germann CA, Strout TD, Park YS, Tekian A. Senior-Year Curriculum in U.S. Medical Schools: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2020; 32:34-44. [PMID: 31179752 DOI: 10.1080/10401334.2019.1618307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Phenomenon: Many U.S. medical schools have responded to the adoption of competency-based medical education (CBME) frameworks by renewing their final-year curricula and including internship preparatory courses. The purpose of this scoping review was to map the published literature regarding the final year to discern how medical schools have responded to this paradigm change. Approach: A structured 5-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal, and 8 medical education journals were conducted to identify relevant articles published from 2006 to 2016. Four authors screened articles for inclusion using standardized eligibility criteria; interrater agreement was discussed and calculated. Authors extracted data elements, and a consensus-based approach was used to categorize, sort, and structure information gathered. Findings: Among 6,485 articles retrieved, 817 articles were included in the study. From 2007-2011 to 2012-2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. The majority of articles did not reference a CBME framework (572/817; 70%), the frequency of mentions increased 268% from 2007-2011 to 2012-2016. Nearly three fourths of preparatory course-related papers reference a CBME framework (37/50; 74%). Insights: Our findings may reflect a movement in U.S. medical schools toward using shared assessment metrics to support 4th-year medical students' preparation for their postgraduate medical education. Despite an increased reference to CBME, there is relatively little use of competency-based assessment frameworks to evaluate learning outcomes. This review also found a substantial increase in the frequency of articles referencing senior-year preparatory courses in U.S. medical schools. Articles tended to describe institution-specific research or experiences. Opportunities likely exist for multi-institutional and organizational collaboration in determining the structure of the final year of medical school.
Collapse
Affiliation(s)
- Carl A Germann
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Tania D Strout
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| |
Collapse
|
27
|
Klima S, Cornwall J, Kieser D, Hammer N. The utility and benefit of a newly established postgraduate training course in surgical exposures for orthopedic and trauma surgery. Arch Orthop Trauma Surg 2019; 139:1673-1680. [PMID: 31041521 DOI: 10.1007/s00402-019-03189-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Limited data exist on specialty surgical cadaver courses for graduates, their skill gain, and whether the course contents are transferable to other surgical disciplines. AIM We present the details on the establishment of a specialist trauma and orthopedics approach course, and explore educational and career outcomes from this program. METHODS A 3-day surgical approach course was developed, including a dissection program utilizing Thiel embalmed cadavers. The course was accredited with the local orthopedics association. Participants were assessed by survey on acquired surgical knowledge, skill, decision-making, confidence, and on self-development and effect on career. RESULTS Thirty-one participants successfully completed the courses over 3 years. Increases in surgical skill, knowledge, surgical decision-making and confidence were reported. Skills and confidence also positively impacted on other surgical disciplines. Courses rated highly for learning outcomes; comments highlighted usefulness, applicability, and practicing opportunities, while also impacting positively on career opportunities. CONCLUSION Surgical courses have shown being useful for the acquisition of skills, knowledge, confidence and decision-making, with a positive impact on confidence and decision-making. This information is relevant to future participants, benefactors, surgical programs, and tertiary institutions who want to establish specialist surgical courses.
Collapse
Affiliation(s)
- Stefan Klima
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand.,Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany.,Orthopedicus Clinics, Leipzig, Germany
| | - Jon Cornwall
- Center for Early Learning in Medicine, University of Otago, Dunedin, New Zealand
| | - David Kieser
- Department of Orthopedic Surgery and MSM, Christchurch Hospital, Christchurch, New Zealand
| | - Niels Hammer
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand. .,Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Medical Division, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany.
| |
Collapse
|
28
|
Olasky J, Kim M, Muratore S, Zhang E, Fitzgibbons SC, Campbell A, Acton R. ACS/ASE Medical Student Simulation-Based Skills Curriculum Study: Implementation Phase. JOURNAL OF SURGICAL EDUCATION 2019; 76:962-969. [PMID: 30797756 DOI: 10.1016/j.jsurg.2019.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/18/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient safety initiatives have revealed a need for standardized medical student skills curricula. In 2014 the America College of Surgeons/Association for Surgical Education Medical Student Simulation-based Skills Research Collaborative initiated a multisite study to implement and study the effect of a skills curriculum during the surgical clerkship. DESIGN Students underwent knot-tying and suturing sessions. They performed a self-evaluation survey before and after the modules to assess their comfort level with the skills. Faculty members also evaluated the students at the completion of the skills sessions. The comfort level choices were: needs further review; proficient in simulated setting with assistance; proficient in simulated setting without assistance; and proficient in clinical setting under supervision. RESULTS At the completion of the modules greater than 99.3% and 98.5% of students reported that they were proficient in knot-tying and suturing, respectively, in either a simulated or clinical environment. Similarly, when faculty evaluated student performance after a session, simulated or clinically proficiency reached over 97% for both two-handed and instrument knot-tying. The faculty rated the students 86.6% proficient for suturing. CONCLUSIONS After completing the modules, a large percentage of students obtained proficiency in knot-tying and suturing, representing technical skills improvements noted by both the participants and the evaluating faculty. The America College of Surgeons/Association for Surgical Education medical student surgical skills modules represent expert developed, low cost, easy to access resources that should continue to be evaluated and disseminated to medical student learners.
Collapse
Affiliation(s)
- Jaisa Olasky
- Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts.
| | - Michael Kim
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sydne Muratore
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric Zhang
- Weill Cornell Medical College, New York, New York
| | - Shimae C Fitzgibbons
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, California
| | - Robert Acton
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
29
|
Buckley LA, Gilbert GE, Bauman EB. Psychometric testing of a checklist for procedural training of peripheral intravenous insertion. Adv Simul (Lond) 2019; 4:5. [PMID: 31019738 PMCID: PMC6471996 DOI: 10.1186/s41077-019-0092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Nurses, medical technologists, nuclear medicine technologists, pre-hospital providers, and medical students are a few groups of healthcare learners asked to learn intravenous (IV) cannulation in their training (J Surg Educ. 69:536-43, 2012). Despite the fact that IV cannulation has been taught to several health professions, it is difficult to find a psychometrically validated checklist to guide teaching this skill in the simulated procedural training (Pediatrics 124: 610-9, 2009, J Assoc Vasc Access 21: 196-204, 2016). In the absence of a pragmatic, valid checklist for the initial teaching of peripheral IV skills in the simulation procedural skills lab, this investigation sought to describe the process and create a psychometrically valid checklist. Methods Expert raters used Lawshe's method for identifying valid items from the universe of items for IV insertion. Gwet's AC2 and generalizability (G) theory was used assess inter-rater reliability. Results The literature and in-house IV checklists were examined for steps to inserting a peripheral IV, and the steps were compiled into a survey and sent to experts who rated each item. Of the 37 potential steps, 16 steps were identified as being psychometrically valid. The checklist content validity index was .82. Inter-rater reliability was .94 (95% CI .91-.98). Good inter-rater reliability was confirmed using generalizability theory. Conclusions This study created and provided evidence of content validity and reliability for this checklist using Lawshe's methodology. As such, this method of evaluating a checklist for validity and reliability evidence can be followed for other healthcare checklists. This checklist can be used for teaching IV placement in healthcare students in the simulation procedural training lab.
Collapse
Affiliation(s)
- Lisa A Buckley
- Ross University School of Medicine, 2300 SW 145th, Suite 200, Miramar, FL 33027 USA
| | - Gregory E Gilbert
- SigmaStats© Consulting, LLC, 1865 Bairds Cove, Charleston, SC 29414 USA
| | - Eric B Bauman
- Clinical Playground, LLC, 1615 Maple Street, Middleton, WI 53562 USA
| |
Collapse
|
30
|
Neurosurgery Training Camp for Sub-Internship Preparation: Lessons From the Inaugural Course. World Neurosurg 2019; 127:e707-e716. [PMID: 30947014 DOI: 10.1016/j.wneu.2019.03.246] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/23/2019] [Accepted: 03/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Historically, medical student education in neurological surgery has generally limited student involvement to assisting in research projects with minimal formal clinical exposure before starting sub-internships and application for the neurosurgery match. Consequently, students have generally had little opportunity to acquire exposure to clinical neurosurgery and attain minimal proficiency. A medical student training camp was created to improve the preparation of medical students for the involvement in neurological surgery activities and sub-internships. METHODS A 1-day course was held at Weill Cornell Medicine, which consisted of a series of morning lectures, an interactive resident lunch panel, and afternoon hands-on laboratory sessions. Students completed self-assessment questionnaires regarding their confidence in several areas of clinical neurosurgery before the start of the course and again at its end. RESULTS A significant increase in self-assessed confidence was observed in all skill areas surveyed. Overall, rising fourth year students who were starting sub-internships in the subsequent weeks reported a substantial increase in their preparedness for the elective rotations in neurosurgery. CONCLUSIONS The preparation of medical students for clinical neurosurgery can be improved. Single-day courses such as the described training camp are an effective method for improving knowledge and skill gaps in medical students entering neurosurgical careers. Initiatives should be developed, in addition to this annual program, to increase the clinical and research skills throughout medical student education.
Collapse
|
31
|
Weis JJ, Farr D, Abdelfattah KR, Hogg D, Scott DJ. A proficiency-based surgical boot camp May not provide trainees with a durable foundation in fundamental surgical skills. Am J Surg 2019; 217:244-249. [DOI: 10.1016/j.amjsurg.2018.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/02/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
|
32
|
Dean KM, DeMason CE, Choi SS, Malloy KM, Malekzadeh S. Otolaryngology boot camps: Current landscape and future directions. Laryngoscope 2019; 129:2707-2712. [DOI: 10.1002/lary.27835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Kelly M. Dean
- Department of Otolaryngology–Head and Neck SurgeryUniversity of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina
| | - Christine E. DeMason
- Department of Otolaryngology–Head and Neck SurgeryUniversity of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina
| | - Sukgi S. Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's HospitalHarvard Medical School Boston Massachusetts
| | - Kelly M. Malloy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Health System Ann Arbor Michigan
| | - Sonya Malekzadeh
- Department of Otolaryngology–Head and Neck SurgeryMedStar Georgetown University Hospital Washington District of Columbia U.S.A
| |
Collapse
|
33
|
Lee M, Vermillion M. Comparative values of medical school assessments in the prediction of internship performance. MEDICAL TEACHER 2018; 40:1287-1292. [PMID: 29390938 DOI: 10.1080/0142159x.2018.1430353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Multiple undergraduate achievements have been used for graduate admission consideration. Their relative values in the prediction of residency performance are not clear. This study compared the contributions of major undergraduate assessments to the prediction of internship performance. METHODS Internship performance ratings of the graduates of a medical school were collected from 2012 to 2015. Hierarchical multiple regression analyses were used to examine the predictive values of undergraduate measures assessing basic and clinical sciences knowledge and clinical performances, after controlling for differences in the Medical College Admission Test (MCAT). RESULTS Four hundred eighty (75%) graduates' archived data were used in the study. Analyses revealed that clinical competencies, assessed by the USMLE Step 2 CK, NBME medicine exam, and an eight-station objective structured clinical examination (OSCE), were strong predictors of internship performance. Neither the USMLE Step 1 nor the inpatient internal medicine clerkship evaluation predicted internship performance. The undergraduate assessments as a whole showed a significant collective relationship with internship performance (ΔR2 = 0.12, p < 0.001). CONCLUSIONS The study supports the use of clinical competency assessments, instead of pre-clinical measures, in graduate admission consideration. It also provides validity evidence for OSCE scores in the prediction of workplace performance.
Collapse
Affiliation(s)
- Ming Lee
- a David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Michelle Vermillion
- a David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| |
Collapse
|
34
|
Arumpanayil AJ, Winkelman C, McConnell KK, Pelyak MR, Brandt CP, Lipman JM. Attitudes Toward Communication and Collaboration After Participation in a Mock Page Program: A Pilot of an Interprofessional Approach to Surgical Residency Preparation. JOURNAL OF SURGICAL EDUCATION 2018; 75:1491-1497. [PMID: 29935925 DOI: 10.1016/j.jsurg.2018.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE A source of insecurity among new physicians and new nurses is communicating and managing acute changes in patient condition. Mock page programs are an effective method for teaching communication and clinical decision-making skills to medical students. Joint participation in a mock page program provides a unique opportunity for medical and nursing students to practice communication, collaboration, and clinical decision-making in a low-risk learning environment. The purpose of this pilot study was to examine attitudes toward communication and collaboration among medical and nursing students after participation in a mock page program. DESIGN Twenty-four medical students participating in a surgical residency preparatory course were paired with 24 senior level nursing students. Over a period of 3 weeks, nursing students delivered 5 mock pages to the medical students. Mock pages consisted of peer-reviewed, prescripted scenarios depicting patients experiencing common postoperative complications. A 12-question survey measuring attitudes toward communication and collaboration between physicians and nurses was administered prior to delivery of the first page and after delivery of the last page. A dependent sample t test was used to perform item analysis. RESULTS Individual item analysis of medical student surveys indicated significant improvement in attitudes toward communication and collaboration with nurses in 12 out of 12 survey items (p < 0.05). Individual item analysis of nursing student surveys indicated significant improvement in attitudes toward communication and collaboration with physicians in 6 out of 10 survey items (p < 0.05). There was no decline in attitudes among any of the survey items. CONCLUSIONS The results from this study suggest that an interprofessional mock page program improves attitudes toward communication and collaboration between medical and nursing students. This program has the potential to improve the quality of education and increase confidence among medical and nursing students as they prepare for their professional roles.
Collapse
Affiliation(s)
| | - Chris Winkelman
- Case Western Reserve University, School of Nursing, Cleveland, Ohio.
| | - Kelly K McConnell
- Case Western Reserve University, School of Nursing, Cleveland, Ohio.
| | - Michael R Pelyak
- Case Western Reserve University, School of Nursing, Cleveland, Ohio.
| | - Christopher P Brandt
- Case Western Reserve University, School of Medicine, Cleveland, Ohio; MetroHealth Medical Center, Cleveland, Ohio.
| | - Jeremy M Lipman
- Case Western Reserve University, School of Medicine, Cleveland, Ohio; Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
35
|
Steinemann S, Gardner A, Aulet T, Fitzgibbons S, Campbell A, Acton R. American College of surgeons /Association for Surgical Education Medical Student Simulation-based Surgical Skills Curriculum: Alignment with Entrustable Professional Activities. Am J Surg 2018; 217:198-204. [PMID: 30497660 DOI: 10.1016/j.amjsurg.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 09/09/2018] [Accepted: 10/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND We hypothesized that medical experts would concur the American College of Surgeons/Association for Surgical Education Medical Student Simulation-based Surgical Skills Curriculum ("ACS/ASE Curriculum") could be used to teach and assess Entrustable Professional Activities (EPAs). METHODS A "crosswalk" was created between ACS/ASE Curriculum modules and eight EPAs. Medical education experts participated in a Delphi process regarding feasibility of using the modules for teaching and assessing EPAs. RESULTS Twenty-eight educators from six clinical fields participated. There was consensus that five of the EPAs could be taught and assessed by the ACS/ASE Curriculum. A median of nine hours per month outside the surgical clerkship was recommended for skills training. CONCLUSIONS The ACS/ASE Curriculum lays the framework for implementing select EPAs into medical student education. Experts recommended increased time for skills training with incorporation of the modules into the first three years of medical education, with assessments planned in the third to fourth years.
Collapse
Affiliation(s)
- Susan Steinemann
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine, United States.
| | - Aimee Gardner
- Department of Surgery, Baylor College of Medicine, United States
| | - Tess Aulet
- Department of Surgery, University of Vermont, United States
| | - Shimae Fitzgibbons
- Department of Surgery, Georgetown University School of Medicine, United States
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, United States
| | - Robert Acton
- Department of Surgery, University of Minnesota, United States
| |
Collapse
|
36
|
Kucera W, Nealeigh M, Dunkin B, Ritter EM, Gardner A. The SAGES flexible endoscopy course for fellows: a worthwhile investment in furthering surgical endoscopy. Surg Endosc 2018; 33:1189-1195. [PMID: 30167950 DOI: 10.1007/s00464-018-6395-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The SAGES flexible endoscopy course for minimally invasive surgery (MIS) fellows improves confidence and skills in performing gastrointestinal (GI) endoscopy. This study evaluated the long-term retention of these confidence levels and investigated how fellows changed practices within their fellowships due to the course. METHODS Participating MIS fellows completed surveys 6 months after the course. Respondents rated their confidence to independently perform 16 endoscopic procedures (1 = not at all; 5 = very), barriers to use of endoscopy, and current uses of endoscopy. Respondents also noted participation in additional skills courses and status of fundamentals of endoscopic surgery (FES) certification. Comparisons of responses from the immediate post-course survey to the 6-month follow-up survey were examined. McNemar and paired t tests were used for analyses. RESULTS 23 of 57 (40%) course participants returned to the 6-month survey. No major barriers to endoscopy use were identified. Fellows reported less competition with GI providers as a barrier to practice compared to their original post-course expectations (50% vs. 86%, p < 0.01). In addition, confidence was maintained in performing the majority of the 16 endoscopic procedures, although fellows reported significant decreases in confidence in independently performing snare polypectomy (- 26%; p < 0.05), control of variceal bleeding (- 39%; p < 0.05), colonic stenting (- 48%; p < 0.01), BARRX (- 40%; p < 0.05), and TIF (- 31%; p < 0.05). Fewer fellows used the GI suite to manage surgical problems than was anticipated post course (26% vs. 74%, p < 0.01). Fellows who passed FES noted no significant loss of independence, changes in use, or barriers to use. 18% made additional partnerships with industry after the course. 41% stated flexible endoscopy has influenced their post-fellowship job choice. CONCLUSIONS The SAGES flexible endoscopy course for MIS fellows results in long-term practice changes with participating fellows maintaining confidence to perform the majority of taught endoscopic procedures 6 months later. Additionally, fellows experienced no major barriers to implementing endoscopy into practice.
Collapse
Affiliation(s)
- Walter Kucera
- Department of Surgery, Uniformed Services University of the Health Sciences/Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA.
| | - Matthew Nealeigh
- Department of Surgery, Uniformed Services University of the Health Sciences/Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA
| | - Brian Dunkin
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - E Matthew Ritter
- Department of Surgery, Uniformed Services University of the Health Sciences/Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA
| | - Aimee Gardner
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
37
|
McClintic JA, Snyder CL, Brown KM. Curricular Innovation in the Surgery Clerkship: Can Assessment Methods Influence Development of Critical Thinking and Clinical Skills? JOURNAL OF SURGICAL EDUCATION 2018; 75:1236-1244. [PMID: 29545129 DOI: 10.1016/j.jsurg.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Although key clinical skills have been defined in the Core Entrustable Professional Activities, there is a need to improve medical school curricula with standardized training opportunities and assessments of these skills. Thus, we aimed to develop an innovative curriculum that emphasized critical thinking and clinical skills. We hypothesized that we would be able to observe measurable improvement on assessments of students' critical thinking and clinical skills after the implementation of the new curriculum. DESIGN Prospective, Quasi-Experimental study with the use of historical controls. SETTING This study took place through the third-year surgical clerkship at the University of Texas Medical Branch at the Galveston, Houston, and Austin, Texas, locations. PARTICIPANTS A total of 214 students taking the third-year surgical clerkship for the first time during the periods of interest were included. RESULTS Although the students with traditional curriculum improved 9.5% on a short answer exam from preclerkship to postclerkship completion, the students with new curriculum improved by 40%. Students under the new curriculum performed significantly better on the Objective Structured Clinical Exam; however, their shelf scores were lower. CONCLUSIONS Under this new curriculum and grading system, we demonstrated that students can be incentivized to improve critical thinking and clinical skills, but this needs to be balanced with knowledge-based incentives.
Collapse
Affiliation(s)
- James A McClintic
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
| | - Clifford L Snyder
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Kimberly M Brown
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
38
|
LaPorta J, McClure T, Tieman ME. Results of a Surgical Simulation Course Designed to Improve Surgery Clerkship Performance. JOURNAL OF SURGICAL EDUCATION 2018; 75:656-663. [PMID: 29079109 DOI: 10.1016/j.jsurg.2017.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/09/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES During the 2015-2016 academic year, Rocky Vista University College of Osteopathic Medicine (RVUCOM) conducted a required 1-week surgical simulation course as the first week of students' 8-week surgical clerkship. This course was adapted from a pilot RVUCOM surgical simulation course and other surgical simulation courses identified in the literature. The objectives of this course were to teach surgical skills and clinical knowledge, aid students in adjusting to the stress of a surgical clerkship, and improve students' confidence and abilities during the clerkship. METHODS In all, 148 students participated in the surgical simulation course. Subjective assessment of this course included each student completing a daily standardized stress survey and student feedback surveys at the end of the course and at the end of the surgical clerkship. Objective assessment of this course compared precourse and postcourse tests of surgical knowledge and instrument identification, as well as comparison of NBME Surgery Subject Assessment percentile ranks of this class with 3 prior classes. RESULTS Daily stress surveys indicated decreased stress on day 5 compared to day 1 (p < 0.01). Students' confidence level increased significantly on day 5 compared to day 1 (p < 0.01). Student feedback surveys demonstrated students' perception that surgical skills and clinical skills had been learned during the course and that the course improved their performance during the surgical clerkship. NBME Surgery Subject Assessment percentile rank improved significantly (p < 0.01) from a mean percentile rank of 36.94 for 3 previous classes to a mean percentile rank of 43.82 for the class who completed the simulation course. Surgical knowledge improved significantly (p < 0.001) from a pretest mean score of 47.02% to a posttest mean score of 55.14%. Surgical instrument identification improved significantly (p < 0.001) from a pretest mean of 13.81% to a posttest mean of 95.28%. CONCLUSION The RVUCOM surgery simulation course significantly improved student performance academically and helped students acclimate to stress, increase their confidence level, and acquire surgical skills needed during the third-year surgery clerkship.
Collapse
Affiliation(s)
- Joseph LaPorta
- Department of Specialty Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Tanner McClure
- Department of Specialty Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Michael E Tieman
- Department of Specialty Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado.
| |
Collapse
|
39
|
Owei L, Neylan C, Kelz R, Dumon KR, Allen SR, Williams N, Dempsey DT, Fisher C. Resource Usage Implementing the Surgical Resident Prep Curriculum at a Single Institution. JOURNAL OF SURGICAL EDUCATION 2018; 75:650-655. [PMID: 29037824 DOI: 10.1016/j.jsurg.2017.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Resident Prep Curriculum (RPC), published in 2014 and developed as a collaboration of the American College of Surgeons, Association of Program Directors in Surgery, and the Association for Surgical Education, was designed to improve the quality and consistency of medical student preparation for surgical residency. We aim to assess the feasibility of and resource usage for implementation of this curriculum at our institution. DESIGN Our institution expanded upon a pre-existing 2-week surgical preparatory course, adding modules designed to meet the goals and objectives of the RPC. We performed an evaluation of the resources required for these additions, namely time, logistics and incremental cost. SETTING The course took place at the Perelman School of Medicine, which is a large, academic medical center affiliated with the Hospital of the University of Pennsylvania. RESULTS Our course satisfied each of the six domains outlined in the RPC. In 2015, 22 students were enrolled in the course. It was run over a consecutive 4-week period in the spring of 2015, with 9 full and 9 half days. To meet the needs of the Curriculum, approximately 33 hours (38%) were spent in the classroom, 34 hours (39%) in a simulation center, and 20 hours (23%) in the anatomical laboratory. Seventy faculty-hours (from 5 disciplines) and 73 resident-hours (double-counting for cotaught modules) were required to support the course. Besides room availability, funding was required for certain aspects of the course such as cadavers, dedicated anatomy teaching, and the costs of supplies in the simulation center. There is also a cost associated with the use of the Penn Medicine Simulation Center. Taking these into account, the total cost of implementing the curriculum amounted to $30,627.10. CONCLUSION The implementation of the RPC was feasible but relied heavily upon faculty/resident time. As a result of the success of this initiative, our medical school seeks to expand the idea across multiple specialties.
Collapse
Affiliation(s)
- Lily Owei
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Neylan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rachel Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve R Allen
- Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Noel Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carla Fisher
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
40
|
Bamford R, Langdon L, Rodd CA, Eastaugh-Waring S, Coulston JE. Core trainee boot camp, a method for improving technical and non-technical skills of novice surgical trainees. A before and after study. Int J Surg 2018; 57:60-65. [PMID: 29653248 DOI: 10.1016/j.ijsu.2018.03.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The transition to surgical training can be a stressful time for trainees and is most evident during national handover periods where new graduates start and senior trainees rotate to new programmes. During this time, patient mortality can increase and Hospital efficiency reduces. This influence is compounded by the impact of working time directives. Intensive, simulation rich training programmes or "Boot Camps" have been postulated as a solution. This article highlights the development of a surgical boot camp for novice surgical trainees and the impact this can have on training. METHOD A novel surgical boot camp was developed for all trainees within a surgical training region including nine acute NHS trusts. Participating cohort of trainees completed pre and post course questionnaires to assess technical and non-technical skills. RESULTS 25 trainees attended and completed the pre and post boot camp questionnaire. Significant improvements were seen with technical skills (p = 0.0429), overall non-technical skills (p < 0.001) including leadership (p = 0.022), communication (p = 0.010), situational awareness (p = 0.022), patient handover (p = 0.003), ward round skills (p = 0.005) and outpatient skill (p = 0.002). Trainees reported significantly increased ability to assess and manage a critically unwell patient (p = 0.001) and a trauma patient (p = 0.001). 96% of trainees have utilised the skills they learnt on Boot Camp and all trainees would recommend it as an induction programme. CONCLUSION Surgical Boot Camps offer a timely chance to develop technical and non-technical skills whilst enhancing a trainee's confidence and knowledge and reduce the patient safety impact of the handover period.
Collapse
Affiliation(s)
- R Bamford
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom.
| | - L Langdon
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - C A Rodd
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - S Eastaugh-Waring
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| | - J E Coulston
- HESW Severn Post-Graduate School of Surgery, Deanery House, Unit D-Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, United Kingdom
| |
Collapse
|
41
|
Polk TM, Greer J, Alex J, Kiser R, Gunzelman K, Petersen C, Spooner M. Simulation Training for Operational Medicine Providers (STOMP): Design and Implementation of a Novel Comprehensive Skills-Based Curriculum for Military General Medical Officers. Mil Med 2018; 183:40-46. [DOI: 10.1093/milmed/usx140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/21/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Travis M Polk
- Department of Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Joy Greer
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - John Alex
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
- Department of Emergency Medicine, Naval Hospital Okinawa, Japan, PSC 482 BOX 1600, FPO, AP 96362-1600, Okinawa, Japan
| | - Rebecca Kiser
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Kim Gunzelman
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Carl Petersen
- Department of Psychiatry, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Michael Spooner
- Healthcare Simulation and Bioskills Training Center, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
- Department of Cardiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| |
Collapse
|
42
|
Acosta D, Castillo-Angeles M, Garces-Descovich A, Watkins AA, Gupta A, Critchlow JF, Kent TS. Surgical Practical Skills Learning Curriculum: Implementation and Interns' Confidence Perceptions. JOURNAL OF SURGICAL EDUCATION 2018; 75:263-270. [PMID: 28827182 DOI: 10.1016/j.jsurg.2017.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide an overview of the practical skills learning curriculum and assess its effects over time on the surgical interns' perceptions of their technical skills, patient management, administrative tasks, and knowledge. DESIGN An 84-hour practical skills curriculum composed of didactic, simulation, and practical sessions was implemented during the 2015 to 2016 academic year for general surgery interns. Totally, 40% of the sessions were held during orientation, whereas the remainder sessions were held throughout the academic year. Interns' perceptions of their technical skills, administrative tasks, patient management, and knowledge were assessed by the practical skills curriculum residents' perception survey at various time points during their intern year (baseline, midpoint, and final). Interns were also asked to fill out an evaluation survey at the completion of each session to obtain feedback on the curriculum. SETTING General Surgery Residency program at a tertiary care academic institution. PARTICIPANTS 20 General Surgery categorical and preliminary interns. RESULTS Significant differences were found over time in interns' perceptions on their technical skills, patient management, administrative tasks, and knowledge (p < 0.001 for all). The results were also statistically significant when accounting for a prior boot camp course in medical school, intern status (categorical or preliminary), and gender (p < 0.05 for all). Differences in interns' perceptions occurred both from baseline to midpoint, and from midpoint to final time point evaluations (p < 0.001 for all). Prior surgical boot camp in medical school status, intern status (categorical vs. preliminary), and gender did not differ in the interns' baseline perceptions of their technical skills, patient management, administrative tasks, and knowledge (p > 0.05 for all). CONCLUSIONS Implementation of a Practical Skills Curriculum in surgical internships can improve interns' confidence perception on their technical skills, patient management skills, administrative tasks, and knowledge.
Collapse
Affiliation(s)
- Danilo Acosta
- Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, New York
| | | | | | - Ammara A Watkins
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alok Gupta
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan F Critchlow
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| |
Collapse
|
43
|
A surgical residency preparatory course for senior medical students leads to earlier independence in ACGME competencies. Am J Surg 2018; 215:309-314. [DOI: 10.1016/j.amjsurg.2017.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 08/22/2017] [Indexed: 11/17/2022]
|
44
|
Peluso MJ, Luckett R, Mantzor S, Bedada AG, Saleeb P, Haverkamp M, Mosepele M, Haverkamp C, Maoto R, Prozesky D, Tapela N, Nkomazana O, Barak T. Strengthening medical training programmes by focusing on professional transitions: a national bridging programme to prepare medical school graduates for their role as medical interns in Botswana. BMC MEDICAL EDUCATION 2017; 17:261. [PMID: 29268729 PMCID: PMC5740920 DOI: 10.1186/s12909-017-1102-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 12/12/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND The improvement of existing medical training programmes in resource-constrained settings is seen as key to addressing the challenge of retaining medical graduates trained at considerable cost both in-country and abroad. In Botswana, the establishment of the national Medical Internship Training Programme (MIT) in 2014 was a first step in efforts to promote retention through the expansion and standardization of internship training, but MIT faces a major challenge related to variability between incoming trainees due to factors such as their completion of undergraduate medical training in different settings. To address this challenge, in August 2016 we piloted a bridging programme for foreign and locally trained medical graduates that aimed to facilitate their transition into internship training. This study aimed to describe the programme and evaluate its impact on the participants' self-rated perceptions of their knowledge, experience, clinical skills, and familiarity with Botswana's healthcare system. METHODS We conducted a national, intensive, two-week programme designed to facilitate the transition from medical student to intern and to prepare all incoming interns for their work in Botswana's health system. Participants included all interns entering in August 2016. Formats included lectures, workshops, simulations, discussions, and reflection-oriented activities. The Kellogg Foundation Outcomes Logic Model was used to evaluate the programme, and participants self-rated their knowledge, skills, and attitudes across each of the programme objectives on paired questionnaires before and after participation. RESULTS 48/54 participants (89%) provided paired data. Participants reported a high degree of satisfaction with the programme (mean 4.2/5). Self-rated preparedness improved after participation (mean 3.2 versus 3.7, p < 0.001), as did confidence across 18/19 knowledge/skill domains, suggesting that participants felt that the programme prepared them for their internship training. Exploratory analysis revealed that 20/25 participants (80%) reporting either no effect or a negative effect following participation had rated themselves "extremely" or "quite" prepared beforehand, suggesting the programme grounded expectations for interns who initially were overconfident. In contrast, no interns who had initially rated themselves "moderately" or "somewhat" prepared reported a decline in their self-rated sense of preparedness. Interns commented on the benefits of learning about roles/responsibilities, interacting with clinicians from Botswana's healthcare sectors, and the sense of community the programme engendered. CONCLUSIONS This programme was feasible to implement and was well-received by participants. Overall, participants perceived an enhancement of their knowledge, skills, and expectations about their role in Botswana's health system after completion of the programme. Our results are likely to be of interest to educators dedicated to training, professional transitions, and career pathways in similar settings in the region and beyond.
Collapse
Affiliation(s)
- Michael J. Peluso
- Botswana-Harvard Partnership, Gaborone, Botswana
- Department of Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, USA
| | - Rebecca Luckett
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Department of Obstetrics and Gynecology, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Savara Mantzor
- Children’s Hospital of Philadelphia, Philadelphia, USA
- Department of Paediatrics, Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Alemayhu G. Bedada
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Paul Saleeb
- University of Maryland, College Park, MD USA
- Botswana-University of Maryland School of Medicine Health Initiative, Gaborone, Botswana
| | - Miriam Haverkamp
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Mosepele Mosepele
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Rosa Maoto
- Medical Internship Training Programme, Gaborone, Botswana
| | - Detlef Prozesky
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Neo Tapela
- Botswana-Harvard Partnership, Gaborone, Botswana
- Department of Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, USA
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
- Botswana Ministry of Health, Gaborone, Botswana
| | - Oathokwa Nkomazana
- Medical Internship Training Programme, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tomer Barak
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| |
Collapse
|
45
|
King CJ, Bolton A, Guerrasio J, Trosterman A. Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey. South Med J 2017; 110:765-769. [PMID: 29197310 DOI: 10.14423/smj.0000000000000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school. METHODS We developed a mixed-methods survey that was delivered to representatives of 82 schools via an e-mail link to an online survey. RESULTS Our response rate was 54% (44/82). Of those responding, 28% reported that students do not write any patient care orders at their institution and 34% reported not receiving pages related to patient care. Only 26% of institutions provide an increased patient load to students during their final year of training. Students identified many areas to improve the role of fourth-year medical students, including writing patient care orders, answering pages, increasing autonomy, defining their role better, and providing them with a longer subinternship experience. CONCLUSIONS Our survey suggests that students are graduating from the undergraduate medical education system and moving to the graduate medical education system in the United States without a guarantee of having answered a page related to patient care or having placed a patient care order. Further studies of students' experiences should be conducted to explore whether exposure to these skills improves first-year resident performance.
Collapse
Affiliation(s)
- Christopher J King
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Andrew Bolton
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Jeannette Guerrasio
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| | - Adam Trosterman
- From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA
| |
Collapse
|
46
|
Bommer C, Sullivan S, Campbell K, Ahola Z, Agarwal S, O'Rourke A, Jung HS, Gibson A, Leverson G, Liepert AE. Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance. Am J Surg 2017; 215:266-271. [PMID: 29174166 DOI: 10.1016/j.amjsurg.2017.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making. METHODS Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty. RESULTS The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p < 0.05). CONCLUSIONS Pre-simulation orientation reduces anxiety while increasing confidence and improving performance.
Collapse
Affiliation(s)
- Cassidy Bommer
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Sarah Sullivan
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Krystle Campbell
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Zachary Ahola
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, United States
| | - Suresh Agarwal
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Ann O'Rourke
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Hee Soo Jung
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Angela Gibson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Glen Leverson
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States
| | - Amy E Liepert
- University of Wisconsin Department of Surgery, Clinical Science Center, Madison, WI, United States.
| |
Collapse
|
47
|
Potts JR. You can't blame the wreck on the train. Am J Surg 2017; 214:974-978. [DOI: 10.1016/j.amjsurg.2016.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
|
48
|
Perone JA, Anton NE, Gardner AK, Steinemann S. Simulation Training in Surgical Education. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0182-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
49
|
Lomis K, Amiel JM, Ryan MS, Esposito K, Green M, Stagnaro-Green A, Bull J, Mejicano GC. Implementing an Entrustable Professional Activities Framework in Undergraduate Medical Education: Early Lessons From the AAMC Core Entrustable Professional Activities for Entering Residency Pilot. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:765-770. [PMID: 28557937 DOI: 10.1097/acm.0000000000001543] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs) that medical school graduates might be expected to perform, without direct supervision, on the first day of residency. Soon after, the AAMC commissioned a five-year pilot with 10 medical schools across the United States, seeking to implement the Core EPA framework to improve the transition from undergraduate to graduate medical education.In this article, the pilot team presents the organizational structure and early results of collaborative efforts to provide guidance to other institutions planning to implement the Core EPA framework. They describe the aims, timeline, and organization of the pilot as well as findings to date regarding the concepts of entrustment, assessment, curriculum development, and faculty development. On the basis of their experiences over the first two years of the pilot, the authors offer a set of guiding principles for institutions intending to implement the Core EPA framework. They also discuss the impact of the pilot, its limitations, and next steps, as well as how the pilot team is engaging the broader medical education community. They encourage ongoing communication across institutions to capitalize on the expertise of educators to tackle challenges related to the implementation of this novel approach and to generate common national standards for entrustment. The Core EPA pilot aims to better prepare medical school graduates for their professional duties at the beginning of residency with the ultimate goal of improving patient care.
Collapse
Affiliation(s)
- Kimberly Lomis
- K. Lomis is associate dean for undergraduate medical education and professor of surgery, Vanderbilt University School of Medicine, Nashville, Tennessee. J.M. Amiel is associate dean for curricular affairs and associate professor of psychiatry, Columbia University College of Physicians and Surgeons, New York, New York. M.S. Ryan is assistant dean for clinical medical education and associate professor of pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia. K. Esposito is associate dean for curriculum and medical education and professor and vice chair of psychiatry and behavioral health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. M. Green is professor of medicine and director for student assessment, Yale School of Medicine, New Haven, Connecticut. A. Stagnaro-Green is regional dean and professor of medicine, obstetrics and gynecology, and medical education, University of Illinois College of Medicine, Rockford, Illinois. J. Bull is lead specialist in competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. G.C. Mejicano is senior associate dean for education and professor of medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Neylan CJ, Nelson EF, Dumon KR, Morris JB, Williams NN, Dempsey DT, Kelz RR, Fisher CS, Allen SR. Medical School Surgical Boot Camps: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:384-389. [PMID: 27939818 DOI: 10.1016/j.jsurg.2016.10.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 05/13/2023]
Abstract
PURPOSE Many medical schools have begun to offer surgical boot camps to senior medical students. The aim of the present study is to systematically review the literature and evidence surrounding medical school surgical boot camps to direct future research into the effectiveness of boot camps. METHODS A systematic review was conducted, searching MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. The review was conducted according to the PICOTS structure, with an intervention of a surgical boot camp for senior medical students entering surgical residencies. RESULTS The search resulted in 5351 database hits, from which we identified 10 published studies that met the inclusion criteria. Two reviews were identified that met the PICOTS criteria but were excluded from data synthesis. Boot camps increase the confidence and competence of medical students entering their surgical internships. There is no objective assessment of the effect of boot camps on the clinical performance of interns. CONCLUSIONS Despite the success of medical school surgical boot camps, no objective data exist to show that boot camps translate into improved performance during internship.
Collapse
Affiliation(s)
- Christopher J Neylan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth F Nelson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jon B Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carla S Fisher
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven R Allen
- Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|