1
|
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
|
2
|
The Impact of Surgical Boot Camp on Medical Student Confidence and Imposter Syndrome. J Surg Res 2023; 283:872-878. [PMID: 36915015 DOI: 10.1016/j.jss.2022.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/21/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Transitioning from medical student to surgical intern is accompanied by increased responsibility, stress, and clinical burden. This environment lends itself to imposter syndrome (IS), a psychological condition grounded in self-doubt causing fear of being discovered as fraud despite adequate abilities. We hypothesized a 2-week surgical boot camp for fourth year medical students would improve confidence in technical skills/knowledge and IS. METHODS Thirty medical students matching into surgical specialties completed the boot-camp in February 2020. Presurveys/postsurveys assessed confidence levels using a 1-5 Likert scale regarding 32 technical skills and knowledge points. The Clance Impostor Phenomenon Scale (CIPS) assessed IS, where increasing scores correlate to greater IS. RESULTS Median (interquartile range [IQR]) subject age was 27 y (26, 28), 20 (66.7%) were male, and 21 (70%) were Caucasian. Of the 30 students, 23 (76.7%) had a break in training with a median [IQR] of 2 [1, 3] y outside of medicine. Confidence scores were significantly improved in all five assessment categories (P < 0.05); however, there was no change in CIPS in median [IQR] presurveys versus postsurveys (65.5 [52, 75] versus 64 [52, 75], P = 0.70). Females had higher mean (standard deviation) pre-CIPS than males (68.4 [15.2] versus 61.6 [14.9], P = 0.02). There was no strong correlation between age and CIPS in the presurvey (Spearman Rank Correlation Coefficient [SRCC]: 0.29, P = 0.19) or postsurvey (SRCC: 0.31, P = 0.10). While subjects who worked outside of medicine had a stronger relationship with IS (SRCC: 0.37, P = 0.05), multivariable regression analysis did not reveal any significant differences. CONCLUSIONS We advocate for surgical boot-camp training courses to improve trainee skill and confidence. As IS is not improved by boot camp, additional research is needed to identify opportunities to improve IS among surgical trainees.
Collapse
|
3
|
Liu Q, Geertshuis S, Gladman T, Grainger R. Student video production within health professions education: A scoping review. MEDICAL EDUCATION ONLINE 2022; 27:2040349. [PMID: 35180045 PMCID: PMC8865118 DOI: 10.1080/10872981.2022.2040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recent technological developments have influenced a shift in the use of videos in Health Professions Education (HPE). Rather than casting students in the role of observers of videos, educators have been asking students to produce videos as a learning activity. The assumption is that video production is often an active and collaborative exercise, therefore could engage students and enhance learning. However, applications of this emerging pedagogical approach vary, and there has not been a knowledge synthesis to guide future research and practice. METHODS With a view to mapping existing knowledge, identifying avenues for further research, and informing practice, we conducted a scoping review to establish current understanding of video production in HPE. We undertook a literature search of seven databases and identified thirty-six studies. RESULTS The findings showed considerable variation in purposes and implementation approaches, consequences and challenges associated with video production. In particular, the assumption that creating a video automatically promotes student engagement was not well supported, especially when the intended learning was not made apparent to students. CONCLUSION Overall, the review suggests that despite the increasing adoption of video production in HPE, the purposes are often unclear; pedagogical considerations underlying project design are limited, which risks undermining the intended learning. To optimise educational benefits, future video production projects should be explicit in their intention and approach, draw upon pedagogical theories, anticipate and address implementation issues, and be robust in their formative and summative assessment processes. Future research should more explicitly show the relationship between the intended learning and the underlying pedagogy and thoroughly evaluate the effectiveness and feasibility of video production projects.
Collapse
Affiliation(s)
- Qian Liu
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand
| | - Susan Geertshuis
- Department of Management and International Business, University of Auckland, Auckland, New Zealand
| | - Tehmina Gladman
- Education Unit, University of Otago, Wellington, New Zealand
| | | |
Collapse
|
4
|
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
|
5
|
Antimicrobial Prescribing Confidence and Knowledge Regarding Drug Resistance: Perception of Medical Students in Malaysia and the Implications. Antibiotics (Basel) 2022; 11:antibiotics11050540. [PMID: 35625184 PMCID: PMC9137524 DOI: 10.3390/antibiotics11050540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 02/01/2023] Open
Abstract
Worldwide, microbes are becoming more challenging by acquiring virulent skills to adapt and develop antimicrobial resistance (AMR). This is a concern as AMR increases morbidity, mortality, and costs. Consequently, physicians need to be trained on appropriate antimicrobial prescribing, starting as medical students. Objective: To evaluate medical students’ confidence in antimicrobial prescribing and AMR. Methods: Cross-sectional study assessing medical students’ knowledge, perception, and confidence in prescribing antimicrobials and AMR in a Malaysian University. A universal sampling method was used. Results: Most responding students believed that educational input regarding overall prescribing was sufficient. Regarding the principle of appropriate and accurate prescriptions, female medical students had less knowledge (odds ratio (OR) = 0.51; 95% confidence interval (CI) 0.25–0.99; p = 0.050). Year-IV and Year-V medical students had more excellent knowledge than Year-III students regarding confidence in potential antibiotic prescribing once qualified. Year-V students also showed an appreciably higher confidence in the broad principles of prescribing, including antibiotics for infectious diseases, compared to those in other years. Conclusion: Overall, medical students gain more knowledge and confidence regarding the potential prescribing of antimicrobials as their academic careers progress. This is important given concerns with the current excessive use of antimicrobials in Malaysia.
Collapse
|
6
|
Developing, conducting and evaluating the internship preparatory program (Ipp). Ann Med Surg (Lond) 2022; 73:103215. [PMID: 35079360 PMCID: PMC8767267 DOI: 10.1016/j.amsu.2021.103215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background Medical schools worldwide have employed different practices to facilitate a smooth transition from medical school into the internship phase to promote success in graduates’ future professional life. The College of Medicine at Princess Nourah University (PNU) has developed a unique internship preparatory program focusing on soft and clinical skills. Objective The aim of this study was to describe the internship preparatory program (IPP) and evaluate its effectiveness in improving medical students’ transition to internship. Materials and methods The IPP for fifth-year medical students at PNU was planned and designed based on students’ needs, the Saudi-Med framework, and similar national/international programs. The one-year longitudinal IPP in 2016–2017 covered four modules conducted as ten workshops focusing on soft skills, clinical skills, and professional development for the future. All data were analyzed by using SPSS version 20. Results The IPP was attended and evaluated by 48 participants; 70% of them attended 80% of the IPP workshops. The satisfaction rate for workshop participants was 6.8–8.8 out of 10. Most participants were either satisfied or strongly satisfied with respect to each item on the IPP satisfaction scale; the median satisfaction score was 4 out of 5. A positive significant correlation between the satisfaction score and the number of workshops attended was detected. Conclusion The IPP was a satisfying initiative for most participants. It refines their clinical and soft skills, facilitates future planning, and provides a smooth transition from medical school to internship. Internship preparatory program (IPP) refines the graduate's clinical skills. Internship preparatory program (IPP) refines the graduate's soft skills like communication and collaboration. IPP may facilitates future planning for future career. IPP provides a smooth transition from medical school to internship.
Collapse
|
7
|
Buist N, Webster CS. Simulation Training to Improve the Ability of First-Year Doctors to Assess and Manage Deteriorating Patients: a Systematic Review and Meta-analysis. MEDICAL SCIENCE EDUCATOR 2019; 29:749-761. [PMID: 34457539 PMCID: PMC8368756 DOI: 10.1007/s40670-019-00755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many simulation courses now exist which aim to prepare first-year doctors for the task of assessing and managing potentially deteriorating patients. Despite the substantial resources required, the degree to which participants benefit from such courses, and which aspects of the simulation training are optimal for learning, remains unclear. A systematic literature search was undertaken across seven electronic databases. Inclusion criteria were that the intervention must be a simulation of a deteriorating patient scenario that would likely be experienced by first-year doctors, and that participants being first-year doctors or in their final year of medical school. Studies reporting quantitative benefits of simulation on participants' knowledge and simulator performance underwent meta-analyses. The search returned 1444 articles, of which 48 met inclusion criteria. All studies showed a benefit of simulation training, but outcomes were largely limited to self-rated or objective tests of knowledge, or simulator performance. The meta-analysis demonstrated that simulation improved participant performance by 16% as assessed by structured observation of a simulated scenario, and participant knowledge by 7% as assessed by written assessments. A mixed-methods analysis found conflicting evidence about which aspects of simulation were optimal for learning. The results of the review indicate that simulation is an important tool to improve first-year doctors' confidence, knowledge and simulator performance with regard to assessment and management of a potentially deteriorating patient. Future research should now seek to clarify the extent to which these improvements translate into clinical practice, and which aspects of simulation are best suited to achieve this.
Collapse
Affiliation(s)
- Nicholas Buist
- Department of Emergency Medicine, Whangarei Hospital, Northland District Health Board, Maunu Rd, Private Bag 9742, Whangarei, 0110 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Surgical boot camp for fourth-year medical students: Impact on objective skills and subjective confidence. Surgery 2019; 167:298-301. [PMID: 31427073 DOI: 10.1016/j.surg.2019.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Within surgical education, there has been a recent emphasis on preparing medical students for the rigors of residency in an effort to improve confidence and technical preparedness throughout postgraduate training. The aim of this study is to test the impact of a boot camp course using the American College of Surgeons-based curriculum and objective, observer-based rating tools on both subjective confidence and objective skills of fourth-year medical students. MATERIALS AND METHODS Informed consent was obtained on the first day of the boot camp. Before any teaching, students performed 5 tasks (patient handoff, suturing, knot tying, central line placement, and chest tube placement), which were scored using objective rating tools provided by the American College of Surgeons. Students also completed 2 confidence measures. After 2 weeks of dedicated teaching and review, students were scored on the 5 same tasks and repeated the confidence measures. RESULTS Fourth-year medical students (N = 12) who had matched into surgical subspecialties were invited to participate in a 2-week surgical boot camp. All students beginning the study completed the study. The average age was 26.7 years; 25% of students were female. Subspecialties represented included general surgery (n = 5), orthopedics (n = 3), integrated plastics (n = 2), urology (n = 1), and neurosurgery (n = 1). Scores on objective skills improved significantly in all 5 tasks measured. Confidence improved significantly on individual task items, while overall self-efficacy remained unchanged. CONCLUSIONS Implementation of a 2-week, multimodal surgical boot camp improved student performance on objectively rated surgical skills and increased student confidence.
Collapse
|
9
|
Technical skill improvement with surgical preparatory courses: What advantages are reflected in residency? Am J Surg 2018; 216:155-159. [DOI: 10.1016/j.amjsurg.2017.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
|
10
|
Green CA, Kim EH, O'Sullivan PS, Chern H. Using Technological Advances to Improve Surgery Curriculum: Experience With a Mobile Application. JOURNAL OF SURGICAL EDUCATION 2018; 75:1087-1095. [PMID: 29397357 DOI: 10.1016/j.jsurg.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/23/2017] [Accepted: 12/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Our previous home-video basic surgical skills curriculum required substantial faculty time and resources, and was limited by delayed feedback and technical difficulties. Consequently, we integrated that curriculum with a mobile application platform. Our purpose is to describe this application and learner satisfaction. MATERIALS AND METHODS The mobile platform incorporates a patented pedagogical design based on Ericsson's deliberate practice and Bandura's social learning theory. Instructors built step-wise skills modules. During the challenge phase, learners watched a video of surgical tasks completed by experts and uploaded a video of themselves performing the same task. In the Peer Review phase, they used a grading rubric to provide feedback. In the Recap stage, learners received individual feedback and could review their own videos. Two groups of learners, graduating medical students and matriculating surgical residents, participated in this independent learning platform, along with 2 to 4 laboratory sessions, and completed a survey about their experience. Survey responses were summarized descriptively and comments analyzed using content analysis. RESULTS Fifty learners submitted videos of assigned tasks and completed peer reviews. Learners reported positive experiences specifically for the Peer Review Stage, structured home practice, ease of mobile access to submit and review videos, and ongoing immediate feedback. Over half of the learners reported spending at least 10 to 30 minute practicing skills before recording their videos and over 80% rerecorded at least 2 times before submission. Content analysis revealed learners engaged with the educational concepts designed into the platform. CONCLUSION Learners easily used and were satisfied with a mobile-technology teaching platform that maintained the fundamental content, educational theories, and organizational structure of our previously effective surgical skills curriculum. Prior challenges were directly addressed through the mobile application's ease of use, support of deliberate practice, and improved timeliness of feedback.
Collapse
Affiliation(s)
- Courtney A Green
- Department of Surgery, University of California, San Francisco, California.
| | - Edward H Kim
- Department of Surgery, University of California, San Francisco, California
| | | | - Hueylan Chern
- Department of Surgery, University of California, San Francisco, California
| |
Collapse
|
11
|
Heimroth J, Jones VM, Howard JD, Sutton ER. Utilizing Surgical Bootcamps to Teach Core Entrustable Professional Activities to Senior Medical Students. Am Surg 2018. [DOI: 10.1177/000313481808400619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To promote residency preparedness, the Association of American Medical Colleges defined 13 core entrustable professional activities for entering residency (CEPAERs), which represent tasks that students should be able to perform on day one of residency. At the authors’ institution, a four-week surgery boot camp course is offered to senior medical students, which may provide an effective mechanism for teaching the CEPAERs. Nine senior students participating in a surgery boot camp course were subjected to pre- and post-course surveys. Student expectations were closely aligned with the CEPAERs. Competence was demonstrated in all CEPAERs; however, four students did require remediation with Advanced Cardiovascular Life Support before achieving competence. In the “death on the wards module,” we found a significant increase in student confidence (19.78, SD 1.47, P > 0.05 vs 31.56, SD 1.49, P < 0.01) and knowledge (16.11, SD 1.32, P > 0.05 vs 31.33, SD 2.04, P < 0.01). In a one-year follow-up survey, all participants agreed that the boot camp course was useful and positively impacted their intern year. Surgical boot camp courses provide an effective and reproducible means for teaching the CEPAERs and was found useful in preparing medical students for residency.
Collapse
|
12
|
Bochenska K, Milad MP, DeLancey JO, Lewicky-Gaupp C. Instructional Video and Medical Student Surgical Knot-Tying Proficiency: Randomized Controlled Trial. JMIR MEDICAL EDUCATION 2018; 4:e9. [PMID: 29650503 PMCID: PMC5920196 DOI: 10.2196/mededu.9068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Many senior medical students lack simple surgical and procedural skills such as knot tying. OBJECTIVE The aim of this study was to determine whether viewing a Web-based expert knot-tying training video, in addition to the standard third-year medical student curriculum, will result in more proficient surgical knot tying. METHODS At the start of their obstetrics and gynecology clerkship, 45 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded female pelvic medicine and reconstructive surgery physicians evaluated proficiency with a standard checklist (score range 0-16) and anchored scoring scale (range 0-20); higher numbers represent better skill. Students were then randomized to either (1) expert video (n=26) or (2) nonvideo (n=24) groups. The video group was provided unlimited access to an expert knot-tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. RESULTS At initial evaluation, preclerkship cumulative scores (range 0-36) on the standard checklist and anchored scale were not significantly different between the nonvideo and video groups (mean 20.3, SD 7.1 vs mean 20.2, SD 9.2, P=.90, respectively). Postclerkship scores improved in both the nonvideo and video groups (mean 28.4, SD 5.4, P<.001 and mean 28.7, SD 6.5, P=.004, respectively). Increased knot board practice was significantly correlated with higher postclerkship scores on the knot-tying task, but only in the video group (r=.47, P<.05). CONCLUSIONS The addition of a Web-based expert instructional video to a standard curriculum, coupled with knot board practice, appears to have a positive impact on medical student knot-tying proficiency.
Collapse
Affiliation(s)
- Katarzyna Bochenska
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Magdy P Milad
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - John Ol DeLancey
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|