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Dascalu CG, Topoliceanu C, Antohe ME. Instructional Videos for Students in Dental Medicine: Rules of Design and Correlations with Their Habits as Internet Consumers. Eur J Investig Health Psychol Educ 2024; 14:1627-1646. [PMID: 38921074 PMCID: PMC11202797 DOI: 10.3390/ejihpe14060108] [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: 04/22/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Multimedia resources, such as instructional videos, are currently enjoying a certain popularity in the training programs for medical and dental students. The major challenge is to create such resources with quality content that is approved by students. In order to answer this challenge, it is imperative to find out which features of instructional videos are considered to be necessary and useful by students, thus being able to excite them, to hold their attention, and to stimulate them in learning with pleasure. AIM We investigated the opinions of a sample of 551 students from four medical universities in Romania, in order to identify the students' preferred characteristics in instructional videos, both globally and comparatively on genders and age groups and also according to their general preferences for using internet services. MATERIAL AND METHODS We used univariate (hypothesis testing) and multivariate (two-step clustering) data analysis techniques and revealed three clusters of students, primarily determined by their perceptions of the visual appearance of the instructional videos. RESULTS The structure of the clusters by gender and age group was relatively similar, but we recorded differences associated with the students' expressed preferences for certain internet services compared to others. The first identified cluster (35.4% of the cases) contains students who prefer instructional videos to contain images used only for aesthetic purposes and to fill the gaps; they use internet services mainly for communication. The second cluster of students (34.8%) prefers videos designed as practical lessons, using explanatory drawings and diagrams drawn at the same time as the explanations; they also use internet services mainly for communication. The last cluster of students (29.8%) prefer videos designed as PowerPoint presentations, with animated pictures, diagrams, and drawings; they are slightly younger than the others and use internet services mainly for information and communication, but also for domestic facilities. CONCLUSIONS The students' preferences for certain features of instructional videos depend not only on gender and age but are also related to their developmental background and general opinions about modern technologies.
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Affiliation(s)
- Cristina Gena Dascalu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania
| | - Claudiu Topoliceanu
- Department of Odontology, Periodontology, Fixed Restorations, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania;
| | - Magda Ecaterina Antohe
- Department of Implantology, Removable Dentures, Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania;
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Komasawa N. Revitalizing Postoperative Pain Management in Enhanced Recovery After Surgery via Inter-departmental Collaboration Toward Precision Medicine: A Narrative Review. Cureus 2024; 16:e59031. [PMID: 38800337 PMCID: PMC11127797 DOI: 10.7759/cureus.59031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
This narrative review explores the crucial aspects of postoperative pain management within the framework of Enhanced Recovery After Surgery (ERAS). It emphasizes the significance of effective and secure pain management, highlighting its impact on patient well-being, surgical outcomes, and hospital stays. The inadequacy of perioperative pain relief increases the risk of persistent postoperative pain, emphasizing the need to challenge the notion that pain is expected after surgery. The goals of postoperative pain management extend beyond mere relief, encompassing comfortable sleep, pain-free rest, and liberation from pain during initial recovery. Inadequate pain management can lead to complications such as heightened postoperative bleeding and an increased risk of thrombosis. The review delves into various analgesic methods, their complications, and safety measures. ERAS programs, focused on reducing complications and medical costs, emphasize the importance of judicious postoperative pain management and active rehabilitation. The review discusses complications associated with analgesic methods like opioids, epidural analgesia, and adjuvant analgesics. Collaboration within the perioperative management team is crucial for effective postoperative pain relief. Interdepartmental collaboration is essential for evaluating surgical procedures, analgesic methods, and crisis management strategies. The review concludes by integrating precision medicine into postoperative pain management, emphasizing the potential of genetic information in assessing pain sensitivity. It underscores the importance of inter-departmental collaboration and information gathering for the successful implementation of precision medicine tailored to each facility's perioperative management systems. Additionally, the impact of artificial intelligence (AI) on preoperative risk assessment and innovative monitoring techniques is discussed, paving the way for the advancement of precision medicine in postoperative pain management.
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Affiliation(s)
- Nobuyasu Komasawa
- Community Medicine Education Promotion Office, Faculty of Medicine, Kagawa University, Miki-cho, JPN
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Imanipour M, Mirzaeipour F, Hazaryan M. Effectiveness of feedback type on performance quality and satisfaction of nursing student: A comparative interventional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:324. [PMID: 38023073 PMCID: PMC10670950 DOI: 10.4103/jehp.jehp_1178_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/21/2022] [Indexed: 12/01/2023]
Abstract
BACKGROUND Although feedback has a major impact on teaching and learning, the type and way of providing it can have diverse effects. The purpose of this study was to compare the effect of two types of verbal and written feedback on nursing students' performance quality and satisfaction. MATERIALS AND METHODS This experimental study, that carried out in 2019, has a crossover design. The participants included 30 bachelors of science in nursing at Shushtar Faculty of Medical Sciences, who were assigned to two groups of 15. The first group received first verbal feedback and then written, during basic nursing skills training. The second group received first written feedback and then verbal. At the end of each half of the training sessions, students' performance and their satisfaction were assessed by, researchermade observational checklists, and a satisfaction questionnaire, respectively. Data were analyzed using SPSS16 software and analyzed using Chi-square and paired t test. Significance level < 0.01 was considered. RESULTS The mean scores of students' performance in the stages of verbal and written feedback were 15.7 ± 2.5 and 17.7 ± 2.3, respectively. Written feedback was more effective in students' performance (P = 0.001) and students were more satisfied with this type of feedback (P = 0.001). CONCLUSIONS According to the present study, using written feedback can improve the quality of students' performances and is associated with high satisfaction. Thus, professors should pay more attention to feedback in their educational processes and use different types of feedback, especially written feedback, in line with the context.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center (NMCRC), Tehran University of Medical Sciences, Tehran, Iran
- Critical Care Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Hazaryan
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Kerr CL, Abdulghani M, Smith C, Khosa DK. Randomized Trial Comparing Instructor-Delivered Feedback with Self-Assessment Using Video during Basic Skills Training. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:790-798. [PMID: 34807806 DOI: 10.3138/jvme-2021-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Feedback has been shown to be one of the most powerful and effective influences on student achievement; however, the optimal method for providing feedback to trainees during veterinary skills training has yet to be determined. A prospective mixed-methods study was undertaken to evaluate student perceptions and performance outcomes with self-assessment using video- or instructor-delivered feedback during skills training using a model. Forty participants naïve to intravenous (IV) catheter placement were randomly assigned either to self-assessment using video or to instructor-directed feedback. A questionnaire probing participants' perceptions of their knowledge level and confidence in their skills was completed before and after the training, and an interview was done at study completion. Final skill performance was recorded using video capture to permit blind evaluations using a standard assessment tool. A quantitative evaluation of the performance and questionnaire scores, as well as a qualitative assessment of the interviews, was performed. Questionnaire scores were significantly higher in the post-study questionnaire for 12 of the 14 questions in both groups. Students assigned to the instructor-directed group had significantly higher scores than students in the self-directed group on the skill performance (p < .05). Self-reported confidence in knowledge and skill related to the IV catheterization technique improved with both self-directed feedback using video and instructor-directed feedback. Skill performance, however, was superior following instructor-directed feedback. Participants expressed positive experiences associated with use of the models for skills training, the value of the learning materials including the video, and guidance during learning.
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Aldinc H, Gun C, Yaylaci S, Senuren CO, Guven F, Sahiner M, Kayayurt K, Turkmen S. Comparison of self versus expert-assisted feedback for cricothyroidotomy training: a randomized trial. BMC MEDICAL EDUCATION 2022; 22:455. [PMID: 35701782 PMCID: PMC9199165 DOI: 10.1186/s12909-022-03519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of two video feedback methods by comparing the improvement in performing cricothyroidotomy procedure following self video feedback (trainees review their performance by themselves) and expert-assisted video feedback (trainees review their performance while an emergency physician provides additional feedback). METHODS This study was pretest-posttest and two-group designed research performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. After seeing an educational presentation and a best practice video, trainees were randomized into two groups; self video feedback group (SVFG) and expert-assisted video feedback group (EVFG). They performed the cricothyroidotomy before and after the feedback. The procedures were also recorded and scored by two emergency physicians. RESULTS There was a statistically significant improvement between pre-feedback and post-feedback assessments in terms of scores received and time needed for the procedures in both SVFG and EVFG groups (p < 0.05). Additionally, the post-feedback assessment scores were higher and time needed for the procedure was lower in the EVFG when compared with SVFG (p < 0.05 for both). CONCLUSIONS Results demonstrated significant improvement in cricothyroidotomy performance with both types of video feedback method. Even though the improvement was better in the EVFG compared to the SVFG, the self video feedback may have value especially in situations where expert-assisted feedback is not possible.
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Affiliation(s)
- Hasan Aldinc
- Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cem Gun
- Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Serpil Yaylaci
- Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cigdem Ozkaya Senuren
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Feray Guven
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Melike Sahiner
- Department of Medical Education, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Kamil Kayayurt
- Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Suha Turkmen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
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Nagayo Y, Saito T, Oyama H. Augmented reality self-training system for suturing in open surgery: A randomized controlled trial. Int J Surg 2022; 102:106650. [PMID: 35525415 DOI: 10.1016/j.ijsu.2022.106650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Existing self-training materials are insufficient to learn open surgical procedures, and a new self-training system that provides three-dimensional procedural information is needed. The effectiveness and usability of a self-training system providing three-dimensional information by augmented reality (AR) were compared to those of an existing self-training system, instructional video, in self-learning of suturing in open surgery. MATERIALS AND METHODS This was a prospective, evaluator-blinded, randomized, controlled study. Medical students who were suturing novices were randomized into 2 groups: practice with the AR training system (AR group) or an instructional video (video group). Participants were instructed in subcuticular interrupted suture and each training system and watched the instructional video once. They then completed a pretest performing the suture on a skin pad. Participants in each group practiced the procedure 10 times using each training system, followed by a posttest. The pretest and posttest were video-recorded and graded by blinded evaluators using a validated scoring form composed of global rating (GR) and task-specific (TS) subscales. Students completed a post-study questionnaire assessing system usability, each system's usefulness, and their confidence and interest in surgery. RESULTS Nineteen participants in each group completed the trial. No significant difference was found between the AR and video groups on the improvement of the scores from pretest to posttest (GR: p = 0.54, TS: p = 0.91). The posttest scores of both GR and TS improved significantly from pretest in both groups (GR: both p < 0.001, TS: both p < 0.001). There was no significant difference between the groups in the system usability scale scores (p = 0.38). The motion provided in the AR system was more helpful for manipulating surgical instruments than the video (p = 0.02). CONCLUSION The AR system was considered as understandable and easy to use as the instructional video in learning suture technique in open surgery for novices.
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Affiliation(s)
- Yuri Nagayo
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Toki Saito
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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Nathan A, Fricker M, Georgi M, Patel S, Hang MK, Asif A, Sinha A, Mullins W, Shea J, Hanna N, Monks M, Peprah D, Sharma A, Ninkovic-Hall G, Lamb BW, Kelly J, Sridhar A, Collins JW. Virtual Interactive Surgical Skills Classroom: A Parallel-group, Non-inferiority, Adjudicator-blinded, Randomised Controlled Trial (VIRTUAL). JOURNAL OF SURGICAL EDUCATION 2022; 79:791-801. [PMID: 34857499 DOI: 10.1016/j.jsurg.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study evaluated the efficacy of virtual classroom training (VCT) in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. DESIGN This was a parallel-group, non-inferiority, prospective randomised controlled trial with three intervention groups conducted in 2021. There were three intervention groups with allocation ratio 1:1:1. Outcome adjudicators were blinded to intervention assignment. Interventions consisted of 90-minute training sessions. VCT was delivered via the BARCO weConnect platform, FFT was provided in-person by expert instructors and CBL was carried out by participants independently. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills score, adjudicated by two experts and adjusted for baseline proficiency. The assessed task was to place three interrupted sutures with hand-tied knots. SETTING This multicentre study recruited from five medical schools in London. PARTICIPANTS Inclusion criteria were medical student status and access to a personal computer and smartphone. One hundred fifty-nine eligible individuals applied online. Seventy-two participants were randomly selected and stratified by subjective and objective suturing experience prior to permuted block randomization. RESULTS Twenty-four participants were allocated to each intervention, all were analysed per-protocol. The sample was 65.3% female with mean age 21.3 (SD 2.1). VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI: 0.41-2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI: 0.20-2.29). The costs per-attendee associated with VCT, FFT and CBL were £22.15, £39.69 and £16.33 respectively. Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively. CONCLUSIONS VCT provides greater accessibility and resource efficiency compared to FFT, with similar educational benefit. VCT has the potential to improve global availability and accessibility of surgical skills training.
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Affiliation(s)
- Arjun Nathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Monty Fricker
- School of Medicine, Newcastle University, Newcastle, United Kingdom
| | - Maria Georgi
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Sonam Patel
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Man Kien Hang
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Amil Sinha
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - William Mullins
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jessie Shea
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nancy Hanna
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Massimo Monks
- Department of Surgery, North Middlesex University Hospitals NHS Foundation Trust, London, United Kingdom
| | - David Peprah
- Department of Surgery, North Middlesex University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Akash Sharma
- Department of Radiology, Imperial College London, London, United Kingdom
| | - George Ninkovic-Hall
- Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Justin W Collins
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Battaglia F, Ivankovic V, Merlano M, Patel V, Sayed C, Wang H, McConnell M, Rastogi N. A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:34-39. [PMID: 34804286 PMCID: PMC8603885 DOI: 10.36834/cmej.71483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. METHODS A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. RESULTS Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. CONCLUSION Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students' transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.
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Affiliation(s)
- Frank Battaglia
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Maria Merlano
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Vishesh Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Céline Sayed
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Hao Wang
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Meghan McConnell
- Department of Innovation in Medical Education, University of Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
| | - Nikhil Rastogi
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
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Mikhail D, Margolin EJ, Sfakianos J, Clifton M, Sorenson M, Thavaseelan S, Haleblian G, Kavoussi L, Badalato GM, Richstone L. Changing the Status Quo: Developing a Virtual Sub-Internship in the Era of COVID-19. JOURNAL OF SURGICAL EDUCATION 2021; 78:1544-1555. [PMID: 33896734 PMCID: PMC8419923 DOI: 10.1016/j.jsurg.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 05/10/2023]
Abstract
PROBLEM Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships - negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU). METHODS The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the "vSIU Guidebook." RESULTS The vSIU Guidebook contains 212 pages - 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally. NEXT STEPS The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.
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Affiliation(s)
- David Mikhail
- Department of Urology, Northwell Health, New York, New York.
| | - Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | | | - Marisa Clifton
- Department of Urology, Johns Hopkins, Baltimore, Maryland
| | - Mathew Sorenson
- Department of Urology, University of Washington, Seattle, Washington
| | | | - George Haleblian
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Louis Kavoussi
- Department of Urology, Northwell Health, New York, New York
| | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Lee Richstone
- Department of Urology, Northwell Health, New York, New York
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Martinelli SM, Chen F, Isaak RS, Huffmyer JL, Neves SE, Mitchell JD. Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond. Anesth Analg 2021; 132:585-593. [PMID: 33201006 DOI: 10.1213/ane.0000000000005333] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision article discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19, and evidence for these modifications, and suggests future directions for anesthesiology education. Learning management systems provide structure to online learning. They have been increasingly utilized to improve access to didactic materials asynchronously. Despite some historic reservations, the pandemic has necessitated a rapid uptake across programs. Commercially available systems offer a wide range of peer-reviewed curricular options. The flipped classroom promotes learning foundational knowledge before teaching sessions with a focus on application during structured didactics. There is growing evidence that this approach is preferred by learners and may increase knowledge gain. The flipped classroom works well with learning management systems to disseminate focused preclass work. Care must be taken to keep virtual sessions interactive. Simulation, already used in anesthesiology, has been critical in preparation for the care of COVID-19 patients. Multidisciplinary, in situ simulations allow for rapid dissemination of new team workflows. Physical distancing and reduced availability of providers have required more sessions. Early pandemic decreases in operating volumes have allowed for this; future planning will have to incorporate smaller groups, sanitizing of equipment, and attention to use of personal protective equipment. Effective technical skills training requires instruction to mastery levels, use of deliberate practice, and high-quality feedback. Reduced sizes of skill-training workshops and approaches for feedback that are not in-person will be required. Mock oral and objective structured clinical examination (OSCE) allow for training and assessment of competencies often not addressed otherwise. They provide formative and summative data and objective measurements of Accreditation Council for Graduate Medical Education (ACGME) milestones. They also allow for preparation for the American Board of Anesthesiology (ABA) APPLIED examination. Adaptations to teleconferencing or videoconferencing can allow for continued use. Benefits of teaching in this new era include enhanced availability of asynchronous learning and opportunities to apply universal, expert-driven curricula. Burdens include decreased social interactions and potential need for an increased amount of smaller, live sessions. Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.
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Affiliation(s)
- Susan M Martinelli
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Fei Chen
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Robert S Isaak
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Sara E Neves
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - John D Mitchell
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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11
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Chartrand G, Soucisse M, Dubé P, Trépanier JS, Drolet P, Sideris L. Self-directed learning by video as a means to improve technical skills in surgery residents: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:91. [PMID: 33546679 PMCID: PMC7863545 DOI: 10.1186/s12909-021-02524-y] [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: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND With their demanding schedules, surgical residents have limited time to practice techniques. The aim is to evaluate the pedagogic model of self-directed learning using video in surgery residents. METHODS Informed consent was obtained from all the participants. A randomized controlled trial was conducted in 2018 at Hôpital Maisonneuve-Rosemont (University of Montreal). Participants were general surgery residents. There were 27 eligible residents; 22 completed the study. They were filmed performing an intestinal anastomosis on cadaveric pig bowel. The self-directed learning by video (SDL-V) group was given an expert video, which demonstrated the technique performed by an experienced surgeon. The control group continued with their regular duties. Three weeks later, participants performed a second filmed anastomosis. Two attending surgeons evaluated the residents' filmed anastomosis using the Objective Structured Assessment of Technical Skills scale. After their second anastomosis, all participants had access to the expert video and completed a survey. RESULTS Score did not differ significantly between groups during the first (control: 23.6 (4.5) vs. SDL-V: 23.9 (4.5), p = 0.99, presented as mean (SD)) or second filmed anastomosis procedure (control: 27.1 (3.9) vs. SDL-V: 29.6 (3.4) p = 0.28). Both groups improved significantly from pre- to post-intervention (mean difference between the two anastomosis procedure with 95% CI for control: 3.5, [1.1; 5.9] and for SDL-V: 5.8, [3.4: 8.2]). Correlation between the evaluators for score was moderate (r = 0.6, 95% CI: [0.3: 0.8]). The pass/fail global evaluation exhibited poor inter-rater reliability (Kappa: 0.105, 95% CI: [- 0.2:0.4]). On the survey, all participants wanted more expert-made videos of specific surgical techniques. CONCLUSIONS Despite a higher final OSATS score for the intervention group, self-directed learning by video failed to produce a statistically significant difference on the overall OSATS scores between the two groups in this small cohort.
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Affiliation(s)
- Geneviève Chartrand
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - Mikael Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Jean-Sébastien Trépanier
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Drolet
- Centre d'acquisition des attitudes et habiletés cliniques, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
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Patel R, Green W, Shahzad MW, Church H, Sandars J. Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing. MEDICAL TEACHER 2020; 42:886-895. [PMID: 32301633 DOI: 10.1080/0142159x.2020.1748183] [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: 06/11/2023]
Abstract
Introduction: Medical school graduates in the UK consistently report feeling underprepared for the task of prescribing when embarking on practice. The effective application of self-regulated learning (SRL) approaches and feedback on complex tasks are associated with improved outcomes in practice-based clinical skills.Aims: This study aimed to investigate the effectiveness of an educational intervention using SRL-enhanced video feedback for improving the prescribing competency of junior doctors.Methods: A prospective cohort study was designed to compare intervention and control cohorts of junior doctors undertaking simulated clinical encounters at the beginning and end of their 4-month rotation through renal medicine.Results: The improvement in prescribing competency for the intervention cohort was significant (p < 0.001) with large effect size (d = 1.42). Self-efficacy improved in both cohorts with large (control cohort p = 0.026, r= 0.64) and medium (intervention cohort p = 0.083, d = 0.55) effect sizes. Goal setting and self-monitoring skills improved in the intervention cohort only with medium effect size (p = 0.096, d = 0.53).Conclusions: SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and self-monitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.
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Affiliation(s)
- Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
| | - William Green
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Muhammad Waseem Shahzad
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Helen Church
- School of Medicine, University of Nottingham, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University Medical School, Ormskirk, UK
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Green W, Shahzad MW, Wood S, Martinez Martinez M, Baines A, Navid A, Jay R, Whysall Z, Sandars J, Patel R. Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice. Br J Clin Pharmacol 2020; 86:2234-2246. [PMID: 32343422 PMCID: PMC7576627 DOI: 10.1111/bcp.14325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. METHODS Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness. RESULTS There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention. CONCLUSION Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.
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Affiliation(s)
- William Green
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | | | - Stephen Wood
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Maria Martinez Martinez
- Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, UK
| | - Andrew Baines
- Pilgrim Hospital Boston, United Lincolnshire Hospitals (ULH) NHS Trust, Boston, Lincolnshire, UK
| | - Ahmad Navid
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Robert Jay
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Zara Whysall
- Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
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Matthan J, Gray M, Nesbitt CI, Bookless L, Stansby G, Phillips A. Perceived Anxiety is Negligible in Medical Students Receiving Video Feedback During Simulated Core Practical Skills Teaching: A Randomised Trial Comparing Two Feedback Modalities. Cureus 2020; 12:e7486. [PMID: 32351863 PMCID: PMC7188453 DOI: 10.7759/cureus.7486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The ability to undertake simple practical procedures is essential for graduating medical students and is typically assessed using simulated models. Feedback is a key component of the learning process in developing proficiency in these key skills. Video feedback (VF) has previously shown promise, however, negative effects of VF-related anxiety on performance have been previously reported. Our aim was to investigate for a difference in participant anxiety between supervised individualised video feedback (SIVF) and unsupervised generic video feedback (UGVF) when undertaking simulated basic practical procedures. Methods Undergraduate medical students participating in a clinical skills study to compare UGVF and SIVF completed a Likert scale questionnaire detailing perceived anxiety. During the study, students were recorded performing three basic surgical skills (simple interrupted suturing, intravenous cannulation, urinary catheterisation). Feedback was then provided by one of two methods: (1) SIVF - participant video footage reviewed together with a tutor providing targeted feedback, and (2) UGVF - participant video footage reviewed alone with concurrent access to a generic pre-recorded ‘expert tips' video clip for comparison. Each participant received SIVF and UGVF at least once. Results The majority of participants did not find either SIVF (81.7%) or UGVF (78.8%) stressful. Students had a strong preference for SIVF (77.5%) and disagreed that similar ‘face-to-face’ feedback had impaired learning in the past (80.3%). Conclusion Medical student-perceived anxiety is negligible when video feedback is employed during simulated core practical skill training.
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Affiliation(s)
- Joanna Matthan
- Dental Sciences, Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, GBR
| | - Matthew Gray
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle upon Tyne, GBR
| | - Craig I Nesbitt
- Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, GBR
| | - Lucy Bookless
- Surgery, Northumbria Healthcare Trust, Newcastle upon Tyne, GBR
| | - Gerard Stansby
- Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, GBR
| | - Alexander Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, GBR
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Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology. Anesthesiology 2020; 131:908-928. [PMID: 31365369 DOI: 10.1097/aln.0000000000002827] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.
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Effectiveness of Video-Assisted Debriefing in Simulation-Based Health Professions Education. Nurse Educ 2019; 44:E1-E6. [DOI: 10.1097/nne.0000000000000562] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pedagogical Perspectives on the Use of Technology within Medical Curricula: Moving Away from Norm Driven Implementation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1120:55-65. [DOI: 10.1007/978-3-030-06070-1_5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rammell J, Matthan J, Gray M, Bookless LR, Nesbitt CI, Rodham P, Moss J, Stansby G, Phillips AW. Asynchronous Unsupervised Video-Enhanced Feedback As Effective As Direct Expert Feedback in the Long-Term Retention of Practical Clinical Skills: Randomised Trial Comparing 2 Feedback Methods in a Cohort of Novice Medical Students. JOURNAL OF SURGICAL EDUCATION 2018; 75:1463-1470. [PMID: 29748142 DOI: 10.1016/j.jsurg.2018.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the degree of practical clinical skills' retention over a 7-week period after receiving either video-enhanced direct expert feedback (DEF) or asynchronous unsupervised video-enhanced feedback (UVF). DESIGN A prospective single-blinded randomized trial was conducted over a 7-week period with novice medical students. Following a generic introduction, PowerPoint presentation and live demonstration of intravenous cannulation was given by an expert, and candidates performed the same task in isolation while being recorded and were randomized to receive either DEF or UVF. Further, 20 students were randomized to receive UVF and 22 to receive DEF. Candidates returned to repeat the video-recorded task at week 1, 4, and 7, with no further feedback provision on these occasions. Performances were fully anonymized and independently marked by 2 expert assessors. SETTING Newcastle University, Medical School, England, United Kingdom. PARTICIPANTS A total of 42 novice medical students from the preclinical years were selected, with no prior experience of intravenous cannulation. RESULTS No significant difference existed between demographics of either cohort. Good between-assessor score correlation was noted, with an intraclass correlation coefficient (ICC) of 0.89. The DEF arm significantly improved from their prefeedback performance at Day 1 on repeating the skill a week later (p < 0.0001); this improved score was maintained throughout the duration of the study. The UVF arm showed a nonsignificant improvement; however, there was no significant difference in the scores between the UVF and the DEF groups at any point in the trial. CONCLUSIONS Video-technology may play a significant role in the provision of feedback for practical skills. The ability for experts to provide remotely delivered but individualized feedback can be an efficient use of valuable resources, while students being able to self-assess their own performance alongside an expert video have the potential to provide students with an excellent opportunity to learn clinical skills without requiring intensive educator involvement.
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Affiliation(s)
- James Rammell
- North Tees and Hartlepool NHS Foundation Trust, Stockton, United Kingdom.
| | - Joanna Matthan
- Faculty of Medical Sciences, School of Medical Education, Newcastle University, Newcastle, United Kingdom
| | - Matthew Gray
- County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom
| | - Lucy R Bookless
- County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom
| | - Craig I Nesbitt
- Newcastle Upon Tyne Hospitals NHS foundation Trust, Newcastle, United Kingdom
| | - Paul Rodham
- Newcastle Upon Tyne Hospitals NHS foundation Trust, Newcastle, United Kingdom
| | - John Moss
- Faculty of Medical Sciences, School of Medical Education, Newcastle University, Newcastle, United Kingdom
| | - Gerard Stansby
- Newcastle Upon Tyne Hospitals NHS foundation Trust, Newcastle, United Kingdom
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