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Yohannan DG, Oommen AM, Kumar AS, Devanand S, Ut MR, Sajan N, Thomas NE, Anzer N, Raju NK, Thomas B, Rajan JE, Govindapillai UK, Harish P, Kapilamoorthy TR, Kesavadas C, Sivaswamy J. "Visualization matters" - stereoscopic visualization of 3D graphic neuroanatomic models through AnaVu enhances basic recall and radiologic anatomy learning when compared with monoscopy. BMC MEDICAL EDUCATION 2024; 24:932. [PMID: 39192274 DOI: 10.1186/s12909-024-05910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND The authors had previously developed AnaVu, a low-resource 3D visualization tool for stereoscopic/monoscopic projection of 3D models generated from pre-segmented MRI neuroimaging data. However, its utility in neuroanatomical education compared to conventional methods (specifically whether the stereoscopic or monoscopic mode is more effective) is still unclear. METHODS A three-limb randomized controlled trial was designed. A sample (n = 152) from the 2022 cohort of MBBS students at Government Medical College, Thiruvananthapuram (GMCT), was randomly selected from those who gave informed consent. After a one-hour introductory lecture on brainstem anatomy and a dissection session, students were randomized to three groups (S - Stereo; M - Mono and C - Control). S was given a 20-min demonstration on the brainstem lesson module in AnaVu in stereoscopic mode. M was given the same demonstration, but in monoscopic mode. The C group was taught using white-board drawn diagrams. Pre-intervention and post-intervention tests for four domains (basic recall, analytical, radiological anatomy and diagram-based questions) were conducted before and after the intervention. Cognitive loads were measured using a pre-validated tool. The groups were then swapped -S→ M, M →S and C→S, and they were asked to compare the modes. RESULTS For basic recall questions, there was a statistically significant increase in the pre/post-intervention score difference of the S group when compared to the M group [p = 0.03; post hoc analysis, Bonferroni corrections applied] and the C group [p = 0.001; ANOVA test; post hoc analysis, Bonferroni corrections applied]. For radiological anatomy questions, the difference was significantly higher for S compared to C [p < 0.001; ANOVA test; post hoc analysis, Bonferroni corrections applied]. Cognitive load scores showed increased mean germane load for S (33.28 ± 5.35) and M (32.80 ± 7.91) compared with C (28.18 ± 8.17). Subjective feedbacks showed general advantage for S and M compared to C. Out of the S and M swap cohorts, 79/102 preferred S, 13/102 preferred M, and 6/102 preferred both. CONCLUSIONS AnaVu tool seems to be effective for learning neuroanatomy. The specific advantage seen when taught with stereoscopy in basic recall and radiological anatomy learning shows the importance of how visualization mode influences neuroanatomy learning. Since both S and M are preferred in subjective feedbacks, these results have implications in choosing methods (stereoscopic - needs 3D projectors; monoscopic - needs web based or hand-held devices) to scale AnaVu for anatomy teaching in medical colleges in India. Since stereoscopic projection is technically novel and cost considerations are slightly higher compared to monoscopic projection, the specific advantages and disadvantages of each are relevant in the Indian medical education scenario.
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Affiliation(s)
- Doris George Yohannan
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India.
| | - Aswathy Maria Oommen
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Amruth S Kumar
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - S Devanand
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Minha Resivi Ut
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Navya Sajan
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Neha Elizabeth Thomas
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Nasreen Anzer
- Department of Anatomy, Government Medical College, Thiruvananthapuram (GMCT), Thiruvananthapuram, India
| | - Nithin Kadakampallil Raju
- Department of Anatomy, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chithra Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Jayadevan Enakshy Rajan
- Department of Imaging Sciences and Interventional Radiology, Sree Chithra Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | | | | | - Tirur Raman Kapilamoorthy
- Department of Imaging Sciences and Interventional Radiology, Sree Chithra Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chithra Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
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Robinson SJ, Yin Mar Oo, Ljuhar D, McLeod E, Pacilli M, Nataraja RM. A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries. ANZ J Surg 2024; 94:1011-1020. [PMID: 38553885 DOI: 10.1111/ans.18987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/16/2024] [Accepted: 03/13/2024] [Indexed: 06/19/2024]
Abstract
Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation. This review provides a framework for conducting outcome evaluation of simulation-based education programmes in low and middle-income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation-based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower-middle-income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed-methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low-resource settings to evaluate their own activities.
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Affiliation(s)
- Samuel Ja Robinson
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Yin Mar Oo
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - Damir Ljuhar
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth McLeod
- Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
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Issa M, Furia F, Whaiba A, Meaney PA, Shilkofski N, Donoghue A, Lockey A. Physical Realism of Simulation Training for Health Care in Low- and Middle-Income Countries-A Systematic Review. Simul Healthc 2024; 19:S41-S49. [PMID: 38240617 DOI: 10.1097/sih.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT This systematic review was conducted, according to PRISMA standards, to examine the impact of the level of physical realism of simulation training on clinical, educational, and procedural outcomes in low- and middle-income countries (LMICs) as defined by the World Bank. A search from January 1, 2011 to January 24, 2023 identified 2311 studies that met the inclusion criteria including 9 randomized (n = 627) and 2 case-controlled studies (n = 159). Due to the high risk of bias and inconsistency, the certainty of evidence was very low, and heterogeneity prevented any metaanalysis. We observed limited evidence for desirable effects in participant satisfaction and confidence, but no significant difference in skills acquisition and performance in the clinical practice environment. When considering the equivocal evidence and cost implications, we recommend the use of lower physical realism simulation training in LMIC settings. It is important to standardize outcomes and conduct more studies in lower income settings.
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Affiliation(s)
- Moussa Issa
- From the Emergency Department (M.I., A.L., A.W.), Calderdale & Huddersfield NHS Trust, Halifax, UK; Department of Pediatrics and Child Health (F.F.), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Pediatrics (P.A.M.), Stanford University School of Medicine, Palo Alto, CA; Departments of Pediatrics and Anesthesiology/Critical Care Medicine (N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Critical Care and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK
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Jaffry Z, Sabawo M, Harrison WJ, Schade AT. Using a consensus meeting to enhance fracture care education in low income countries. BMC MEDICAL EDUCATION 2023; 23:111. [PMID: 36793036 PMCID: PMC9930265 DOI: 10.1186/s12909-023-04077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A key strategy to building surgical capacity in low income countries involves training care providers, particularly in the interventions highlighted by the Lancet Commission for Global Surgery, including the management of open fractures. This is a common injury, especially in areas with a high incidence of road traffic incidents. The aim of this study was to use a nominal group consensus method to design a course on open fracture management for clinical officers in Malawi. METHODS The nominal group meeting was held over two days, including clinical officers and surgeons from Malawi and the UK with various levels of expertise in the fields of global surgery, orthopaedics and education. The group was posed with questions on course content, delivery and evaluation. Each participant was encouraged to suggest an answer and the advantages and disadvantages of each suggestion were discussed before voting through an anonymous online platform. Voting included use of a Likert scale or ranking available options. Ethical approval for this process was obtained from the College of Medicine Research and Ethics Committee Malawi and the Liverpool School of Tropical Medicine. RESULTS All suggested course topics received an average score of greater than 8 out of 10 on a Likert scale and were included in the final programme. Videos was the highest ranking option as a method for delivering pre-course material. The highest ranking methods for each course topic included lectures, videos and practicals. When asked what practical skill should be tested at the end of the course, the highest ranking option was "initial assessment". CONCLUSION This work outlines how a consensus meeting can be used to design an educational intervention to improve patient care and outcomes. Through combining the perspectives of both the trainer and trainee, the course aligns both agendas so that it is relevant and sustainable.
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Affiliation(s)
| | | | - William J Harrison
- Countess of Chester Hospital NHS Trust, London, UK
- AO Alliance Africa, Davos, Switzerland
| | - Alexander T Schade
- Malawi- Liverpool Wellcome Trust, Blantyre, Malawi.
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Ayaz O, Ismail FW. Healthcare Simulation: A Key to the Future of Medical Education - A Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:301-308. [PMID: 35411198 PMCID: PMC8994530 DOI: 10.2147/amep.s353777] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
Aim Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education. Purpose To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides. Conclusion Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.
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Affiliation(s)
- Omair Ayaz
- Aga Khan University Medical College, Karachi, Sindh, Pakistan
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Moore M, Mabedi C, Phull M, Payne SR, Biyani CS. The utility of Urological Clinical and Simulation Training for Sub-Saharan Africa. BJU Int 2022; 129:563-571. [PMID: 35338556 DOI: 10.1111/bju.15731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Madeline Moore
- Urology Registrar Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Charles Mabedi
- Consultant Urologist, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Stephen R Payne
- Urolink Secretary, British Association of Urological Surgeons
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Co-Director Surgical Cadaveric Simulation Lab, University of Leeds, Leeds
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