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Gheihman G, Harrold GK, Howard D, Albin CSW, Kaplan TB. Using Neurology Trainees as Standardized Patients in a Neurological Emergency Simulation Curriculum for Medical Students. MEDICAL SCIENCE EDUCATOR 2024; 34:589-599. [PMID: 38887414 PMCID: PMC11180045 DOI: 10.1007/s40670-024-02016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/20/2024]
Abstract
Purpose Simulation manikins have limited ability to mimic neurological exam findings, which has historically constrained their use in neurology education. We developed a cased-based simulation curriculum in which neurology trainees acted as standardized patients (SPs) and portrayed the neurologic exam for medical students. Materials/Methods We ran monthly simulations of two cases (acute stroke and seizure) with resident/fellow SPs. Pre-/post-session surveys assessed students' self-rated confidence in neurological clinical skills (gathering a history, performing an exam, presenting a case) and knowledge domains. Questions about students' attitudes about neurology were adapted from a validated assessment tool. Paired t-tests were performed for quantitative items. Qualitative thematic analysis identified key themes. Results Sixty-one students participated. Post-session, students reported significantly higher self-confidence in all neurological clinical skills and knowledge domains (p < 0.002). Greater than ninety-five percent agreed the session met the learning objectives; 95% recommended it to others. Resident/fellow SPs were cited as the most effective educational component. Students appreciated evaluating acute emergencies and reported an increased interest in neurology careers. Conclusions A case-based simulation curriculum with neurology trainees portraying the SP increased students' self-reported knowledge, skills, and confidence in managing neurological emergencies. Our intervention may improve medical student neurology education and increase interest in the field. Future research should evaluate clinical skills objectively. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-024-02016-w.
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Affiliation(s)
- Galina Gheihman
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - G. Kyle Harrold
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danielle Howard
- Department of Neurology, Tufts Medical Center, Boston, MA USA
| | | | - Tamara B. Kaplan
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Klein MR, Loke DE, Barsuk JH, Adler MD, McGaghie WC, Salzman DH. Twelve tips for developing simulation-based mastery learning clinical skills checklists. MEDICAL TEACHER 2024:1-6. [PMID: 38670308 DOI: 10.1080/0142159x.2024.2345270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Simulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid decisions. The following twelve tips are intended to help educators create defensible and effective clinical skills checklists for use in mastery learning curricula. These tips focus on defining the scope of a checklist using established principles of curriculum development, crafting the checklist based on a literature review and expert input, revising and testing the checklist, and recruiting judges to set a minimum passing standard. While this article has a particular focus on mastery learning, with the exception of the tips related to standard setting, the general principles discussed apply to the development of any clinical skills checklist.
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Affiliation(s)
- Matthew R Klein
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Dana E Loke
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jeffrey H Barsuk
- Department of Medicine (Hospital Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark D Adler
- Department of Pediatrics (Emergency Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William C McGaghie
- Department of Medical Education and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David H Salzman
- Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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McGaghie WC, Barsuk JH, Wayne DB, Issenberg SB. Powerful medical education improves health care quality and return on investment. MEDICAL TEACHER 2024; 46:46-58. [PMID: 37930940 DOI: 10.1080/0142159x.2023.2276038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. METHODS This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. RESULTS PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. CONCLUSIONS The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.
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Affiliation(s)
- William C McGaghie
- Departments of Medical Education and Preventive Medicine and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Barry Issenberg
- Departments of Medicine and Medical Education and the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Albin C, Berkowitz AL. Engaging teaching strategies in neurology: the flipped classroom and simulation training. Pract Neurol 2022; 22:pn-2022-003371. [PMID: 35863883 DOI: 10.1136/pn-2022-003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/04/2022]
Abstract
Just as neurology continues to expand its diagnostic and therapeutic modalities, so too does neurology education continue to expand in its pedagogical modalities. In this article, we describe two educational techniques-the flipped classroom and simulation-that we have incorporated in our teaching of neurology to students and doctors in training, with some practical tips for their successful implementation.
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Affiliation(s)
| | - Aaron L Berkowitz
- Neurology, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
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Wei H, Zhao H, Huang Z, Lei X, He M, Dong R, Wu J, Yue J. Treatment of status epilepticus in pediatrics: curriculum learning combined with in-situ simulations. BMC MEDICAL EDUCATION 2022; 22:557. [PMID: 35850766 PMCID: PMC9295428 DOI: 10.1186/s12909-022-03626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Appropriate and timely treatment of status epilepticus (SE) reduces morbidity and mortality. Therefore, skill-based identification and management are critical for emergency physicians. PURPOSE To assess whether the ability of training physicians, residents, nurses, and others to respond to SE as a team could be improved by using curriculum learning [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training] combined with in-situ simulations of emergency department (ED) staff. APPROACH A pre-training-post-training design was used on SE skills and teamwork skills. Emergency training, residents, and N1 and N2 nurses completed the SE skill and teamwork assessments (pre-training) through in-situ simulation. Next, the participating physicians and nurses attended the SE course [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training], followed by conscious skill practice, including in-situ simulation drills every 20 days (eight times total) and deliberate practice in the simulator. The participants completed the SE skill and teamwork assessments (post-training) again in an in-situ simulation. Pre-training-post-training simulated SE skills and teamwork performance were assessed. The simulation training evaluation showed that the training process was reasonable, and the training medical staff had different degrees of benefit in increasing subject interest, improving operational skills, theoretical knowledge, and work self-confidence. FINDINGS Sixty doctors and nurses participated in the intervention. When comparing the SE skills of 10 regular training physicians pre-training and post-training, their performance improved from 40% (interquartile range (IQR): 0-1) before training to 100% (IQR: 80.00-100) after training (p < 0.001). The teamwork ability of the 10 teams improved from 2.43 ± 0.09 before training to 3.16 ± 0.08 after training (p < 0.001). CONCLUSION SE curriculum learning combined with in-situ simulation training provides the learners with SE identification and management knowledge in children and teamwork skills.
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Affiliation(s)
- Huiping Wei
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Hui Zhao
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ziming Huang
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Xinyun Lei
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ming He
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ran Dong
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Jiannan Wu
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Jing Yue
- Department of Emergence, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
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Casolla B. Simulation for Neurology training: Acute setting and beyond. Rev Neurol (Paris) 2021; 177:1207-1213. [PMID: 34229869 DOI: 10.1016/j.neurol.2021.03.008] [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: 11/23/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 10/20/2022]
Abstract
Simulation-based training is adapted for teaching neurology, and it can offer multiple programs for general and specialized neurologists. Indeed, simulation training is "learner-centered", assuring sessions tailored to each learner level, and provides a realistic, safe, controlled and reproducible environment to improve knowledge, technical and non-technical skills, including situational awareness, communication, teamwork and leadership. Indeed, simulation tools allow multidisciplinary sessions with different team members (nurses, physician associates, specialist trainees, technicians) participating with their experiences. Multidisciplinary scenarios maximize awareness on the "human factors" and contribute to the safety of future patients. Simulation sessions require clear learning objectives and debriefing points tailored to the learning groups, but instructors may vary the scenarios in real time according to learners' actions. Different simulation techniques are applied according to learning objectives. The simulation session always includes a briefing, a simulation scenario and a structured debriefing, driven by the instructor, which is crucial for learning consolidation. In neurology training, simulation methods are applicable for: i) training on emergency situations, where the neurologist team has to manage in frontline a specific medical emergency (stroke, status epilepticus, coma, neuromuscular respiratory failure); ii) improving technical skills (lumbar puncture, electroencephalography (EEG), cervical ultrasound and transcranial Doppler, endovascular thrombectomy procedures, neuroradiological investigations); iii) improving procedures and patient pathways (stroke pathway, telemedicine); and iv) training non-technical skills (communication, teamwork, leadership). This manuscript provides a brief overview on the general principles of simulation techniques and their potential application in neurology training, in the acute setting and beyond.
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Affiliation(s)
- B Casolla
- University Côte d'Azur (UCA), Department of Neurology, Stroke unit, CHU Nice, 06000 Nice, France.
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Mass-Ramírez S, Vergara-Burgos H, Sierra-Ochoa C, Lozada-Martinez ID, Moscote-Salazar LR, Janjua T, Rahman MM, Rahman S, Picón-Jaimes YA. Utility of medical simulation in neurovascular critical care education. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Mikhaeil-Demo Y, Holmboe E, Gerard EE, Wayne DB, Cohen ER, Yamazaki K, Templer JW, Bega D, Culler GW, Bhatt AB, Shafi N, Barsuk JH. Simulation-Based Assessments and Graduating Neurology Residents' Milestones: Status Epilepticus Milestones. J Grad Med Educ 2021; 13:223-230. [PMID: 33897956 PMCID: PMC8054597 DOI: 10.4300/jgme-d-20-00832.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/05/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The American Board of Psychiatry and Neurology and the Accreditation Council for Graduate Medical Education (ACGME) developed Milestones that provide a framework for residents' assessment. However, Milestones do not provide a description for how programs should perform assessments. OBJECTIVES We evaluated graduating residents' status epilepticus (SE) identification and management skills and how they correlate with ACGME Milestones reported for epilepsy and management/treatment by their program's clinical competency committee (CCC). METHODS We performed a cohort study of graduating neurology residents from 3 academic medical centers in Chicago in 2018. We evaluated residents' skills identifying and managing SE using a simulation-based assessment (26-item checklist). Simulation-based assessment scores were compared to experience (number of SE cases each resident reported identifying and managing during residency), self-confidence in identifying and managing these cases, and their end of residency Milestones assigned by a CCC based on end-of-rotation evaluations. RESULTS Sixteen of 21 (76%) eligible residents participated in the study. Average SE checklist score was 15.6 of 26 checklist items correct (60%, SD 12.2%). There were no significant correlations between resident checklist performance and experience or self-confidence. The average participant's level of Milestone for epilepsy and management/treatment was high at 4.3 of 5 (SD 0.4) and 4.4 of 5 (SD 0.4), respectively. There were no significant associations between checklist skills performance and level of Milestone assigned. CONCLUSIONS Simulated SE skills performance of graduating neurology residents was poor. Our study suggests that end-of-rotation evaluations alone are inadequate for assigning Milestones for high-stakes clinical skills such as identification and management of SE.
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Affiliation(s)
- Yara Mikhaeil-Demo
- Yara Mikhaeil-Demo, MD, is Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Eric Holmboe
- Eric Holmboe, MD, MACP, FRCP, is Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education (ACGME)
| | - Elizabeth E. Gerard
- Elizabeth E. Gerard, MD, is Director, Clinical Neurophysiology Fellowship, and Associate Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Diane B. Wayne
- Diane B. Wayne, MD, is Vice Dean for Education, Chair, Department of Medical Education, and Professor of Medicine and Medical Education, Northwestern University, Feinberg School of Medicine
| | - Elaine R. Cohen
- Elaine R. Cohen, MEd, is Research Associate, Department of Medicine, Northwestern University, Feinberg School of Medicine
| | - Kenji Yamazaki
- Kenji Yamazaki, PhD, is Senior Analyst, Milestones Research and Evaluation, ACGME
| | - Jessica W. Templer
- Jessica W. Templer, MD, is Director, Epilepsy Fellowship, and Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Danny Bega
- Danny Bega, MD, is Director, Neurology Residency Program, and Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - George W. Culler
- George W. Culler, MD, is Epilepsy Fellow, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Amar B. Bhatt
- Amar B. Bhatt, MD, is Assistant Professor, Department of Neurological Sciences, Rush University
| | - Neelofer Shafi
- Neelofer Shafi, MD, is Director, Students and Faculty Development, and Assistant Professor, Department of Neurology and Rehabilitation, University of Illinois Chicago
| | - Jeffrey H. Barsuk
- Jeffrey H. Barsuk, MD, MS, is Director, Simulation and Patient Safety, and Professor of Medicine and Medical Education, Northwestern University, Feinberg School of Medicine
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