Undergraduate education in anaesthesia, intensive care, pain, and perioperative medicine: The development of a national curriculum framework

Co-creation in healthcare and research to improve service delivery for young people with chronic pain

Introduction

The process of co-creation can enable more effective, agile and integrated healthcare solutions achieving outcomes that effectively translate to healthcare delivery. Collaborative knowledge generation is particularly important in fields such as pediatric chronic pain where there is a complex interplay between biological, social, environmental, emotional, familial and school factors. The co-creation initiative described here was designed to amplify the voices of youth with chronic pain and their families and a variety of key stakeholders and generate novel approaches to the management of chronic pediatric pain in the setting of the South Australian Pediatric Chronic Pain Service.

Methods

Stakeholders who were identified as influential in this ecosystem were allocated to 6 groups. A skilled facilitator co-prepared and delivered the workshop, engaging participants in three structured activities. Firstly, the challenges to service delivery were outlined, followed by the groups discussing what is currently working. The second activity involved lateral thinking without restrictions on time, resources or system to generate solutions to the key challenges presented. Finally, stakeholders were asked to agree on a generated solution from Activity 2 and build a case for actionable implementation of this solution. Data were summarised by the workshop facilitator and reflexive thematic analysis was used for coding and generating themes.

Results

From Activity 1, six themes collectively demonstrated that stakeholders valued many of the existing strengths of the service delivery, but some areas such as pain education was undervalued. Activity 2 generated solutions from high-level ideas to more day-to- day management strategies. Each of six groups generated unique solutions to an identified challenge for Activity 3.

Discussion

Engaging a wide variety of stakeholders in collaborative knowledge generation successfully provided the South Australian Pediatric Chronic Pain Service with a variety of novel, scalable solution across the healthcare continuum. Equally important is that this initiative helped to raise awareness about the complex issues faced in pediatric chronic pain care and helped to establish new partnerships that have led to enhanced service delivery.

Student advanced trauma management and skills (SATMAS): a validation study

INTRODUCTION

Despite trauma accounting 9% of global mortality, it has been demonstrated that undergraduate trauma teaching is inadequate nationally and worldwide. With COVID-19 exacerbating this situation, a scalable, accessible, and cost-effective undergraduate trauma teaching is required.

METHODS

Our Continual Professional Development United Kingdom (CPUDK)-accredited University Hospitals Birmingham (UHB) Major Trauma Service (MTS) affiliated programme consisted of seven biweekly pre-recorded sessions that were delivered online through the Moodle educational platform to University of Birmingham students. Pre- and post-randomised session-specific multiple-choice questions (MCQs) and anonymous feedback forms were administered.

RESULTS

There were 489 student responses, with 63 students completing all seven sessions. On an 8-point scale, students' objective knowledge scores increased by a mean of 1.2 (p < 0.001). Using a 5-point Likert scale, students also showed improvement in subjective outcomes including their confidence in assessing trauma patient (absolute difference (AD) 1.38, p < 0.001), advising initial investigations and formulating initial management plans (AD 1.78, p < 0.001) and thereby their confidence to manage a trauma patient overall (AD 1.98, p < 0.001). A total of 410 student responses endorsed the online delivery of SATMAS through Moodle and recommended SATMAS to future medical students.

CONCLUSION

SATMAS has demonstrated positive student feedback and extensive recruitment from only one centre, demonstrating that our programme can be an indispensable low-cost learning resource that prepares undergraduate medical students for their trauma exams and informs the implementation of clinical skills required by all doctors. We publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities nationally and internationally, to synergistically benefit students, tutors, and ultimately patients, on a larger scale.

Evaluation of National Anaesthetics Teaching in Undergraduate Medicine (ENATUM)

BACKGROUND

During a global pandemic where anaesthetists play a pertinent role in treating coronavirus 2019 (COVID-19), it is crucial to inspire medical students to consider a career in anaesthetics and perioperative care. Where anaesthetic skills are vital for all surgical foundation doctors, regardless of whether they have a rotation in anaesthetics, this study seeks to establish the current level of exposure to anaesthetics in the UK medical schools' curriculum and evaluate if the current anaesthetic undergraduate curriculum is sufficient to prepare students to pass their exams and perform the duties expected of them as future junior doctors.

METHODS

A 35-item structured questionnaire, registered at University College London Hospital Research & Development (R&D), was distributed amongst foundation doctors who had graduated from UK universities within the previous 3 years between August and October 2020.

RESULTS

In total, 239 participants completed the questionnaire from 34 UK medical schools. Despite 90.0% of participants being allocated an 'anaesthesia' placement, 54.0% spent <15 hours shadowing an anaesthetist throughout their medical school. Of participants, 38.5% agreed that their anaesthetic teaching was sufficient compared to teaching of other specialities, with 48.6% of students not satisfied with the teaching provided to meet anaesthetic learning outcomes set by The Royal College of Surgeons of England; 72.4% said they would have benefited from additional anaesthetic teaching, with 80.7% stating it would have increased understanding into the speciality; and 71.5% stated a short course in anaesthetics alongside undergraduate training would have been beneficial.

CONCLUSIONS

Our results demonstrate that there is a lack of standardization in undergraduate anaesthetics teaching nationally and an additional undergraduate anaesthetic teaching programme is required to increase understanding and provide further insight into anaesthetics. Key messages:  The emergence of the coronavirus 2019 (COVID-19) pandemic has halted undergraduate medical education, in particular perioperative medicine and surgery.Exposure to anaesthesia is already limited in the medical undergraduate curriculum, with a limited number of anaesthesia-themed foundation rotations available for junior doctors.Recent UK graduates feel that undergraduate anaesthetics education is inadequate at medical school, reporting a lack of confidence in applying undergraduate anaesthesia learning outcomes.Additional anaesthetic teaching and online teaching methods are suggested ways of improving the delivery of undergraduate anaesthetic education.Can a national, standardized anaesthetics teaching curriculum improve the undergraduate knowledge base of anaesthesia?

Anaesthetic National Teaching Programme for Students (ANTPS)

The COVID-19 pandemic has significantly undermined undergraduate anaesthetic teaching in spite of the vital role of the specialty against the pandemic. Anaesthetic National Teaching Programme for Students (ANTPS) was designed to meet the evolving needs of undergraduates and tomorrow's doctor by standardising anaesthetic training, preparing for final exams and equipping competencies vital for doctors of all grades and specialties. Our Royal College of Surgeons England-accredited University-College-Hospital-affiliated programme consisted of six-biweekly sessions were delivered online by anaesthetic trainees. Prerandomised and postrandomised session-specific multiple-choice questions (MCQs) assessed students' improvement in knowledge. Anonymous feedback forms were provided to students after each session and 2 months following the programme. 3743 student feedback forms (92.2% of attendees) across 35 medical-schools were recorded. There was a mean improvement in test score (0.94±1.27, p<0.001). 313 students completed all six sessions. Based on 5-point Likert scale, students who completed the programme showed an improvement in their confidence in knowledge and skills to face common foundation challenges (1.59±1.12, p<0.001) and thus felt better prepared for life as junior doctors (1.60±1.14, p<0.001). With an increase in confidence in students to pass their MCQs, Observed Structured Clinical Examinations and case-based discussion assessments, 3525 students stated they would recommend ANTPS to other students. Unprecedented COVID-19 factors impacting training, positive student feedback and extensive recruitment, demonstrate that our programme is an indispensable learning resource which standardises anaesthetic undergraduate education nationally, prepares undergraduates for their anaesthetic and perioperative exams and lays strong foundations for implementation of clinical skills required by all doctors, to optimise training and patient care.

Teaching Practical Skills in Anesthesia, Intensive Care, Emergency and Pain Medicine—What Is Really Relevant for Medical Students? Results of a German National Survey of Nearly 3000 Anesthesiologists

As a part of a major reform of the medical curriculum in Germany, the national catalogue of learning objectives is being revised with the focus shifting from theory-based learning to teaching practical skills. Therefore, we conducted an online survey to answer the question, which practical skills are essential in anesthesia. Participants were asked to rate the relevance of several skills, that medical students should be able to perform at the time of graduation. A total of 2898 questionnaires could be evaluated. The highest ratings were made for “bringing a patient into lateral recumbent position” and “diagnosing a cardiac arrest”. All learning objectives regarding regional anesthesia were rated as irrelevant. Furthermore, learning objectives like “performing a bronchoscopy” or “performing a rapid sequence induction” had low ratings. In the subgroup analysis, physicians with advanced training and those who were working at university hospitals rated most skills with higher relevance compared to others. Our survey provides a good prioritization of practical skills for the development of new curricula and assessment frameworks. The results can also help to establish our discipline as a cross-sectional subject in competency-based medical education, thus further increasing the attractiveness for medical students.

Comparison of Malaysia's Bachelor of Dental Technology curriculum with three other countries: Proposing a basic curriculum framework

INTRODUCTION

A dental technologist is one of the most essential allied dental health professionals and the dental technology curriculum should be comprehensively reviewed on a regular basis. This study aims to compare the only existing Bachelor of Dental Technology (BDT) curriculum in Malaysia with BDT programmes offered by other well-established universities, and map out the similarities and differences, as well as to explore future recommendations and propose a new curriculum framework.

MATERIALS AND METHODS

A descriptive analysis was carried out using Laurie Brady's four-stage strategy. First, available curriculum materials were collected from four different institutions' electronic webpage: AIMST (Malaysia), GU (Australia), UO (New Zealand) and CMU (United Kingdom), and then compared based on three key domains: curriculum contents, teaching and learning strategies and assessments. Following that, the similarities and differences between various curricula were identified. Future recommendations and a curriculum framework were then proposed.

RESULTS

The core BDT curriculum content is concurred upon by all four universities, with an emphasis on basic sciences, laboratory materials, practical sessions and research projects. However, the credit weightage for each course or module varied across the four institutions, with some offering unique subjects and implementing different teaching methods and assessments. A simple BDT curriculum framework with a proposed syllabus was designed based on the three key domains and future recommendations for curriculum improvement were explored.

CONCLUSION

The present study identified several areas for Malaysian BDT curriculum development and improvement. The proposed framework can be a guide for Malaysian dental schools in designing a comprehensive dental technology programme.

A Scoping Review of Assessment Methods Following Undergraduate Clinical Placements in Anesthesia and Intensive Care Medicine

Introduction

Anesthesia and intensive care medicine are relatively new undergraduate medical placements. Both present unique learning opportunities and educational challenges to trainers and medical students. In the context of ongoing advances in medical education assessment and the importance of robust assessment methods, our scoping review sought to describe current research around medical student assessment after anesthesia and intensive care placements.

Methods

Following Levac's 6 step scoping review guide, we searched PubMed, EMBASE, EBSCO, SCOPUS, and Web of Science from 1980 to August 2021, including English-language original articles describing assessment after undergraduate medical placements in anesthesia and intensive care medicine. Results were reported in accordance with PRISMA scoping review guidelines.

Results

Nineteen articles published between 1983 and 2021 were selected for detailed review, with a mean of 119 participants and a median placement duration of 4 weeks. The most common assessment tools used were multiple-choice questions (7 studies), written assessment (6 studies) and simulation (6 studies). Seven studies used more than one assessment tool. All pre-/post-test studies showed an improvement in learning outcomes following clinical placements. No studies used workplace-based assessments or entrustable professional activities. One study included an account of theoretical considerations in study design.

Discussion

A diverse range of evidence-based assessment tools have been used in undergraduate medical assessment after anesthesia and intensive care placements. There is little evidence that recent developments in workplace assessment, entrustable activities and programmatic assessment have translated to undergraduate anesthesia or intensive care practice. This represents an area for further research as well as for curricular and assessment developments.

Erratum: Notice of duplicate publication: Qualitative research and pain: Current controversies and future directions

Much of what we know about the meaning and experience of pain has been facilitated through qualitative research. However, qualitative inquiry continues to be underrepresented in the pain literature relative to quantitative approaches. In this Commentary and Introduction to the Special Issue on Qualitative Research and Pain, we present a collection of high-quality, cutting-edge qualitative studies in pain that highlight theoretical and methodological advancements in the field. The articles included in this Special Issue feature a range of designs (e.g., grounded theory, phenomenology, qualitative description), methods of data collection (e.g., interviews, object elicitation, photovoice), and populations (e.g., immigrant women, individuals with heart disease). Throughout this Commentary we also address three common controversies regarding the quality of qualitative research and the stance we took on them for the Issue. These primarily deal with the procedure-related issues of sample size, generalizability, and saturation. We discuss how a more substantive-centered approach to evaluation—that is, an approach that considers the methodological and theoretical significance of the work—is crucial for advancing qualitative research in pain.

STAGES AND FACTORS OF THE "PERIOPERATIVE PROCESS": POINTS IN COMMON WITH THE AERONAUTICAL INDUSTRY

BACKGROUND

The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications.

AIM

To identify and develop the stages of the surgical process so that they could be applied to surgery departments.

METHODS

A search, review and bibliographic analysis of the application of aeronautical control and safety to medical practice in general and to surgery, in particular, were carried out.

RESULTS

Surgical process comprises the perioperative period. It is composed of Preoperative Stage (it is divided into 2 "sub-steps": hospital admission and control of preoperative studies) Operative Stage (it is divided into 3 "sub-steps": anesthetic induction, surgery, and anesthetic recovery) and Postoperative Stage (it is divided into 2 "sub-steps": control during hospitalization and ambulatory control). Two checkpoints must be developed. Checkpoint #1 would be located between the preoperative and operative stages, and checkpoint #2 would be located between the operative and postoperative stages. Surgical factors are surgeons, instrumental and technology, anesthesiology and operating room environment.

CONCLUSION

It is possible and necessary to develop a systematic surgical procedure. Its application in the department of surgery could optimize the results and reduce the complications and errors related to daily practice.