Use of mannequin-based simulation to decrease student anxiety prior to interacting with male teaching associates

Confidence degree and skill development in undergraduate medical students using male urogenital training simulators

INTRODUCTION

medical training should provide the future professional, in addition to theoretical knowledge, general and specific skills. In urology, urogenital training simulators have been presented as an ally in improving the degree of confidence and development of competencies for undergraduate medical students.

METHODS

exploratory descriptive research with a quantitative approach, of an experimental nature, of the randomized controlled type with cross-sectional cut. Conducted with the students of the 4th year of medicine of a Higher Education Institution in the West of Paraná.

RESULTS

91 students attended a theoretical class with a complete explanation of the activities to be performed and answered the initial questionnaire about the degree of confidence to perform tasks in three stations with male urogenital training simulators (prostatic touch, bladder catheterization and scrotal evaluation). Of these, 45 received guidance and training with the simulators prior to the stations, while 46 should demonstrate skills directly in the three stations, mimicking patient care, only with information from the theoretical classes. The students who received previous guidance with the simulators had their scores in the development of competence higher. And, when they repeated the questionnaire about the degree of confidence to demonstrate skills with the mannequins, there was a higher degree of confidence in performing the tasks, except for the execution of a task considered more difficult.

CONCLUSION

there was an improvement in the degree of confidence and in the development of competencies of undergraduate medical students with the orientations in the male urogenital training simulators.

Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis

Background

Digital rectal examination (DRE) is a challenging examination to learn.

Objective

To synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.

Study selection

EMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.

Findings

863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).

Conclusions

TES training is associated with improved DRE skills and should be used more widely.

Improving Male Genital Examinations in Adolescent Patients: Creation and Preliminary Validation of an Assessment Tool

PURPOSE

Providers cite lack of training and knowledge as reasons for omitting male genitourinary (GU) examinations. Also, no standard tools exist for assessment of male GU exams despite instruments for female pelvic exams. The objective of this project was to create and validate a male GU assessment instrument to evaluate trainee skill level.

METHODS

A first-author created 18-item assessment instrument (addressing preparation, exam, communication) was reviewed by a seven-member expert panel of adolescent medicine providers who reviewed items using a 4-point Likert scale. Adolescent medicine faculty completed the instrument (n = 48) for trainees, and differences in assessments were analyzed utilizing chi-square (SPSS, v. 24.0 p < .05). Exempt status was granted by the Institutional Review Board.

RESULTS

Nineteen trainees (13 female, 6 male) completed the instrument; no significant differences existed in assessments by gender. Trainees who completed the assessment > 2 times inspected the glans/meatus (p = .045), palpated the inguinal canals (p = .02), and informed of exam steps (p = .04) well compared to their first assessment. There were differences between provider assessments washing hands (p = .001); inspecting pubic hair (p = .000), glans (p = .001), and penis shaft (p = .002); palpating inguinal canals (p = .000); explaining exam steps (p = .000); being professional (p = .000); and explaining exam findings (p = .000). Excluding the creator, only professionalism was rated differently among providers (p = .023).

CONCLUSIONS

The male genital exam assessment tool was preliminarily validated as highly relevant to the male GU exam, was not affected by learner gender, and showed learner improvement over time. There are differences between faculty, indicating individual perception of exam items and need for increased discussion before implementing the assessment instrument into practice.

Do pediatricians routinely perform genitourinary examinations during well-child visits? A review from a large tertiary pediatric hospital

BACKGROUND

The male genital examination is a common source of discomfort for the patient and medical provider. Performance of male genital examination is imperative; however, as many treatable diagnoses can be made. Undescended testicles (UDTs), hernias, testicular tumors, and urethral abnormalities are all potentially concerning findings which can be discovered on routine examination.

OBJECTIVE

The objectives of this study are to determine the rate at which general pediatricians perform routine genitourinary (GU) examinations in the pediatric population and to determine the rate at which UDT are diagnosed or documented in the patient's history. The authors hypothesize the rate of pediatric GU examination during routine well-child visits to be in line with the previously reported rates in the adult literature.

STUDY DESIGN

Nine hundred ninety-six consecutive male well-child visits conducted by general pediatricians at the study institution were reviewed. These visits were evaluated for documentation of a detailed GU examination as well as the presence of UDT from these examinations. In addition, past medical and surgical histories were reviewed to determine if a diagnosis of UDT was noted.

RESULTS

Pediatricians at the study institution documented GU examinations 99.1% of the time during male well-child visits. Only 1.1% of the cohort had a documentation of UDT at any time point. Of the 11 patients with UDT, 6 boys (54.5%) had spontaneous descent with no referral to urology, whereas 5 (45.5%) required orchidopexy.

DISCUSSION

Prior reports suggest 70-75% of routine office visits include a genital examination. None of these reports reviewed the pediatric population, thus making this review novel in this respect. In addition, the results are vastly different from these prior studies as the authors demonstrated over 99% of male well-child examinations included documentation of a thorough genital examination. A limitation of the study is its retrospective nature, which creates a lack of standardization across the data set. In addition, without being physically present in the examination room, one cannot discern whether an examination is simply being documented without actual performance because of the template format of the electronic medical record (EMR). Furthermore, the study was not designed to best evaluate the true rate of UDTs; therefore, the reported rate of 1.1% cannot be accurately associated with a particular age at diagnosis.

CONCLUSIONS

Pediatricians do, in fact, document GU examinations on a routine basis. This finding cannot be taken with complete certainty as verification of actual examination performance is impractical. While the data demonstrated a lower than expected rate of UDT, depending upon age at diagnosis, this could indicate that although examinations are being documented, their accuracy may be diminished because of various factors at play in the healthcare system as a whole, including improper exam performance and EMR templates. Follow-up studies are required to verify these potentially changing rates of UDT and to determine if there is discordance between documentation and performance of GU examinations.

Do positional variations of epididymis affect infertility?

OBJECTIVE

To determine the ratio of epididymal position variations and whether this had any effect on seminal parameters.

MATERIAL AND METHODS

Scrotal examination results and epididymal positions were retrospectively assessed in subjects presenting to our clinic for infertility, varicocele, and sexual developmental delay. Scrotal examination consisted of epididymal position, testicular volumes, and vas deferens and varicocele presence. The subjects were categorized according to sperm counts per mL. Data were assessed whether there was a significant difference in terms of epididymal positions among the groups.

RESULTS

A total of 5812 epididymides were examined. There was no significant difference with respect to one or two epididymides being in an anterior position between the groups allocated with respect to a sperm count above 15 million per mL, between 5 and 15 million per mL, and below 5 million per mL (p=0.542). Sperm counts and motility did not differ according to the position of the epididymis in analyzes performed separately within each group.

CONCLUSION

Positional variations of epididymis can be seen at a considerable rate. Nevertheless, there was no clear relationship between these variations and infertility. In terms of avoiding possible misdiagnoses and treatment complications possible epididymal position variations should be kept in mind during clinical practice.

Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency

OBJECTIVE

Develop new performance evaluation standards for the clinical breast examination (CBE).

SUMMARY BACKGROUND DATA

There are several, technical aspects of a proper CBE. Our recent work discovered a significant, linear relationship between palpation force and CBE accuracy. This article investigates the relationship between other technical aspects of the CBE and accuracy.

METHODS

This performance assessment study involved data collection from physicians (n = 553) attending 3 different clinical meetings between 2013 and 2014: American Society of Breast Surgeons, American Academy of Family Physicians, and American College of Obstetricians and Gynecologists. Four, previously validated, sensor-enabled breast models were used for clinical skills assessment. Models A and B had solitary, superficial, 2 cm and 1 cm soft masses, respectively. Models C and D had solitary, deep, 2 cm hard and moderately firm masses, respectively. Finger movements (search technique) from 1137 CBE video recordings were independently classified by 2 observers. Final classifications were compared with CBE accuracy.

RESULTS

Accuracy rates were model A = 99.6%, model B = 89.7%, model C = 75%, and model D = 60%. Final classification categories for search technique included rubbing movement, vertical movement, piano fingers, and other. Interrater reliability was (k = 0.79). Rubbing movement was 4 times more likely to yield an accurate assessment (odds ratio 3.81, P < 0.001) compared with vertical movement and piano fingers. Piano fingers had the highest failure rate (36.5%). Regression analysis of search pattern, search technique, palpation force, examination time, and 6 demographic variables, revealed that search technique independently and significantly affected CBE accuracy (P < 0.001).

CONCLUSIONS

Our results support measurement and classification of CBE techniques and provide the foundation for a new paradigm in teaching and assessing hands-on clinical skills. The newly described piano fingers palpation technique was noted to have unusually high failure rates. Medical educators should be aware of the potential differences in effectiveness for various CBE techniques.

Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance

BACKGROUND

We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making.

METHODS

Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty.

RESULTS

The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p < 0.05).

CONCLUSIONS

Pre-simulation orientation reduces anxiety while increasing confidence and improving performance.

Evaluation of nursing students about learning with clinical simulation

OBJECTIVE

to describe the contributions of clinical simulation for learning cognitive and procedural attributes through debriefing, from the perspective of nursing students.

METHOD

descriptive exploratory study. Twenty nursing undergraduate students from a university in the interior of the state of São Paulo participated in this study. Data collection was performed at the debriefing stage. Student's perceptions about the simulation, positive aspects and what they could have done differently were registered. The students' statements were grouped according to the central themes and the framework of Bardin's content analysis (2011) and were analyzed using descriptive statistics.

RESULTS

enhancement of active, critical and reflective learning (47.5%) was identified due to the closeness to reality in nursing care (20.3%), manifestation of feelings experienced during the simulation (15.3%) and composition of the scenario (15.3%).

CONCLUSION

the clinical simulation followed by debriefing promotes the understanding of the link between action and achievements in learning.

Making models to simulate testicular swellings

BACKGROUND

Testicular examination and the recognition of common scrotal swellings is a key clinical skill that is difficult to teach undergraduates because of its intimate nature. A novel approach for this topic was prompted by the description of handmade models in the medical literature to teach anatomical knowledge and clinical skills.

METHODS

Affordable low-cost materials were purchased and assembled to form six models replicating key scrotal pathologies: epididymal cyst, epididymitis, hydrocoele, inguinoscrotal hernia, testicular tumour and varicocoele. They were used to teach the examination of testicular swellings to undergraduate medical students alongside a rubber manikin exhibiting testicular tumours, and all participants were invited to complete a post-session evaluation on their experiences.

RESULTS

There were 66 participants in total: 83.3 per cent felt that the handmade models were more beneficial and 81.8 per cent would recommend them to colleagues to train in testicular examination, rather than the rubber model. The most common reasons provided were the greater variety of pathologies demonstrated, separate models for each pathology and the presence of key diagnostic features for certain swellings. The recognition of common scrotal swellings is a key clinical skill that is difficult to teach undergraduates DISCUSSION: These models took approximately 1 hour to assemble. We hope that they can be widely used by Urology departments as a cost-effective aid in the practical teaching of testicular examination and recognition of common scrotal swellings, thus reducing the dependency and intimacy of examining real patients with clinical signs.

Missing the mark: Current practices in teaching the male urogenital examination to Canadian undergraduate medical students

INTRODUCTION

The urogenital physical examination is an important aspect of patient encounters in various clinical settings. Introductory clinical skills sessions are intended to provide support and alleviate students' anxiety when learning this sensitive exam. The techniques each Canadian medical school uses to guide their students through the initial urogenital examination has not been previously reported.

METHODS

This study surveyed pre-clerkship clinical skills program directors at the main campus of English-speaking Canadian medical schools regarding the curriculum they use to teach the urogenital examination.

RESULTS

A response rate of 100% was achieved, providing information on resources and faculty available to students, as well as the manner in which students were evaluated. Surprisingly, over one-third of the Canadian medical schools surveyed failed to provide a setting in which students perform a urogenital examination on a patient in their pre-clinical years. Additionally, there was no formal evaluation of this skill set reported by almost 50% of Canadian medical schools prior to clinical training years.

CONCLUSIONS

To ensure medical students are confident and accurate in performing a urogenital examination, it is vital they be provided the proper resources, teaching, and training. As we progress towards a competency-based curriculum, it is essential that increased focus be placed on patient encounters in undergraduate training. Further research to quantify students' exposure to the urogenital examination during clinical years would be of interest. Without this commitment by Canadian medical schools, we are doing a disservice not only to the medical students, but also to our patient population.

Medical students' experiences learning intimate physical examination skills: a qualitative study

BACKGROUND

Intimate physical examination skills are essential skills for any medical graduate to have mastered to an appropriate level for the safety of his or her future patients. Medical schools are entrusted with the complex task of teaching and assessing these skills for their students. The objectives of this study were to explore a range of medical students' experiences of learning intimate physical examination skills and to explore their perceptions of factors which impede or promote the learning of these skills.

METHODS

Individual semi-structured interviews (N = 16) were conducted with medical students in years two to five from the University of Newcastle, as part of a larger research project investigating how medical students develop their attitudes to gender and health. This was a self-selected sample of the entire cohort who were all invited to participate. A thematic analysis of the transcribed data was performed.

RESULTS

Students reported differing levels of discomfort with their learning experiences in the area of intimate physical examination and differing beliefs about the helpfulness of these experiences. The factors associated with levels of discomfort and the helpfulness of the experience for learning were: satisfaction with teaching techniques, dealing with an uncomfortable situation and perceived individual characteristics in both the patients and the students. The examination causing the greatest reported discomfort was the female pelvic examination by male students.

CONCLUSIONS

Student discomfort with the experience of learning intimate physical examination skills may be common and has ongoing repercussions for students and patients. Recommendations are made of ways to modify teaching technique to more closely match students' perceived needs.

Leveraging virtual humans to effectively prepare learners for stressful interpersonal experiences

Stressful interpersonal experiences can be difficult to prepare for. Virtual humans may be leveraged to allow learners to safely gain exposure to stressful interpersonal experiences. In this paper we present a between-subjects study exploring how the presence of a virtual human affected learners while practicing a stressful interpersonal experience. Twenty-six fourth-year medical students practiced performing a prostate exam on a prostate exam simulator. Participants in the experimental condition examined a simulator augmented with a virtual human. Other participants examined a standard unaugmented simulator. Participants reactions were assessed using self-reported, behavioral, and physiological metrics. Participants who examined the virtual human experienced significantly more stress, measured via skin conductance. Participants stress was correlated with previous experience performing real prostate exams; participants who had performed more real prostate exams were more likely to experience stress while examining the virtual human. Participants who examined the virtual human showed signs of greater engagement; non-stressed participants performed better prostate exams while stressed participants treated the virtual human more realistically. Results indicated that stress evoked by virtual humans is linked to similar previous real-world stressful experiences, implying that learners real-world experience must be taken into account when using virtual humans to prepare them for stressful interpersonal experiences.