Virtual Telesimulation for Medical Students During the COVID-19 Pandemic

A Modified Delphi Study for Curricular Content of Simulation-Based Medical Education for Pediatric Residency Programs

OBJECTIVE

We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME).

METHODS

We conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥70% rated the item as extremely important and exclusion as ≥70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of three rounds.

RESULTS

A total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least one content item that experts considered important to teach through simulation as compared to other modalities.

CONCLUSIONS

Using consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content.

Remote feedback in endovascular simulation training: a mixed-methods study

BACKGROUND

There is an increasing need to increase simulation-based learning opportunities for vascular surgery residents in endovascular skills training. This study aims to explore the effectiveness of remote expert instructional feedback of endovascular simulation-based education, as a means of increasing training opportunities in this area for vascular surgery residents.

METHODS

A mixed-methods study design was adopted. Twelve vascular surgery residents from Ireland were tasked with completing two endovascular renal artery procedures: one with in-person expert feedback and the other with remote instruction. Participants ranged in experience levels from second year to final year of residency. Following the training activities, interviews and a questionnaire were employed to gather information on the usefulness of remote feedback.

RESULTS

There was no significant difference reported by participants using a post-event validated questionnaire between remote and in-person feedback. During the interviews, participants expressed mixed feelings about the presence of the educator while practicing, but they eventually saw no limiting factors to their practice when the trainer provided remote feedback. When receiving performance feedback remotely, clear communication and a shared knowledge of the task development are critical to success.

CONCLUSIONS

We believe these findings can inform the design and development of remote learning and assessment of endovascular skills training and ultimately provide increased opportunities for more skills practice for vascular surgical residents.

A Comparison Between In-Person and Virtual Communication Skills OSCE for Medical Students

Objectives

This study investigates the effectiveness of a virtual format of an advanced communication skills observed structured clinical examination (OSCE) for senior medical students in comparison to an in-person format. The study also examines the emotional support students experience in the virtual setting. Our analysis was based on quantitative data collected through objective checklists and post-OSCE survey results.

Methods

The virtual OSCE was a revision of an earlier in-person formative advanced communication skills OSCE for fourth-year medical students. Student performances were assessed by self and peers using objective checklists-the modified Master Interview Rating Scale (mMIRS) and Communication Behavior Checklist (CBC). The mMIRS measured interview process such as avoiding jargon and demonstrating empathy. The CBC examined interview content which included tasks specific to the content of the case. The OSCE was followed by a faculty-led debrief and quantitative survey. The virtual OSCE was conducted in 2021, and the results of the checklists and survey were compared with those collected from two earlier in-person OSCEs.

Results

Eighty-three students participated in the virtual OSCE. There was no difference in mMIRS scores between the virtual and in-person OSCE. Overall CBC scores were lower in the virtual OSCE compared to in-person (p < 0.05). Sixty-seven out of 83 (80.7%) students completed the post-OSCE survey. There were no differences between the virtual and in-person OSCE in terms of educational value, whether the OSCE would change the way participants talk to patients, and preparedness to have serious conversations with patients. All respondents somewhat or strongly agreed with feeling emotionally supported during the virtual OSCE.

Conclusion

The virtual format was a suitable alternative to an in-person, formative, advanced communication skills OSCE for medical students. The virtual OSCE was educationally effective and was met with student satisfaction and a sense of emotional support. Future virtual iterations must ensure adequate instruction on interview content.

Medical Students' Perception of Telesimulation Training: A Qualitative Analysis

OBJECTIVES

Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced. The project aims to explore students' perspectives on simulated teleconsultation training compared to simulated clinics in person.

METHODS

Ten pre-clerkship students in the Faculty of Medicine at the University of Ottawa participated in interviews following in-person and teleconsultation simulated clinic sessions. The interview guide was developed based on previous work. The questions asked concerned experience with teleconsultation, interaction with the tutor and patient, practical or logistical obstacles, educational value and feasibility. The authors evaluated the results using a thematic analysis.

RESULTS

The interview analysis showed that the tutor feedback received during the simulated teleconsultation was comparable to that received after the in-person simulated clinic. Although most of the students enjoy teleconsultation, they raised the challenge of carrying out physical examinations and creating a personal connection with the tutor/patient.

CONCLUSION

Given the circumstances of the pandemic and students' comfort with technology, the new generation of medical students seems prepared to embrace teleconsultation. The themes identified in the analysis will enable the necessary adjustments to be made in order to optimize their teleconsultation training, an inextricable step in promoting the active offer of healthcare services.

Simulation training for medical emergencies of dental patients: A review of the dental literature

In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Virtual Adaptation of Empathetic Communication Training for Pediatric Interns

OBJECTIVE

Evaluate feasibility and effectiveness of virtual adaptation of in-person simulation-based empathetic communication training.

METHODS

Pediatric interns participated in virtual training session then completed post-session and 3 months follow up surveys.

RESULTS

Self-reported preparedness on the skills all improved significantly. The interns report the educational value as extremely high both immediately after and 3 months after training. 73% of the interns report using the skills at least weekly.

CONCLUSION

A 1 day virtual simulation-based communication training is feasible, well received, and similarly effective as in-person training.

Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting

AIM

To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training.

METHODS

Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months.

RESULTS

Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group.

CONCLUSION

One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.

Telesimulation in healthcare education: A scoping review

OBJECTIVES

To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education.

DESIGN

A scoping review.

DATA SOURCES

A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022.

REVIEW METHODS

Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised.

RESULTS

29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies.

CONCLUSION

Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.

Exploring lemology teaching with "internet plus" flipped classroom pedagogy

BACKGROUND

To investigate the use of flipped classroom pedagogy based on "Internet plus" in teaching viral hepatitis in the lemology course during the COVID-19 epidemic.

METHODS

This study included students from the clinical medicine general practitioner class at Nanjing Medical University's Kangda College, with the observation group consisting of 67 students from the 2020-2021 school year and the control group consisting of 70 students from the 2019-2020 school year. The observation group used "Internet plus" flipped classroom pedagogy, while the control group used conventional offline instruction. The theory course and case analysis ability scores from the two groups were compared and analyzed, and questionnaire surveys were administered to the observation group.

RESULT

After the flipped classroom, the observation group had significantly higher theoretical test scores (38.62 ± 4.52) and case analysis ability scores (21.08 ± 3.58) than the control group (37.37 ± 2.43) (t = 2.024, P = 0.045) and (19.16 ± 1.15) (t = 4.254, P < 0.001), respectively. The questionnaire survey in the observation group revealed that the "Internet plus" flipped classroom pedagogy approach can help enhance students' enthusiasm to learn, clinical thinking ability, practical application ability, and learning efficiency, with satisfaction rates of 81.7%, 85.0%, 83.3%, and 78.8%, respectively; 89.4% of students expressed hope that whenever physical classes resumed, the offline courses could be combined with this pedagogy approach.

CONCLUSION

The use of the "Internet plus" flipped classroom pedagogy technique for teaching viral hepatitis in a lemology course boosted students' theory learning ability as well as their case analysis ability. The majority of students were pleased with this type of instruction and hoped that whenever physical classes resumed, the offline courses may be integrated with the "Internet plus" flipped classroom pedagogical approach.

Virtual fundamentals of laparoscopic surgery (FLS) boot-camp using telesimulation: an educational solution during the covid-19 pandemic

BACKGROUND

The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has organized an FLS boot-camp to teach PGY1 residents the FLS manual skills. During the COVID-19 pandemic, in-person sessions were not possible. The purpose of this study was to utilize telesimulation as an education solution for teaching FLS technical skills to PGY1 residents during the COVID-19 pandemic.

METHODS

A virtual FLS program was established. A complete, easily portable FLS kit was distributed to participants and instructors to set up an FLS box and connect remotely using telesimulation. The program was delivered by three senior residents using the Zoom™ platform. Participants were split into groups of 3-4 individuals, each receiving three 1-h sessions. Sessions were structured with initial demonstration of tasks followed by individual coaching of participants in 'break-out' rooms. The official FLS exam was administered in-person on the 4th week. Pre- and post-course surveys were administered to participants gauging self-reported proficiency with FLS tasks and overall course feedback. Anonymized FLS exam results were collected.

RESULTS

A total of 14 residents participated, and 11 responded to the survey. Participants reported that their overall FLS skills proficiency significantly improved on a 5-point likert scale from 1.5 ± 0.5 pre-course to 4.0 ± 0.5 post-course (mean ± SD). Participants unanimously stated that having the FLS box at home was valuable and enabled them to practice more. On the FLS exam, 13 of 14 participants passed the manual skills component.

CONCLUSIONS

We developed a telesimulation hands-on FLS course as an alternative to in-person training. The course was practical and effective and was preferred to traditional methods by participants. With ever-expanding technological solutions, virtual telesimulation education is an attractive and underutilized tool, not only in the setting of COVID-19, but also more broadly across current educational programs.

Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship

INTRODUCTION

The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible.

METHODS

We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum.

RESULTS

Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning.

DISCUSSION

We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

Evaluating Emotional Outcomes of Medical Students in Pediatric Emergency Medicine Telesimulation

The coronavirus disease 2019 (COVID-19) pandemic has challenged the feasibility of traditional in-person simulation-based clinical training due to the public health recommendation on social distancing. During the pandemic, telesimulation training was implemented to avoid multiple students and faculties gathering in confined spaces. While medical trainees' perceived emotions have been acknowledged as a critical outcome of the in-person simulation-based training, the impact of telesimulation on trainees' emotions has been unexamined. We conducted an educational team-based simulation study with a pediatric case of septic shock. Seventeen and twenty-four medical students participated in the telesimulation training and in-person simulation training, respectively. The institutional pandemic social restrictions at the time of each training session determined the participant assignment to either the telesimulation training or in-person simulation training. All participants responded to the Japanese version of the Medical Emotion Scale, which includes 20 items rated on a five-point Likert-type scale before, during, and after the simulation sessions. The measured emotions were categized into four emotion groups according to two dimensions: positive or negative and activating or deactivating emotions. The one-way analysis of variance between the telesimulation and in-person simulation training revealed no significant differences in the emotions perceived by the participants before, during, and after the simulation training sessions. The perceived emotions of medical students were comparable between the telesimulation and in-person simulation training. Further longitudinal studies with larger samples and multiple variables are needed to generalize the effectiveness of telesimulation.

Medical Student Experiential Learning in Telesimulation

OBJECTIVES

Telesimulation utilizes telecommunication technology to engage learners in simulation while in different physical locations. Despite this potential advantage, understanding of the student experience and assessment of student learning in telesimulation activities is limited. This study evaluates medical student emotional experience and self-identified learning in telesimulation through the Kolb experiential learning framework and qualitative analysis.

METHODS

Fourth-year medical students enrolled in the Spencer Fox Eccles School of Medicine at the University of Utah participated in 3 telesimulation activities as part of a required internal medicine course. Students were surveyed regarding their satisfaction with the activity (N = 114) and responded to questions about their emotional experience and self-identified areas of learning. Free-text responses were analyzed using qualitative content analysis to identify themes until thematic saturation (N = 66).

RESULTS

Students were highly satisfied with telesimulation, with greater than 90% of students expressing a positive view of simulation realism, debrief quality, and group size. Themes of anxiety and uncertainty, confidence versus incompetence, team dynamics, fun, and difficult patient interaction were identified regarding the emotional experience. Themes of communication and teamwork, managing emotions, information gathering, differential diagnosis, resource reference, executing treatment, and medical knowledge were identified regarding student-identified learning.

CONCLUSION

In this analysis of medical student experiences with telesimulation, we found students have rich emotional, cognitive, and behavioral experiences and self-identify learning across a variety of domains. Our findings support further study of telesimulation for medical student learning and demonstrate how assessment of outcomes via Kolb framework, using the learner's reflective observation and self-identified learning, may help better define learning outcomes from simulation.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

INTRODUCTION

The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program.

OBJECTIVE

To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results.

METHODS

Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training.

RESULTS

There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject.

CONCLUSION

This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

The development of new remote technologies in disaster medicine education: A scoping review

Background

Remote teaching and online learning have significantly changed the responsiveness and accessibility after the COVID-19 pandemic. Disaster medicine (DM) has recently gained prominence as a critical issue due to the high frequency of worldwide disasters, especially in 2021. The new artificial intelligence (AI)-enhanced technologies and concepts have recently progressed in DM education.

Objectives

The aim of this article is to familiarize the reader with the remote technologies that have been developed and used in DM education over the past 20 years.

Literature scoping reviews

Mobile edge computing (MEC), unmanned aerial vehicles (UAVs)/drones, deep learning (DL), and visual reality stimulation, e.g., head-mounted display (HMD), are selected as promising and inspiring designs in DM education.

Methods

We performed a comprehensive review of the literature on the remote technologies applied in DM pedagogy for medical, nursing, and social work, as well as other health discipline students, e.g., paramedics. Databases including PubMed (MEDLINE), ISI Web of Science (WOS), EBSCO (EBSCO Essentials), Embase (EMB), and Scopus were used. The sourced results were recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart and followed in accordance with the PRISMA extension Scoping Review checklist. We included peer-reviewed articles, Epubs (electronic publications such as databases), and proceedings written in English. VOSviewer for related keywords extracted from review articles presented as a tabular summary to demonstrate their occurrence and connections among these DM education articles from 2000 to 2022.

Results

A total of 1,080 research articles on remote technologies in DM were initially reviewed. After exclusion, 64 articles were included in our review. Emergency remote teaching/learning education, remote learning, online learning/teaching, and blended learning are the most frequently used keywords. As new remote technologies used in emergencies become more advanced, DM pedagogy is facing more complex problems.

Discussions

Artificial intelligence-enhanced remote technologies promote learning incentives for medical undergraduate students or graduate professionals, but the efficacy of learning quality remains uncertain. More blended AI-modulating pedagogies in DM education could be increasingly important in the future. More sophisticated evaluation and assessment are needed to implement carefully considered designs for effective DM education.

Challenges and opportunities for educating health professionals after the COVID-19 pandemic

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Simulated patient perceptions of telesimulation education

Perspectives of simulated participants (SPs) as stakeholders in simulation education are under-represented. With rapid increase in virtual education and anticipation of post-pandemic continuation it is important to establish best practices. This work aims to determine SP perceptions of telesimulation.

In-depth semi-structured interviews determined SP opinions of participation in telesimulation. Thematic analysis utilizing an inductive and semantic iterative coding process was performed. SPs completed a survey of their demographics, experience and prior SP training, both virtual and in-person.

Data sufficiency occurred after 16 interviews (10 females/6 males; 15 White/1 Black/African American). Median age was 56 years (range 37–72). Median number of in-person simulation experiences was 100 (range 6–300) and 27 telesimulations (range 3–100). Thematic analysis identified five themes: (1) students behave differently (distracted, less professional, less prepared for ‘real life’, less nervous), (2) my performance – some things are easier and some harder (increased cognitive load, coming out of role more, difficulties with non-verbal aspect, more standardized performance), (3) it’s harder to connect with learners (different cues, less of a personal connection), (4) safety for all in telesimulation (as psychologically safe as in-person, appreciate opportunity to continue to educate/work, personal safety), (5) future applications of telesimulation (telehealth training, better access to education for learners).

SP perceptions of telesimulation education revealed appreciation of the educational modality and identified potential benefit in telehealth education. SPs were concerned about learner participation, professionalism and resultant preparation for clinical practice. Incorporating SP feedback into telesimulation education may be important to ensure high quality.

Zooming into the COVID Era Together

The pre-clinical medical school curriculum provides students with extraordinary experiences in preparation to become physicians. However, it was not originally designed to be delivered remotely. The COVID-19 pandemic promptly threw the medical education process into unforeseen circumstances. A model of student-faculty collaboration created to address new challenges and implement practical solutions rapidly is presented. This model was used effectively to respond to pre-clinical educational interruptions that were imposed by the COVID-19 pandemic and maintain high-quality training. Our experience provides valuable insights and lessons learned that can be applied to the ongoing pandemic response and to future educational challenges.

[Interactive intraoperative annotation of surgical landmarks in student education to support learning efficiency and motivation]

BACKGROUND

The development of technological innovations has not only changed social life and the healthcare system, but also affects medical education. The aim of this pilot study was to evaluate whether students, when observing a microsurgical procedure of the temporal bone, gain an additional understanding of the anatomical structures and surgical site when visualization is used that provides identical views for the surgeon and viewer in 3D.

MATERIALS AND METHODS

During regular attendance tutorials, students were randomly assigned to three different groups: control group, 2D group, or 3D group. Evaluation questionnaires and intraoperative student annotation of the surgical view were used to assess the subjective didactic value of different visualization formats and resultant learning experiences for the students.

RESULTS

A total of 47 students were included in the investigations during conventional attendance tutorials. The majority indicated a high added value of the 3D visualization in terms of method (70%) and vividness (80%) compared to the 2D group and self-study; 69% of the students fully agreed with the statement that 2D and 3D visualization increases learning motivation and is a very good way to improve recognition of anatomical topography and structures.

CONCLUSION

New interactive visualization options in teaching promote learning efficiency and motivation among students. Especially 3D visualization and intraoperative annotation of the surgical view by the student is a useful didactic tool and increases the quality of clinical teaching. It supports the perception of anatomical topography and enables more focused surgical training.

Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol

INTRODUCTION

COVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors.

METHODS AND ANALYSIS

We will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory.

ETHICS AND DISSEMINATION

The protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators.

TRIAL REGISTRATION NUMBER

NCT04614844.

Remote online global health education among U.S. medical students during COVID-19 and beyond

BACKGROUND

Due to the COVID-19 pandemic, the 2021 Harvard Medical School course Clinical Topics in Global Health was offered for the first time as a remote class. We sought to understand student and faculty perceptions of the elective and evaluate the perceived effectiveness of teaching global health using an online education platform.

METHODS

Following the course, students and faculty were invited to complete a combined total of three online surveys, which consisted of closed- and open-response questions assessing the strengths and challenges of online learning. Data analyses included traditional descriptive statistics, Net Promoter Score calculation, and inductive thematic analysis of qualitative data.

RESULTS

Thirty-two students and eighteen guest faculty (including four international faculty) participated in the course. Highly-rated course components included guest lecturers, practical skill sessions, polls, and case studies. The Net Promoter Score for the course was excellent at 92, and students reported a greater likelihood of pursuing a career in global health because of the course. While students and faculty highlighted limitations of the remote learning platform (lack of community and interactivity), they also commented on increased accessibility and faculty diversity. Most faculty and students recommended a hybrid model for future versions of the course and suggested strategies to address current limitations.

CONCLUSIONS

A remote learning platform can effectively deliver global health education, both in the pandemic setting and beyond.

The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study

BACKGROUND

Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning.

OBJECTIVE

This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students' sepsis knowledge, team communication skills, and skill use in clinical practice.

METHODS

A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants' sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants' sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice.

RESULTS

Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other's roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education-particularly the use of virtual telesimulation-fostered participants' understanding and appreciation of each other's interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice.

CONCLUSIONS

Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance.

Postgraduate oncology educational shifts during the COVID-19 pandemic: results of faculty and medical student surveys

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice, research and teaching. During peaks, virtual courses were implemented but these changes are poorly described, especially for oncology postgraduate students and faculty teachers.

PATIENTS AND METHODS

We administered two surveys from June 2021 to October 2021 to students and faculty teachers (250 and 80 responses, respectively) who registered at Gustave Roussy School of Cancer Sciences (Université Paris-Saclay) during 3 consecutive university years (October 2018 to October 2021), where a major shift to e-learning was associated with COVID-19 pandemic.

RESULTS

Most students were female (53%), attending physicians (50%), aged 30-39 years (54%) and 2020-2021 (66.4%) was the main year of training. Most faculty teachers were male (58%), aged 40-50 years (44%) and had participated in training for at least 3 years (83%). More than half of the students received 100% virtual training [55% versus 45% face-to-face/mixed teaching modalities; online (84%) versus remote teaching (16%)]. Only 34% of students declared >80% 'active listening' and only 16% of teachers considered e-learning to be more suitable (compared with face-to-face) for postgraduate education. Virtual teaching decreased student-teacher interactions as compared with mixed/face-to-face (lessons were sufficiently interactive for 54% students if virtual only teaching versus for 71% if other teaching modalities; P = 0.009). Teachers stated that virtual learning did not lead to any improvements in terms of attendance (68%), interaction (74%) and quality of teaching (68%). However, most faculty (76%) acknowledged that partial e-learning training should be maintained outside the pandemic, if it represents ≤50% of the whole teaching (teachers: 79% versus student: 66%; P = 0.04).

CONCLUSIONS

COVID-19 accelerated the transition toward novel practices. Students and faculty teachers agreed on the need for future mixed (≤50% e-learning) teaching modalities. Adequate formation and the use of codified best newer virtual practices are required.

Análise conceitual e aplicabilidade de telessimulação no ensino em saúde: Revisão de escopo

RESUMO Objetivo analisar o conceito de telessimulação e sua aplicabilidade no contexto do ensino em saúde. Método trata-se de uma análise conceitual, realizada através de uma scoping review realizada em maio de 2021, nas seguintes bases de dados: PubMed, PMC, Educational Resources Information Center, Web of Science, Science Direct, Scopus, LILACS, Scientific Electronic Library Online e Google Scholar, mediante o uso do descritor “telessimulação” e suas respectivas traduções para inglês e espanhol. Para análise dos estudos, avaliaram-se os atributos, antecedentes e consequentes do conceito. Resultados a telessimulação é definida como uma ramificação da simulação clínica que se caracteriza pela promoção/viabilização de práticas educativas no ensino em saúde, realizadas remotamente, síncrona, através de videochamada. Tem como objetivo facilitar o contato entre instrutores e participantes em situações de necessidade de distanciamento social, acesso dificultado por razões econômicas, como a escassez de recursos humanos e materiais, e/ou geograficamente distantes, com a intenção de desenvolver e aperfeiçoar competências e habilidades pertinentes as profissões da saúde. Conclusão e implicações para a prática a telessimulação representa uma nova oportunidade na formação em saúde, ao ampliar as possibilidades de ensino e romper barreiras que vão desde as geográficas até as econômicas.

Conceptual analysis and applicability of telesimulation in health education: A scoping review

ABSTRACT Objective to analyze the “telesimulation” concept and its applicability in the context of health education. Method this is a conceptual analysis performed through a scoping review carried out in May 2021 in the following databases: PubMed, PMC, Educational Resources Information Center, Web of Science, Science Direct, Scopus, LILACS, Scientific Electronic Library Online and Google Scholar, through the use of the descriptor “telesimulação” and its respective translations into English and Spanish. To analyze the studies, the concept’s attributes, antecedents, and consequences were assessed. Results telesimulation is defined as a branch of clinical simulation that is characterized by the promotion/enabling of educational practices in health education, performed remotely, synchronously, through video call. It aims to facilitate contact between instructors and participants in situations of need for social distance, access made difficult for economic reasons, such as the scarcity of human and material resources, and/or geographically distant, aiming at developing and improving relevant skills and abilities for health professions. Conclusion and implications for practice telesimulation represents a new opportunity in health education as it expands teaching possibilities and breaks down barriers ranging from geographic to economic.

Transitioning preclinical students into clerkships amidst curricular disruptions from the COVID-19 pandemic

The COVID-19 pandemic resulted in significant disruptions to medical education. The patient care space was unavailable as a learning environment, which compounded the complexity of preparing students for clerkships with a traditional transition to clerkship (TTC) curriculum. We developed a multimodal, structured approach to re-introduce students to the clinical space prior to the start of clerkships. 105 second year medical students completed a 4-week clinical enhancement course. A modified Delphi method was used to select core topics, which were then anchored to key Entrustable Professional Activities (EPAs). Students participated in 9 virtual problem-based cases, workshops and multiple supervised patient encounters. Students were surveyed before, during, and after the course; responses were compared with paired t-tests. 25.9% rated the course as excellent, 44.2% as very good, and 19.5% as good. Compared to baseline, self-perceived efficacy grew significantly (P < 0.05) across all EPAs. Improvements in key competencies were sustained when students were surveyed 2 weeks into their first clerkship. This was a well-received, novel course, focused on helping students transition back into the clinical space through a multimodal teaching approach. This framework may be used by other institutions seeking to restructure their TTC initiatives.