A Plea for MERSQI: The Medical Education Research Study Quality Instrument

Medical education research study quality instrument: an objective instrument susceptible to subjectivity

BACKGROUND

The medical education research study quality instrument (MERSQI) was designed to appraise medical education research quality based on study design criteria. As with many such tools, application of the results may have unintended consequences. This study applied the MERSQI to published medical education research identified in a bibliometric analysis.

METHODS

A bibliometric analysis identified highly cited articles in medical education that two authors independently evaluated using the MERSQI. After screening duplicate or non-research articles, the authors reviewed 21 articles with the quality instrument. Initially, five articles were reviewed independently and results were compared to ensure agreed upon understanding of the instrument items. The remainder of the articles were independently reviewed. Overall scores for the articles were analyzed with a paired samples t-test and individual item ratings were analyzed for inter-rater reliability.

RESULTS

There was a significant difference in mean MERSQI score between reviewers. Inter-rater reliability for MERSQI items labeled response rate, validity and outcomes were considered unacceptable.

CONCLUSIONS

Based on these results there is evidence that MERSQI items can be significantly influenced by interpretation, which lead to a difference in scoring. The MERSQI is a useful guide for identifying research methodologies. However, it should not be used to make judgments on the overall quality of medical education research methodology in its current format. The authors make specific recommendations for how the instrument could be revised for greater clarity and accuracy.

Assessing methodological quality in dental education research using MERSQI: Analysis of publications from two journals

PURPOSE

The Medical Education Research Study Quality Instrument (MERSQI) has been used frequently to assess the methodological quality of medical education but not for dental education. The present study aimed to assess the methodological quality using MERSQI scores of articles published in the Journal of Dental Education (JDE) and the European Journal of Dental Education (EJDE).

METHODS

A cross-sectional assessment of the quality of manuscripts published in 2012, 2017, and 2022 JDE and EJDE was conducted. MERSQI data, numbers of authors, first and corresponding author degrees, geographic origins, and funding information were also extracted for each included study. Descriptive and analytical statistics were conducted, and significance level was set at α < 0.05.

RESULTS

Four hundred ninety-five articles met the inclusion criteria. The most common study design was a single-group cross-sectional or single-group posttest and conducted in one institution for all studied years. In all journals and years, studies were assessed mainly by participants. The study outcome was mostly satisfaction, attitudes, perceptions, opinions, and general facts. The total mean MERSQI score for each journal and year varied. Year and geographic origin significantly affected the total MERSQI score. Papers originating from Asia had the highest score, followed by South America, Europe, North America, Oceania, and Africa.

CONCLUSION

MERSQI score is applicable to the assessment of the methodological quality of dental educational research. The MERSQI score for most of the domains was similar for both journals. The MERSQI score was affected by publication years and geographic origins.

A Systematic Review of Peritonsillar Abscess Simulators: Enhancing Training and Identifying the Need for Standardization

OBJECTIVES

To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation.

DATA SOURCES

PubMed, Scopus, Web of Science, Ovid, and Cochrane.

REVIEW METHODS

A search of the abovementioned databases was performed in August 2022 using the terms "peritonsillar abscess/quinsy," "incision/drainage/aspiration," and "simulation." No time restrictions were applied. We included studies that clearly described how their PTA models were built and underwent validation from experts and/or evaluation from trainees. Articles describing a model only without any evaluation and reports in languages other than English were excluded.

RESULTS

Our search initially yielded 80 articles after duplicate removal, 10 of which met our criteria and were included. Two studies trained participants on both needle aspiration and incision and drainage (I&D), four studies on I&D only, and four on needle aspiration only. 87.5% to 100% of junior residents reported minimal exposure to PTA prior to simulation. Five studies provided some form of validation to their models. The value of the simulators to train participants on skills received better appreciation than their anatomical fidelity. The perceived confidence level of trainees in managing PTA, which was assessed in 7 studies, substantially improved after training.

CONCLUSION

PTA simulation improves the confidence of trainees to perform PTA drainage. There is, however, a lack of standardization and evidence regarding transfer validity among PTA simulators. The development of a standardized PTA simulator could allow for more widespread use and increase resident comfort with this procedure in a pre-clinical setting.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2495-2501, 2024.

Self-directed learning assessment practices in undergraduate health professions education: a systematic review

PURPOSE

The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education.

METHODS

Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes.

RESULTS

Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001).

CONCLUSIONS

The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.

Exploring the inclusion of anatomical variation in medical education

The role of anatomical variability in safe clinical practice is underappreciated. A lack of familiarity of anatomical variations is at the center of a multitude of medical and surgical errors. The recent rise in litigation due to such errors suggests that patient care may be compromised. This makes the knowledge of anatomical variation essential to medical education. Empirical studies were identified by searching several databases and repositories, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Eight studies were eligible for this systematic review; three of which were conference abstracts. Thematic summary of these studies yielded six themes namely: (1) importance of anatomical variation in medical education; (2) the ideal time to introduce anatomical variation in medical education; (3) important anatomical variations to include in medical education; (4) approaches to teaching anatomical variation; (5) assessing knowledge on anatomical variation; (6) barriers to including anatomical variation in medical education. Including anatomical variations in medical education would improve clinical reasoning and surgical outcomes. Following the completion of this review, three recommendations were made: (1) increasing the emphasis of anatomical variation in medical education; (2) developing more resources for anatomical variation education; (3) investigating the implications of lack of knowledge of anatomical variation in medical education through further research.

Face, Content, and Construct Validity Evaluation of Simulation Models in General Surgery Laparoscopic Training and Education: A Systematic Review

BACKGROUND

Laparoscopic technical surgical skills (LTS) are considered a fundamental competence for General Surgery residents. Several simulation tools (ST) have been explored to develop LTS. Although a plethora of systematic reviews evaluate the translation of LTS developed in simulation to real surgery, there is a lack of evidence that clarifies effectiveness of different validated ST in acquisition of LTS in surgical residents. The aim of this systematic review (SR) is to summarize published evidence on ST validation used for surgery education and training.

METHODS

A protocol was published in PROSPERO. A SR was carried out following PRISMA guidelines. Complete published articles in English or Spanish that validate either content or construct, plus another form of validation of ST to acquire LTS in general surgery were included. Articles that used only one validation or did not validate an ST were excluded.

RESULTS

1052 publications were initially identified across all searched databases. Title review identified 204 studies eligible for full text screening. 10 studies were included for final review. Two studies assessed both face and content, 4 face and construct, and 4 face, content and construct validity. None of the studies presented comparable outcomes due to metrics variation and scores used for the validation strategies.

CONCLUSIONS

This study assessed validated laparoscopic simulation models, particularly in content and construct validity. Articles reported an increased use of simulation models in laparoscopic training with positive feedback from trainees, but few studies reported validation of training model. Validation strategies are not standardized, limiting comparability between them.

Expanding Educational Frontiers in Neurosurgery: Current and Future Uses of Augmented Reality

BACKGROUND

Augmented reality (AR) technology is a new and promising option to advance and expand neurosurgical training because of recent advances in computer vision technology, improved AR software and hardware, and growing acceptance of this technology in clinical practice.

OBJECTIVE

To analyze the current status of AR use cases with the goal of envisioning future uses of AR in neurosurgical education.

METHODS

Articles applying to AR technology use in neurosurgical education were identified using PubMed, Google Scholar, and Web of Science databases following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines. Articles were included for review based on applicable content related to neurosurgical or neuroanatomy training. Assessment of literature quality was completed using standardized MERSQI scoring.

RESULTS

The systematic search identified 2648 unique articles. Of these, 12 studies met inclusion criteria after extensive review. The average MERSQI score was 10.2 (SD: 1.7). The most common AR platform identified in this study was the Microsoft Hololens. The primary goals of the studies were to improve technical skills and approaches to surgical planning or improve understanding of neuroanatomy.

CONCLUSION

Augmented reality has emerged as a promising training tool in neurosurgery. This is demonstrated in the wide range of cases in technical training and anatomic education. It remains unclear how AR-based training compares directly with traditional training methods; however, AR shows great promise in the ability to further enhance and innovate neurosurgical education and training.

A Modified Medical Education Research Study Quality Instrument (MMERSQI) developed by Delphi consensus

BACKGROUND

The Medical Education Research Study Quality Instrument (MERSQI) is widely used to appraise the methodological quality of medical education studies. However, the MERSQI lacks some criteria which could facilitate better quality assessment. The objective of this study is to achieve consensus among experts on: (1) the MERSQI scoring system and the relative importance of each domain (2) modifications of the MERSQI.

METHOD

A modified Delphi technique was used to achieve consensus among experts in the field of medical education. The initial item pool contained all items from MERSQI and items added in our previous published work. Each Delphi round comprised a questionnaire and, after the first iteration, an analysis and feedback report. We modified the quality instruments' domains, items and sub-items and re-scored items/domains based on the Delphi panel feedback.

RESULTS

A total of 12 experts agreed to participate and were sent the first and second-round questionnaires. First round: 12 returned of which 11 contained analysable responses; second-round: 10 returned analysable responses. We started with seven domains with an initial item pool of 12 items and 38 sub-items. No change in the number of domains or items resulted from the Delphi process; however, the number of sub-items increased from 38 to 43 across the two Delphi rounds. In Delphi-2: eight respondents gave 'study design' the highest weighting while 'setting' was given the lowest weighting by all respondents. There was no change in the domains' average weighting score and ranks between rounds.

CONCLUSIONS

The final criteria list and the new domain weighting score of the Modified MERSQI (MMERSQI) was satisfactory to all respondents. We suggest that the MMERSQI, in building on the success of the MERSQI, may help further establish a reference standard of quality measures for many medical education studies.

Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials

BACKGROUND

Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education.

MATERIALS AND METHODS

Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD).

RESULTS

Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity.

CONCLUSION

The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.

Theoretical Frameworks in Medical Education: Using a Systematic Review of Ophthalmology Education Research to Create a Theory of Change Model

BACKGROUND

Theoretical frameworks provide a lens to examine questions and interpret results; however, they are underutilized in medical education.

OBJECTIVE

To systematically evaluate the use of theoretical frameworks in ophthalmic medical education and present a theory of change model to guide educational initiatives.

METHODS

Six electronic databases were searched for peer-reviewed, English-language studies published between 2016 and 2021 on ophthalmic educational initiatives employing a theoretical framework. Quality of studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach; risk of bias was evaluated using the Medical Education Research Study Quality Instrument (MERSQI) and the Accreditation Council for Graduate Medical Education (ACGME) guidelines for evaluation of assessment methods. Abstracted components of the included studies were used to develop a theory of change model.

RESULTS

The literature search yielded 1661 studies: 666 were duplicates, 834 studies were excluded after abstract review, and 132 after full-text review; 29 studies (19.2%) employing a theoretical framework were included. The theories used most frequently were the Dreyfus model of skill acquisition and Messick's contemporary validity framework. GRADE ratings were predominantly "low," the average MERSQI score was 10.04, and the ACGME recommendation for all assessment development studies was the lowest recommendation. The theory of change model outlined how educators can select, apply, and evaluate theory-based interventions.

CONCLUSIONS

Few ophthalmic medical education studies employed a theoretical framework; their overall rigor was low as assessed by GRADE, MERSQI, and ACGME guidelines. A theory of change model can guide integration of theoretical frameworks into educational initiatives.

Effectiveness of Immersive Virtual Reality in Nursing Education: Systematic Review

BACKGROUND

Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential.

PURPOSE

This review analyzed the effectiveness of and barriers to using immersive VR in nursing education.

METHODS

A structured search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web of Science, and ProQuest Nursing & Allied Health Database. The Medical Education Research Study Quality Instrument was used to assess the quality of studies.

RESULTS

The final review was composed of 9 studies of moderate to high quality published between 2018 and 2020. The review indicated that immersive VR increased learning, cognitive, and psychomotor performance. Most participants of the studies preferred using immersive VR in education and with a variety of experiential scenarios. Barriers were associated with technological hardware and software (eg, simulation sickness, lack of visual comfort).

CONCLUSION

The review supports the viability of immersive VR technology in nursing education.

Assessment of the learning curve for the novel transanal minimally invasive surgery simulator model

BACKGROUND

Transanal minimally invasive surgery (TAMIS) is technically demanding and requires extensive training. We developed the TAMIS simulator model by remodeling an existing laparoscopic training system to educate trainees and analyzed their learning curves.

METHODS

Between March 2020 and June 2020, 12 trainees performed TAMIS simulator training sessions. The total operative time, including specimen removal and wound closure, was recorded. The wound closure and specimen quality, trainee self-confidence, and supervisor evaluation of technical performance were documented. A moving average was used to analyze the number of training sessions required to stabilize the procedure time, while a cumulative sum analysis was performed to identify that required to reach proficiency with each item.

RESULTS

Each trainee completed 20 TAMIS simulator training sessions. The median total procedure time was 13 min (range, 4-60 min), which stabilized after 15 training sessions. The median times for specimen removal and wound closure were 3 min (range, 1-18 min) and 10 min (range, 2-50 min), respectively, which stabilized after 7 and 15 training sessions, respectively. The mean specimen and wound closure quality scores were 2.9 ± 0.9 (on a scale from 1 to 4) and 2.3 ± 1.1 (on a scale from 1 to 4), respectively, competencies in which were achieved after 16 and 20 training sessions, respectively. The mean trainee self-confidence and supervisor evaluation of technical performance scores were 2.4 ± 1.2 (on a scale from 1 to 5) and 2.7 ± 1.2 (on a scale from 1 to 5), respectively, competencies in which were achieved after 20 and 17 training sessions, respectively.

CONCLUSION

Trainees required 15 training sessions to stabilize the procedure time and 16-20 training sessions to demonstrate competencies with the TAMIS simulator model. We expect this simulator model may help surgeons more rapidly acquire the skills required for TAMIS.

Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review

BACKGROUND

Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education.

METHODS

PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review.

RESULTS

Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities.

CONCLUSION

Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.

The innate aptitude's effect on the surgical task performance: a systematic review

Surgery is known to be a craft profession requiring individuals with specific innate aptitude for manipulative skills, and visuospatial and psychomotor abilities. The present-day selection process of surgical trainees does not include aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We aimed to scrutinize the significance of innate aptitudes in surgical practice and impact of training on skills by systematically reviewing their significance on the surgical task performance. A systematic review was performed in compliance with PRISMA guidelines. An initial search was carried out on PubMed/Medline for English language articles published over 20 years from January 2001 to January 2021. Search strategy and terms to be used included ‘aptitude for surgery’, ‘innate aptitude and surgical skills, ‘manipulative abilities and surgery’, and ‘psychomotor skills and surgery’. MERSQI score was applied to assess the quality of quantitatively researched citations. The results of the present searches provided a total of 1142 studies. Twenty-one studies met the inclusion criteria out of which six citations reached high quality and rejected our three null hypothesis. Consequently, the result specified that all medical students cannot reach proficiency in skills necessary for pursuing a career in surgery; moreover, playing video games and/or musical instruments does not promote skills for surgery, and finally, there may be a valid test with predictive value for novices aspiring for a surgical career. MERSQI mean score was 11.07 (SD = 0.98; range 9.25–12.75). The significant findings indicated that medical students with low innate aptitude cannot reach skills necessary for a competent career in surgery. Training does not compensate for pictorial-skill deficiency, and a skill is needed in laparoscopy. Video-gaming and musical instrument playing did not significantly promote aptitude for microsurgery. The space-relation test has predictive value for a good laparoscopic surgical virtual-reality performance. The selection process for candidates suitable for a career in surgery requests performance in a simulated surgical environment.

Toward Competency-Based Training: To What Extent Are We Competency-Based?

BACKGROUND

Time-based training models in plastic surgery vary in exposure, resulting in low confidence levels among graduates. The evolution of postgraduate medical education into a competency-based model to address these issues requires an understanding of interventions described in the plastic surgery literature to identify gaps and guide creation of assessments to demonstrate competence.

METHODS

A systematic search of the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Cochrane databases from inception until December of 2017 was conducted using search terms and synonyms of educational interventions reported in plastic surgery. Full texts were retrieved following filtering and data extracted were related to intervention design and execution, involvement of competency assessment, and educational objectives and alignment to Accreditation Council for Graduate Medical Education competencies and Royal College of Physicians and Surgeons of Canada Canadian Medical Education Directives for Specialists roles. Study quality was assessed using Kirkpatrick's levels of learning evaluation, validity evidence, and the Medical Education Research Study Quality Instrument score.

RESULTS

Of the initial 4307 results, only 36 interventions met the inclusion criteria. Almost all interventions aligned to medical knowledge and patient care Accreditation Council for Graduate Medical Education competencies. One-fifth of the interventions involved no assessment of competency, whereas most displayed assessment at the level of design as opposed to outcomes. Quality assessment revealed low levels of learning evaluation and evidence of validity; the average Medical Education Research Study Quality Instrument score was 10.9 of 18.

CONCLUSION

A systematic review of educational literature in plastic surgery was conducted to assess the quality of reported educational interventions, and to help guide creating tools that ensure competency acquirement among trainees.

Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods

BACKGROUND

Over the past 2 decades, emergency ultrasound has become essential to patient care, and is a mandated competency for emergency medicine residency graduation. However, the best evidence regarding emergency ultrasound education in residency training is not known. We performed a scoping review to determine the (1) characteristics and (2) outcomes of published structured training methods, (3) the quality of publications, and (4) the implications for research and training.

METHODS

We searched broadly on multiple electronic databases and screened studies from the United States and Canada describing structured emergency ultrasound training methods for emergency medicine residents. We evaluated methodological quality with the Medical Education Research Study Quality Instrument (MERSQI), and qualitatively summarized study and intervention characteristics.

RESULTS

A total of 109 studies were selected from 6712 identified publications. Publications mainly reported 1 group pretest-posttest interventions (38%) conducted at a single institution (83%), training in image acquisition (82%) and interpretation (94%) domains with assessment of knowledge (44%) and skill (77%) outcomes, and training in cardiac (18%) or vascular access (15%) applications. Innovative strategies, such as gamification, cadaver models, and hand motion assessment are described. The MERSQI scores of 48 articles ranged from 0 to 15.5 (median, 11.5; interquartile range, 9.6-13.0) out of 18. Low scores reflected the absence of reported valid assessment tools (73%) and higher level outcomes (90%).

CONCLUSIONS

Although innovative strategies are illustrated, the overall quality of research could be improved. The use of standardized planning and assessment tools, intentionally mapped to targeted domains and outcomes, might provide valuable formative and summative information to optimize emergency ultrasound research and training.

Community Based Interventions for Problematic Substance Use in Later Life: A Systematic Review of Evaluated Studies and Their Outcomes

Problematic substance use (PSU) in later life is a growing global problem of significant concern in tandem with a rapidly ageing global population. Prevention and interventions specifically designed for older people are not common, and those designed for mixed-age groups may fail to address the unique and sometimes complex needs of ageing communities. We report findings from a systematic review of the empirical evidence from studies which formally evaluated interventions used with older people and reported their outcomes. Nineteen studies were included, of which thirteen focused solely on alcohol-related problems. Eight interventions utilised different types of screening, brief advice and education. The remaining drew on behavioural, narrative and integrated or multi-disciplinary approaches, which aimed to meet older people's needs holistically. Quality assessment of study design helped to review evaluation practice. Findings point to recommendations for sustainable and well-designed intervention strategies for PSU in later life, which purposefully align with other areas of health and well-being and are delivered in locations where older people normally seek, or receive, help. There is further scope for engagement with older people's own perspectives on their needs and help-seeking behaviours. Economic evaluation of the outcome of interventions would also be useful to establish the value of investing in targeted services to this underserved population.

Educating health and social care practitioners on the experiences and needs of older LGBT+ adults: Findings from a systematic review

AIM(S)

To report review findings into interventions used to educate the health and social care workforce on the experiences and needs of LGBT+ older adults.

BACKGROUND

Research demonstrates that inequalities in outcomes on health and social well-being for LGBT+ older adults are perpetuated by the cumulative disadvantages from discrimination and social exclusion throughout the life course and a lack of culturally competent workforce.

METHODS

A systematic search of peer-reviewed papers published before February 2020 was conducted in electronic databases. The search resulted in a screening of 2,509 papers with nine matching the inclusion criteria, which were rated using the MERSQI quality measure.

RESULTS

Studies demonstrated some positive outcomes of interventions, especially an increase in knowledge, but less so in skills and attitudes.

DISCUSSION

More robust designs such as randomized controlled trials, the use of standardized measures and a focus more on the longitudinal impact of educational interventions could improve the quality of study designs.

CONCLUSION(S)

Diversification of intervention content and patient and public involvement in the design, delivery and evaluation of educational interventions could improve efforts and have a more sustained impact on LGBT+ ageing inequalities.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers have important roles in supporting staff education and ensuring LGBT+ inclusive practice.

Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures

INTRODUCTION

External ventricular drain (EVD) placement can be performed at the bedside in the neurosurgical intensive care unit (ICU) or in the operating room (OR). Systematic review and meta-analysis may permit stronger recommendations to improve accuracy and complication rates.

METHODS

Systematic review of PubMed was performed (inception-December 12, 2019) following PRISMA guidelines.

RESULTS

Our search yielded 356 articles, of which 37 studies underwent full-text analysis. Nine studies met inclusion criteria. Studies were segregated into OR only (n = 3; 1011 patients), ICU only (n = 3; 325 patients), and OR + ICU (n = 3; 613 patients) cohorts. Studies were in addition divided by outcome measures, including catheter placement accuracy (ICU, 4 studies, n = 280 [68.29%] vs. OR, 2 studies, n = 198 [84.25%]); iatrogenic hemorrhagic complications (ICU, 4 studies, n = 112 [18.16%] vs. OR, 2 studies, n = 35 [17.50%]); and ventriculostomy-related infection rates (ICU, 4 studies, n = 48 [7.28%] vs. OR: 5 studies, n = 92 [8.06%]).

CONCLUSIONS

There are likely specific patient populations who would benefit from EVD placement in the ICU versus OR setting. The literature comparing efficacy and morbidity between EVDs placed in the ICU and OR settings is overall inconclusive in both sample size and congruence of methodology. Agreement in outcome metrics and data reporting on this topic is necessary to synthesize high-quality evidence to form practice-changing recommendations for this debated topic.

Iterative approach to journal club

To identify, evaluate and refine a journal club (JC) format that increases faculty and resident engagement. An initial needs assessment followed by a trial of three JC formats: traditional single presenter, debate style and facilitated small group discussion was piloted over 6 months. Anonymous feedback was collected. The facilitated small group format was chosen. Narrative and quantitative feedback were collected from residents and faculty at 6-month intervals for the next 24 months. Changes to the format were made using feedback. Fourteen residents (n=20, 70%) and 10 faculty (n=20, 50%) completed baseline surveys. We initially observed low resident (8/14, 57%) interest in JCs. Additionally, 9/14 (64%) of residents and 1/15 (7%) of faculty reported low confidence presenting articles publicly. After implementation of the new JC format, resident reported enjoyment, on a scale of 1-5, improved from 3.6 to 4.4 (p<0.01). We observed improvement in resident confidence in the ability to critique a paper (2.7 to 4.1, p<0.01) and in confidence speaking in front of both peers (3.8 to 4.6, p<0.01) and faculty (3.0 to 3.8, p=0.04). Faculty confidence with literature critique decreased (from 4.2 to 3.8), but enjoyment remained stable (4.3 to 4.2). A facilitated small group JC format was preferred in our programme. We observed measurable improvements in both resident interest and confidence, as well as sustained faculty interest in JCs. We fostered an environment of inquiry and identified areas of continued professional development.

Associations Between Breastfeeding and Mother-Infant Relationships: A Systematic Review

Introduction: Breastfeeding has been associated to an improved mother-child bond, although this link is lacking the sufficient empirical support. Aims: The aims of this study were to carry out a systematic review as a continuation to the one by Jansen et al., and to clarify the link between breastfeeding and mother-infant relationships. Materials and Methods: Data sources: A search was conducted using PsycINFO, MEDLINE, and CINAHL (2008-2018), using both free text words and subject headings. Additional hand-searching was performed. Study selection: The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) framework guided (the reporting of) the study selection and data extraction. Eligible articles were subsequently selected by title, abstract, and full text review. Data extraction: Data regarding study setting, participants, breastfeeding, mother-infant relationships, and outcome measures were extracted in a systematic way. Results of Data Synthesis: Ultimately, 13 articles were included. Most studies were conducted in Europe (46.15%) and were nonexperimental studies (92.3%). Eight studies were longitudinal, using between two and five assessment time points. The instruments used to assess the bond between mother and child showed great variability. From the studies, 8 (61.5%) employed self-report measures and four assessed maternal perception. Others used open-ended questions regarding the maternal lactation process or about the mother's activity while breastfeeding. Other measures used were maternal perception of her baby and personality variables associated to breastfeeding. Five articles studied the bond using external observations of the interactions between mother-child. The quality of the studies (Medical Education Research Studies Quality Instrument [MERSQI]) was overall fair to good. Conclusion: It is complicated to extract generalizable results because of the conceptual and instrumental variability of the mother-child relationship. This association is complex and the way in which breastfeeding is carried out would appear to be a decisive factor, influenced in turn by additional variables that should also be taken into account. The relationship indicators most frequently associated to breastfeeding are maternal sensitivity and secure attachment.

Tracking Surgical Education Survey Research Through the APDS Listserv

OBJECTIVE

Survey-based studies are cornerstones in medical education research. The Association of Program Directors in Surgery (APDS) listserv offers a method to contact program directors (PD) and residents for such research. To facilitate research beneficial to the APDS, improve the quality of survey-based research and minimize survey fatigue, the APDS research committee (ARC) developed a survey review process to grant access to the listserv for research. This study was conducted to determine the impact of the review process on the quality of survey-based research and eventual publication.

DESIGN

This log was systematically reviewed identifying publications resulting from accepted surveys. Publications were categorically analyzed to determine the components of their survey tool methodology, response rate (RR), and medical education research study quality instrument (MERSQI) score.

SETTING

The ARC used a 2-reviewer peer-review process for survey distribution requests. The request was either accepted, rejected, or returned for revision. Accepted surveys were distributed through the listserv with an ARC attestation of approval.

PARTICIPANTS

A log of all survey requests maintained from 2014 to 2017 and subsequent publications.

RESULTS

Thirty-five requests were accepted (40%), 30 were reviewed discovering 10 surveys that led to 12 publications (publication rate of 33%). The average RR was 60% (SD = 29%). Detailed explanations of survey development strategies were reported in 5 (42%), consisting of methods building validity evidence such as expert consensus, modified Delphi method, and pilot group sampling. Half of study participants were PD (50%). MERSQI scores averaged 10 (SD = 1.6).

CONCLUSION

Based on those survey research published to date, the ARC survey peer-review process has enabled most accepted surveys to achieve adequate RR. Although the pool of accepted requests is small, it does highlight areas of improvement. With further refinement of the process, including questioning the survey development methods, the process and listserv can be a powerful tool for further research.

Systematic review of the current status of cadaveric simulation for surgical training

Background

There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training.

Methods

A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool.

Results

A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7).

Conclusion

There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre.

The Quality Of Evidence In Preclinical Medical Education Literature: A Systematic Review

INTRODUCTION

To practice effective evidence-based teaching, the need for well-designed studies that describe outcomes related to educational interventions is critical. The quality of the literate in basic science disciplines is unknown. The study objective was to conduct a systematic review of the literature to assess study design in articles describing innovations in preclinical medical education.

METHOD

The authors searched PubMed for all articles published in English between 2000 and 2017 describing interventions in preclinical medical education related to anatomy, physiology, and biochemistry. Articles were scored using a modification of the Medical Education Research Study Quality Instrument.

RESULTS

Of the 817 articles identified, 177 met final inclusion criteria (75 anatomy, 86 physiology, and 16 biochemistry). Laboratory, student-driven, and online activities were the most frequently reported. The average score for all papers was 15.7 (27 points possible). More than 80% reported experiences with one cohort of students and >97% involved only one institution. Only 25-49% of reports utilized a comparison (control) group. Proper statistical models for analysis of results were used in only 44-62% of papers.

CONCLUSION

Manuscripts had a strong tendency toward single institutional studies that involved one cohort of students. The use of a control/comparison group when assessing effectiveness was seen in <50% and nearly all reported outcomes solely in the form of student satisfaction or factual recall/skill performance.