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Le Lous M, Dion L, Le Ray C. Simulation training for pelvic examination: A systematic review. J Gynecol Obstet Hum Reprod 2023; 52:102666. [PMID: 37739264 DOI: 10.1016/j.jogoh.2023.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and students, because of its intimate nature. Consequently, education has shifted from a traditional approach to a simulation-enhanced education. This literature review summarizes the level of evidence for these not-so-new training modalities. METHODS For this systematic review, the Pudmed database have been consulted using the following keywords: (Pelvic examination OR Vaginal examination) AND simulation. Eligible studies had to be published in French or English within the past 20 years and investigate simulation training for pelvic examination in the field of gynecology and obstetrics. For each paper, the following outcomes were analyzed: Competence, confidence and communication, and were classified according to the Kirkpatrick hierarchy. RESULTS About competence, in initial training, one meta-analysis (9 studies of which 4 randomized studies) about pelvic examination teaching on procedural simulators have shown a significant benefit of simulation. One meta-analysis and one systematic review also demonstrated that Gynecological Teaching Associates (GTAs) teaching, who exist in Northern America and Scandinavian countries, was better that pelvic task trainers in terms of technical competence, and comfort. For the vaginal examination of women in labor, two randomized trials also showed a positive impact of pelvic task trainer on students' accuracy. CONCLUSION Simulation-enhanced education of pelvic examination brings a significant benefit in comparison to a classic education without simulation in terms of competence, confidence and communication. GTAs have the best impact on competence and communication, but they do not exist currently in France. Hybrid simulation (a patient actor combined with a pelvic task trainer) could be a solution to teach both technical skills and communication.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; LTSI - INSERM UMR 1099, University of Rennes 1, Rennes F35000, France; Academic Visitor at University College of London, Institute for Women's Health, London, UK.
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Camille Le Ray
- Maternité Port-Royal, Groupe Hospitalier Paris Centre, AP-HP, Université Paris Cité, FHU Préma, 75014 Paris, France
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Deffieux X, Pizzoferrato AC, Gaucher L, Rousset-Jablonski C, Le Ray C, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Artzner F, Tavenet A, Gantois A, Fauconnier A. Pelvic exam in Gynecology and Obstetrics: French Guidelines for Clinical Practice. Eur J Obstet Gynecol Reprod Biol 2023; 291:131-140. [PMID: 37871350 DOI: 10.1016/j.ejogrb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Anne-Cécile Pizzoferrato
- Service de Gynécologie Obstétrique, Hôpital Universitaire de La Miletrie, Poitiers F-86000, France; INSERM CIC 1402, Université de Poitiers, Poitiers F-86000, France
| | - Laurent Gaucher
- Collège National des Sages-Femmes de France, CNSF, Paris F-75010, France; Public Health Unit, Hospices Civils de Lyon, Bron F-69500, France; INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon 1, Lyon F-69008, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Département de Chirurgie, et Centre Hospitalier Lyon Sud, Service de Gynécologie-Obstétrique, INSERM U1290 RESHAPE, Lyon F-69000, France
| | - Camille Le Ray
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | | | - Julia Maruani
- Cabinet Médical, 6 Rue Docteur Albert Schweitzer, Marseille F-13006, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | | | - Yoann Athiel
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, Université de Lille, Lille F-59000, France
| | - Alexandre Bailleul
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France
| | - Mathilde Bourdon
- Université Paris Cité, APHP, Center Hospitalier Universitaire (CHU) Cochin Port Royal, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, F-75014, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes F-44000, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance Publique - Hôpitaux de Paris, Bondy F-93140, France; Institut de Recherche Interdisciplinaire sur Les Enjeux Sociaux, UMR 8156-997, UFR SMBH, Université Sorbonne Paris Nord, Bobigny F-9300, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France
| | - Yohann Dabi
- Sorbonne université - APHP - Hôpital Tenon, Service de gynécologie obstétrique et médecine de la reproduction, Paris F75020, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, Faculté de médecine, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux F-33076, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, Paris F-75005, France
| | - Anne Freyens
- DUMG (Département Universitaire de Médecine Générale), Université Paul Sabatier, Toulouse F-31000, France
| | - Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, France; Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Département de maïeutique, Center hospitalier de Melun Santepole, Melun F-77000, France
| | - Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, Créteil F-94000, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France; Université de Bordeaux, Bordeaux Institute of Oncology - Unité Inserm 1312, Bordeaux F-33000, France
| | - Nadege Lauchet
- Groupe Médical François Perrin, 9 rue François Perrin, Limoges F-87000, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France; UMR_S1085, Université d'Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, INSERM, LTSI - UMR 1099, Rennes F-35000, France; Département de gynécologie et obstétrique, CHU de Rennes, Rennes F-35000, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126 Boulevard Saint Germain, Paris F-75006, France
| | | | - Marine Masson
- Département de médecine générale, Poitiers F-86000, France
| | - Caroline Matteo
- Cabinet de maïeutique, 181 rue du Docteur Cauvin, Marseille F-13015, France
| | - Anne Pinton
- Service de gynécologie obstétrique, Hôpital Trousseau, APHP, 26, avenue du Dr-Arnold-Netter, Paris F-75012, France; Sorbonne Université, Paris F-75013, France
| | - Emmanuelle Sabbagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | - Camille Sallee
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU de Limoges, Limoges F-87000 France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes F- 44000, France; Laboratoire Mouvement, Interactions, Performance (MIP), EA 4334, Nantes Université, Nantes F- 44322, France
| | - Isabelle Heron
- Service d'endocrinologie, Université de Rouen, Hôpital Charles Nicolle, Rouen F-76000, France; Cabinet médical, 7 rue de Lessard, Rouen F-76100, France
| | - France Artzner
- CIANE, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101 rue Pierre Corneille, Lyon F-69003, France
| | - Arounie Tavenet
- ENDOFRANCE, Association de lutte contre l'endométriose. 3 rue de la Gare, Tresilley F-70190, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France hébergé au Réseau de Santé Périnatal Parisien (RSPP), Paris F75010, France
| | - Arnaud Fauconnier
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
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Pereda-Nuñez A, Manresa M, Webb SS, Pineda B, Espuña M, Ortega M, Rodríguez-Baeza A. Pelvic + Anatomy: A new interactive pelvic anatomy model. Prospective randomized control trial with first-year midwife residents. ANATOMICAL SCIENCES EDUCATION 2023; 16:843-857. [PMID: 37312278 DOI: 10.1002/ase.2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Detailed knowledge of female pelvic floor anatomy is essential for midwifery and other professionals in obstetrics. Physical models have shown great potential for teaching anatomy and enhancing surgical skills. In this article, we introduce an innovative physical anatomy model called "Pelvic+" to teach anatomical relationships in the female pelvis. The Pelvic+ model's value was compared to a traditional lecture in 61 first-year midwifery students randomly allocated to either the Pelvic+ (n = 30) or a control group (n = 32). The primary outcome measure was a quiz comprised of 15 multiple choice questions on pelvic anatomy. Participants were assessed at baseline (Pre-Test), upon completion of the intervention (Post-Test1) and 4 months afterward (Post-Test2). Satisfaction with the approach was assessed at Post-Test1. Increase in knowledge was greater and the approach more accepted among resident midwives when Pelvic+ was used instead of standard lectures. Four months after the intervention, the improvement in knowledge was preserved in the Pelvic+ group. This randomized study demonstrates that the Pelvic+ simulator is more effective than classical learning for pelvic anatomy education, and offers a higher level of satisfaction among students during the educational process. Medical students training in obstetrics and gynecology, or any professional who specializes in the female pelvic floor might also benefit from incorporation of the Pelvic+ model into their training program.
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Affiliation(s)
- Ana Pereda-Nuñez
- Gynaecology and Obstetrics Service, Hospital General of Granollers, Barcelona, Spain
| | - Margarita Manresa
- Department of Maternal Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | | | - Montserrat Espuña
- Department of Maternal Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marisa Ortega
- Institut Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Department of Morphological Sciences of School of Medicine, UAB, Barcelona, Spain
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Crochet P, Mousty E, Le Lous M, Chauleur C, Berveiller P, Ceccaldi PF, Deffieux X, Hanssens S, Gauthier T, Le Ray C, Legendre G, Rabischong B, Winer N, Tsatsaris V, Ghesquiere L, Rubod C. [Simulation training for French obstetrics and gynecology residents: A national survey in 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:393-399. [PMID: 37295716 DOI: 10.1016/j.gofs.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the use of simulation among French Obstetrics and Gynecology residency programs. METHODS A survey was conducted with all 28 French residency program directors. The questionnaire covered equipment and human resources, training programs, types of simulation tools and time spent. RESULTS Of the cities hosting a residency program, 93% (26/28) responded regarding equipment and human resources, and 75% (21/28) responded regarding training program details. All respondents declared having at least one structure dedicated to simulation. A formal training program was reported by 81% (21/26) of cities. This training program was mandatory in 73% of the cases. There was a median number of seven senior trainers involved, three of whom had received a specific training in medical education. Most of declared simulation activities concerned technical skills in obstetrics and surgery. Simulations to practice breaking bad news were offered by 62% (13/21) of cities. The median number of half-days spent annually on simulation training was 55 (IQR: 38-83). CONCLUSION Simulation training is now widely available among French residency programs. There remains heterogeneity between centers regarding equipment, time spent and content of simulation curricula. The French College of Teachers of Gynecology and Obstetrics has proposed a roadmap for the content of simulation-based training based on the results of this survey. An inventory of all existing "train the trainers" simulation programs in France is also provided.
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Affiliation(s)
- P Crochet
- Service de gynécologie-obstétrique, université de Rouen, CHU Charles-Nicolle, Rouen, France; Univ Rouen Normandie, INSERM, NORDIC UMR 1239 - Team Adrenal and Gonadal Pathophysiology (AGoPath), 76000 Rouen, France.
| | - E Mousty
- Service de gynécologie-obstétrique, université de Montpellier-Nîmes, CHU de Nîmes, Nîmes, France.
| | - M Le Lous
- Service de gynécologie-obstétrique, hôpital Sud, université de Rennes, CHU de Rennes, Rennes, France.
| | - C Chauleur
- Inserm, U 1059, service de gynécologie-obstétrique, université Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France.
| | - P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France.
| | - P-F Ceccaldi
- Université Paris Cité, Paris, France; Service de gynécologie-obstétrique, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, Clichy, France.
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - S Hanssens
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital mère-enfant, CHU de Limoges, 87000 Limoges, France.
| | - C Le Ray
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - G Legendre
- Département de médecine, service de gynécologie-obstétrique, faculté de santé, Angers, France.
| | - B Rabischong
- Department of gynecological surgery, CHU Estaing, Clermont-Ferrand, France.
| | - N Winer
- Service de gynécologie-obstétrique, NUN INRAE PhAN, UMR 1280, CHU de Nantes, 44000 Nantes, France.
| | - V Tsatsaris
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - L Ghesquiere
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - C Rubod
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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6
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Cheung VYT, Tang YM, Chan KKL. Medical students' perception of the application of a virtual reality training model to acquire vaginal examination skills. Int J Gynaecol Obstet 2023; 161:827-832. [PMID: 36637241 DOI: 10.1002/ijgo.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/20/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To review the perception of and feedback from medical students on the application of a virtual reality (VR) model to acquire vaginal examination (VE) skills. METHODS A specially designed VR training model on VE was developed with the aim of enhancing medical students' VE skills. Medical students attending the gynecology clinic were invited to try this VR training model. Their participation was voluntary and at the completion of their VR training, they were asked to complete an anonymous questionnaire to give their feedback and perception regarding this learning experience. RESULTS Sixty-five sixth-year medical students completed the VR training and the feedback questionnaire: 55 (84.7%) of them reported that the training instructions were clear and 60 (92.4%) considered the training to the helpful in recalling the details of the tasks. It was also reported that VR technology could facilitate learning and interaction, and motivate learning in 80.1% and 66.2% of medical students, respectively. CONCLUSION VR technology is a potential teaching modality for medical students to acquire VE skills. However, further evaluation is needed to determine whether this learning tool is effective in enhancing clinical competence.
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Affiliation(s)
- Vincent Y T Cheung
- Department of Obstetrics and Gynaecology, Gleneagles Hospital, The University of Hong Kong, Hong Kong
| | - Yuk Ming Tang
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Karen K L Chan
- Department of Obstetrics and Gynaecology, Gleneagles Hospital, The University of Hong Kong, Hong Kong
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McCabe C, Ly C, Gregg B, Anderson OS. A Description of Breast Models Used to Teach Clinical Skills. Breastfeed Med 2022; 17:875-890. [PMID: 36251448 DOI: 10.1089/bfm.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.
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Affiliation(s)
- Carolyn McCabe
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Carrie Ly
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Brigid Gregg
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Division of Pediatric Endocrinology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Olivia S Anderson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Ando K, Ando A, Tanaka A, Koba S, Sagara H. Educational Effects of Simulation and Non-Simulation Training in Airway Management according to Levels of the Kirkpatrick Model: A Systematic Review and Network Meta-Analysis. J Clin Med 2022; 11:jcm11195614. [PMID: 36233481 PMCID: PMC9571641 DOI: 10.3390/jcm11195614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
There is insufficient validation of the effectiveness of simulation-based training (Sim) or non-simulation-based training (non-Sim) for teaching airway management to healthcare professionals within the literature. We thus conducted a network meta-analysis comparing the effectiveness of Sim, non-Sim, and no educational intervention (NI) for airway management. The primary endpoints were knowledge scores (KnS) and behavioral performance scores (BpS) corresponding to assessments at levels 2 and 3 of the Kirkpatrick model, respectively. Effect sizes were expressed as standardized mean differences (Std. MD) and 95% credible intervals (CrIs). Regarding KnS, the educational effects of Sim and non-Sim were significantly improved compared to those of NI (Std. MD [95% CI]: 1.110 [0.903–1.316] and 0.819 [0.209–1.429], respectively); there was no significant difference between Sim and non-Sim. The educational effect of Sim in BpS was significantly improved compared to that of non-Sim and NI (0.850 [0.015–1.691] and 0.660 [0.241–1.076]); there were no differences between non-Sim and NI. Surface under the cumulative rank curve values demonstrated that Sim ranked highest in efficacy for KnS and BpS. This study provides valuable information regarding the educational efficacy of Sim and non-Sim in airway management. Larger randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Koichi Ando
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
- Division of Internal Medicine, Showa University Dental Hospital Medical Clinic, Senzoku Campus, Showa University, 2-1-1 Kita-senzoku, Ohta-ku, Tokyo 145-8515, Japan
- Correspondence: ; Tel.: +81-3784-8532
| | - Akane Ando
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Shinji Koba
- Division of Internal Medicine, Showa University Dental Hospital Medical Clinic, Senzoku Campus, Showa University, 2-1-1 Kita-senzoku, Ohta-ku, Tokyo 145-8515, Japan
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Kiesel M, Beyers I, Kalisz A, Wöckel A, Quenzer A, Schlaiß T, Wulff C, Diessner J. Evaluating the value of a 3D printed model for hands-on training of gynecological pelvic examination. 3D Print Med 2022; 8:20. [PMID: 35793005 PMCID: PMC9261074 DOI: 10.1186/s41205-022-00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Simulation in the field of gynecological pelvic examination with educational purposes holds great potential. In the current manuscript we evaluate a 3D printed model of the female pelvis, which improves practical teaching of the gynecological pelvic examination for medical staff. Methods We evaluated the benefit of a 3D printed model of the female pelvis (Pelvisio®) as part of a seminar (“skills training”) for teaching gynecological examination to medical students. Each student was randomly assigned to Group A or B by picking a ticket from a box. Group A underwent the skills training without the 3D printed model. Group B experienced the same seminar with integration of the model. Both groups evaluated the seminar by answering five questions on Likert scales (1–10, 1 = “very little” or “very poor”, 10 equals “very much” or “very good”). Additionally, both groups answered three multiple-choice questions concerning pelvic anatomy (Question 6 to 8). Finally, Group B evaluated the 3D printed model with ten questions (Question 9 to 18, Likert scales, 1–10). Results Two of five questions concerning the students’ satisfaction with the seminar and their gained knowledge showed statistically significant better ratings in Group B (6.7 vs. 8.2 points and 8.1 vs. 8.9 points (p < 0.001 and p < 0.009). The other three questions showed no statistically significant differences between the traditional teaching setting vs. the 3D printed model (p < 0.411, p < 0.344 and p < 0.215, respectively). The overall mean score of Question 1 to 5 showed 8.4 points for Group B and 7.8 points for Group A (p < 0.001). All three multiple-choice questions, asking about female pelvic anatomy, were answered more often correctly by Group B (p < 0.001, p < 0.008 and p < 0.001, respectively). The mean score from the answers to Questions 9 to 18, only answered by Group B, showed a mean of 8.6 points, indicating, that the students approved of the model. Conclusion The presented 3D printed model Pelvisio® improves the education of female pelvic anatomy and examination for medical students. Hence, training this pivotal examination can be supported by a custom designed anatomical model tailored for interactive and explorative learning.
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Affiliation(s)
- Matthias Kiesel
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
| | - Inga Beyers
- Institute of Electric Power Systems (IfES), Leibniz Universität Hannover, Appelstraße 9A, 30167, Hannover, Germany
| | - Adam Kalisz
- Department of Electrical, Electronic and Communication Engineering, Information Technology (LIKE), Friedrich-Alexander-Universität Erlangen-Nürnberg, Am Wolfsmantel 33, Erlangen, Germany
| | - Achim Wöckel
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Anne Quenzer
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Tanja Schlaiß
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Christine Wulff
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Joachim Diessner
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
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Janke MJ, Santiago S, Straubhar AM, Uppal S. The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care. Int J Gynecol Cancer 2022; 32:913-917. [PMID: 35675968 DOI: 10.1136/ijgc-2022-003506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Given the recent rapid increase in telemedicine in the setting of the COVID-19 pandemic, we sought to investigate the utility of symptom review, CA125, and physical examination in the detection of ovarian cancer recurrence to determine the role of virtual surveillance care in the COVID-19 era. METHODS This retrospective cohort study included patients diagnosed with ovarian cancer between 2013 and 2020 who achieved remission after primary treatment and then had recurrence while in a routine surveillance program. Modalities that detected recurrence including symptoms, CA125, physical examination, or 'other,' which was denoted if imaging was obtained for reasons other than suspected recurrence and recurrence was incidentally identified, were recorded. Descriptive statistics were performed to summarize the cohort. RESULTS One hundred and nine patients met inclusion criteria. At time of recurrence, elevated CA125 was present in 97 (89.0%) patients, symptoms in 41 (37.6%), and abnormal physical exam findings in 27 (24.8%). Recurrence was incidentally found with imaging obtained for reasons other than suspicion of recurrence in six (5.5%) patients. Recurrence was suspected based on multiple modalities in 46 (42.2%) patients. Elevated CA125, symptoms, or both were present in 102 (93.6%) patients. Of patients with abnormal physical exam findings, 26 (96.3%) also had elevated CA125 or symptoms present. Recurrence was suspected based on physical exam findings alone in one (0.9%) patient. CONCLUSIONS Over 90% of ovarian cancer recurrences were detected by rising CA125, symptoms, or both. Only one patient had recurrence detected by physical examination alone. Given that review of symptoms and CA125 can be conducted virtually, virtual visits may offer a reasonable alternative to in-person visits for ovarian cancer surveillance for patients who have pre-treatment elevated CA125.
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Affiliation(s)
- Monica J Janke
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Santiago
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alli M Straubhar
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shitanshu Uppal
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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A 3D printed model of the female pelvis for practical education of gynecological pelvic examination. 3D Print Med 2022; 8:13. [PMID: 35511353 PMCID: PMC9069962 DOI: 10.1186/s41205-022-00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pelvic palpation is a core component of every Gynecologic examination. It requires vigorous training, which is difficult due to its intimate nature, leading to a need of simulation. Up until now, there are mainly models available for mere palpation which do not offer adequate visualization of the concerning anatomical structures. In this study we present a 3D printed model of the female pelvis. It can improve both the practical teaching of gynecological pelvic examination for health care professionals and the spatial understanding of the relevant anatomy. Methods We developed a virtual, simplified model showing selected parts of the female pelvis. 3D printing was used to create a physical model. Results The life-size 3D printed model has the ability of being physically assembled step by step by its users. Consequently, it improves teaching especially when combining it with commercial phantoms, which are built solely for palpation training. This is achieved by correlating haptic and visual sensations with the resulting feedback received. Conclusion The presented 3D printed model of the female pelvis can be of aid for visualizing and teaching pelvic anatomy and examination to medical staff. 3D printing provides the possibility of creating, multiplying, adapting and sharing such data worldwide with little investment of resources. Thus, an important contribution to the international medical community can be made for training this challenging examination.
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12
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Adu-Bonsaffoh K, Mehrtash H, Guure C, Maya E, Vogel JP, Irinyenikan TA, Aderoba AK, Balde MD, Adanu R, Bohren MA, Tuncalp Ö. Vaginal examinations and mistreatment of women during facility-based childbirth in health facilities: secondary analysis of labour observations in Ghana, Guinea and Nigeria. BMJ Glob Health 2021; 5:bmjgh-2021-006640. [PMID: 34789483 PMCID: PMC8733942 DOI: 10.1136/bmjgh-2021-006640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Previous research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts. Methods A secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains). Results Of the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care; 233/1430 (16.4%) women had their private information shared; 397/1430 (27.8%) women had their genitalia exposed; and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9; Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9; Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9; Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7; Guinea: AOR 0.21, 95% CI 0.12 to 0.38). Conclusion Our results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Department of Obstetrics Gynaecology, University of Ghana Medical School, Accra, Ghana .,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland.,Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Chris Guure
- Department of Biostatistics, University of Ghana School of Public Health, Accra, Ghana
| | - Ernest Maya
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Joshua P Vogel
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
| | - Theresa Azonima Irinyenikan
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Medical Sciences, Ondo City, Nigeria.,Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Akure, Nigeria
| | - Adeniyi Kolade Aderoba
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Akure, Nigeria.,Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Nigeria
| | - Mamadou Dioulde Balde
- Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Richard Adanu
- University of Ghana School of Public Health, Accra, Ghana
| | - Meghan A Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Özge Tuncalp
- Reproductive Health and Research, WHO, Geneva, Switzerland
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Kirubarajan A, Li X, Got T, Yau M, Sobel M. Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1353-1365. [PMID: 33883396 DOI: 10.1097/acm.0000000000004128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. METHOD The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. RESULTS The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. CONCLUSIONS The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.
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Affiliation(s)
- Abirami Kirubarajan
- A. Kirubarajan is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Xinglin Li
- X. Li is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Got
- T. Got is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Yau
- M. Yau is a third-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mara Sobel
- M. Sobel is assistant professor, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Medical education has traditionally relied on in-person-based curriculums in medical school and residency . However, due to the COVID19 pandemic, medical schools and residency programs have been forced to rapidly transition to virtual platforms for learning. Surgical education poses a particular challenge, as virtual platforms cannot adequately replace hands-on learning of surgical skills. In this review, we will discuss the various ways in which virtual learning has been employed in surgical education and how it may be used to enhance learning of medical students and residents in the future. METHODS We conducted a comprehensive literature search to identify articles published regarding medical school and surgical residency curriculum changes after COVID19. RESULTS Over the past year, several surgery departments have piloted programs using virtual learning modules, live online lectures and training workshops, and remote streaming into the OR to supplement more traditional in-person learning. Overall, these programs have received positive feedback from participating medical students and residents, suggesting that virtual and online tools may be helpful in supplementing surgical education. However, several programs also noted the possibility for significant disparities in learning due to variable access to internet and availability of newer technologies. CONCLUSION Going forward, distance learning will play an important role in surgical education to further enhance learning of medical students and residents in a field with rapid technological advancements.
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Affiliation(s)
- Veena Mehta
- College of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Rachel Oppenheim
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC USA
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15
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Tsang ACO, Shih KC, Chen JY. Clinical skills education at the bed-side, web-side and lab-side. MEDICAL EDUCATION 2021; 55:112-114. [PMID: 33047370 DOI: 10.1111/medu.14394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - Kendrick Co Shih
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Julie Yun Chen
- Department of Family Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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16
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Orsi TD, Valadares ALR, Orsi PME, Orsi IME, Moura AS. Simulation-based Training for Pelvic and Breast Physical Examination: Effect on the Anxiety and Self-confidence of Medical Students. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:739-745. [PMID: 33254269 PMCID: PMC10309228 DOI: 10.1055/s-0040-1718433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination. METHODS A longitudinal study was conducted with 4th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated. RESULTS Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders. CONCLUSION The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.
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Affiliation(s)
| | - Ana Lucia Ribeiro Valadares
- Universidade José do Rosário Vellano, Alfenas, MG, Brazil.,Universidade Estadual de Campinas, Campinas, SP, Brazil
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Lim GH, Wang X, Allen JC, Ng RP, Tan BK, McCulley S, Lee HP. Evaluating the feasibility of a novel Marking Breast Oncoplastic Surgery Simulator (MBOSS) as a training tool for marking: a randomised trial. Gland Surg 2020; 9:1227-1234. [PMID: 33224797 DOI: 10.21037/gs-20-476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Currently, volunteers and/or anatomical models are used for teaching oncoplastic surgery marking. However, as the breast is an intimate organ, recruiting volunteers is difficult, and the available droopy breast models have limitations. We evaluated the feasibility of a novel Marking Breast Oncoplastic Surgery Simulator (MBOSS) for the teaching of marking. Methods Breast/plastic surgeons/trainees, grouped according to their oncoplastic experience, were randomized to MBOSS or volunteer. All had a pre-test evaluation prior to receiving hands-on training in inverted T mammoplasty marking in their randomized group, followed by an assessment of their marking skills, by an examiner blinded to their group assignment. All participants then underwent post-test and course evaluations, and those who used MBOSS for training, also evaluated MBOSS realism. Learning outcomes between the two groups were compared using the Kirkpatrick educational model. Results Forty participants were enrolled. Demographics, baseline oncoplastic experience and pre-test results were comparable between the MBOSS and volunteer groups. For Kirkpatrick level 1 satisfaction outcomes, the two groups did not differ significantly. For level 2 knowledge assessment, MBOSS post-test scores were significantly higher (P=0.0471). For level 3 skill application and level 4 organizational impact evaluated 6 months post course, there were no significant differences between the groups. Although MBOSS may not mimic the breast completely, 95% of MBOSS-trained participants rated MBOSS as a good training tool and 85% would use MBOSS instead of a volunteer. Conclusions MBOSS learning outcomes are comparable to outcomes using volunteers, making MBOSS an alternative for teaching oncoplastic surgery marking.
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Affiliation(s)
- Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Xue Wang
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - John C Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Ruey Pyng Ng
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Stephen McCulley
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, UK
| | - Heow Pueh Lee
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
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Al Asmri MA, Ennis J, Stone RJ, Bello F, Haque MS, Parle J. Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:414-421. [DOI: 10.1136/bmjstel-2020-000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BackgroundDigital rectal examination (DRE) is a challenging examination to learn.ObjectiveTo synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selectionEMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.Findings863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.ConclusionsTES training is associated with improved DRE skills and should be used more widely.
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Corroenne R, Legendre G, Riethmuller D, El-Hachem H, Zhu KH, Dreux C, Jeanneateau P, Verhaeghe C, May-Panloup P, Descamps P, Bouet PE. Benefits of an oocyte pickup simulation training program using a high-fidelity simulator (PickUpSim TM) for obstetrics and gynaecology residents: an observational survey study. J OBSTET GYNAECOL 2020; 41:631-636. [PMID: 32808836 DOI: 10.1080/01443615.2020.1789951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate an oocyte pick-up (OPU) simulation training program for residents using the high fidelity PickUpSimTM (Accurate, Cesena, Italy) simulator. The authors carried out an observational study during an OPU simulation workshop. A successful scenario was defined as an oocyte retrieval rate ≥70% without any complications. Forty-six residents affiliated to 23 different French university hospitals were included, and 37/46 (80.4%) of them successfully completed the scenario with a mean time of 3.4 ± 1.1 minutes. The oocyte retrieval rate was 442/561 (78.8%). All residents found training beneficial and 41/46 (87%) were in favour of having simulation-based training programs for OPU in their reproductive medicine departments. All residents who had previous experience with OPU (11/11) recommended the use of a simulator before performing OPU. This study confirms that high-fidelity OPU simulation is a simple and efficient method for training residents.Impact statementWhat is already known on this subject? Simulator-based training has been shown to be effective and useful for oocyte pick-up (OPU) training.What the results of this study add? All residents found the simulation program beneficial and formative, with 80% successfully completing their scenarios in a mean time of 3.4 ± 1.1 minutes. All residents who had previous experience with OPU recommended the use of a simulator before performing OPU.What the implications are of these findings for clinical practice and/or further research? Prospective studies are needed to confirm the short- and long-term positive clinical impact of OPU simulation training programs.
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Affiliation(s)
- Romain Corroenne
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynaecology, Besancon University Hospital, Besancon, France
| | - Hady El-Hachem
- Department of Obstetrics and Gynaecology, Clemenceau Medical Centre, Beirut, Lebanon
| | | | - Cecile Dreux
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Pauline Jeanneateau
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Caroline Verhaeghe
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Pascale May-Panloup
- Department of Reproductive Biology, Angers University Hospital, Angers, France
| | - Philippe Descamps
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Pierre-Emmanuel Bouet
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
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Richardson M, Routson S, Karam A, Dorigo O, Levy K, Renz M, Diver E. The role of asymptomatic screening in the detection of recurrent ovarian cancer. Gynecol Oncol Rep 2020; 33:100595. [PMID: 32548232 PMCID: PMC7286959 DOI: 10.1016/j.gore.2020.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022] Open
Abstract
The pelvic exam was a useful tool in the detection of ovarian recurrence. CA-125 use was not associated with better survival or rate of secondary cytoreductive surgery. Providers should carefully consider modalities for asymptomatic ovarian recurrence monitoring.
Objective To investigate the utility of asymptomatic screening, including CA-125, imaging, and pelvic exam, in the diagnosis and management of recurrent ovarian cancer. Methods Women with ovarian cancer whose cancer recurred after remission were categorized by first method that their provider suspected disease recurrence: CA-125, imaging, symptoms, or physical exam. Differences in clinicopathologic, primary treatment characteristics, and outcomes data including secondary cytoreductive surgery (SCS) outcome and overall survival (OS) were collected. Results 102 patients were identified at our institution from 2003 to 2015. 20 recurrences were detected by symptoms, while 62 recurrences were diagnosed first by asymptomatic rise in CA-125, 5 by pelvic exam, and 15 by imaging in the absence of known exam abnormality or rise in CA-125. Mean time to recurrence was 18.9 months, and median survival was 45.8 months. These did not vary by recurrence detection method (all p > 0.4). Patients whose disease was detected by CA-125 were less likely to undergo SCS than those detected by other means (21.7% vs. 35.0%, p = 0.007). In addition to the 5 patients whose recurrence was detected primarily by pelvic exam, an additional 10 (total n = 15) patients had an abnormal pelvic exam at time of diagnosis of recurrence. Discussion Recurrence detection method was not associated with differing rates of survival or optimal SCS, however those patients detected by CA-125 were less likely to undergo SCS. The pelvic exam was a useful tool for detecting a significant proportion of recurrences.
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Affiliation(s)
| | | | | | | | | | | | - E.J. Diver
- Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University, 900 Blake Wilbur Drive, Palo Alto, CA 94304, USA.
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Hamza A, Warczok C, Meyberg-Solomayer G, Takacs Z, Juhasz-Boess I, Solomayer EF, Radosa MP, Radosa CG, Stotz L, Findeklee S, Radosa JC. Teaching undergraduate students gynecological and obstetrical examination skills: the patient's opinion. Arch Gynecol Obstet 2020; 302:431-438. [PMID: 32488397 PMCID: PMC8595149 DOI: 10.1007/s00404-020-05615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/20/2020] [Indexed: 12/02/2022]
Abstract
Introduction Our study assesses the patients’ opinion about gynecological examination performed by undergraduate students (UgSts). This assessment will be used in improving our undergraduate training program. A positive opinion would mean a lower chance of a patient refusing to be examined by a tutor or student, taking into account vaginal examination (VE). Materials and methods We performed a prospective cross-sectional survey on 1194 patients, consisting of outpatient and inpatient at the departments of obstetrics and gynecology from November 2015 to May 2016. The questionnaire consisted of 46 questions. Besides demographic data, we assessed the mindset of patients regarding the involvement of undergraduate student (UgSt) in gynecological and obstetrical examinations. We used SPSS version 23 for the statistical analysis. For reporting the data, we followed the STROBE statement of reporting observational studies. Results The median age was 38 years having a median of one child. 34% presented due to obstetrical problems, 38% due to gynecological complaints, and 19% due to known gynecological malignancies. Generally, we retrieved a positive opinion of patients towards the involvement of students in gynecological and obstetrical examination under supervision in 2/3 of the cases. Conclusions There is no reason to exclude medical UgSts from gynecological and obstetrical examinations after obtaining a written or oral consent.
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Affiliation(s)
- Amr Hamza
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany.
| | - C Warczok
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - G Meyberg-Solomayer
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - Z Takacs
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - I Juhasz-Boess
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - E-F Solomayer
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - M P Radosa
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - C G Radosa
- Department for Gynecology, Diaconia Clinic Kassel, Kassel, Hessen, Germany
| | - L Stotz
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - S Findeklee
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - J C Radosa
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
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Torres A, Horodeńska M, Witkowski G, Torres K. Hybrid simulation of pediatric gynecologic examination: a mix-methods study of learners' attitudes and factors affecting learning. BMC MEDICAL EDUCATION 2020; 20:164. [PMID: 32448304 PMCID: PMC7245870 DOI: 10.1186/s12909-020-02076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children and adolescents with reproductive health issues may require immediate or emergency care, however in many countries availability of the pediatric and adolescent gynecology (PAG) service is low. That being said, teaching PAG examination to OBGYN, pediatrics and emergency medicine residents seems reasonable, and cannot be underestimated. In order to provide residents with opportunity to learn PAG examination, a high-fidelity hybrid simulation workshop was implemented in our institution. METHODS The study aimed to investigate learners' attitudes towards the high-fidelity simulation (HFS) hybrid model as compared with task trainer-SP (simulated patient)-voice model in the HFS environment and the factors connected to learners' attitudes towards the hybrid model that could influence learning in high-fidelity simulation (HFS). The concept of attitude was used as the theoretical framework and the mixed method approach to study design was utilized with simultaneous collection of quantitative (original questionnaires) and qualitative data (semi-structured interviews). RESULTS Residents valued the HFS hybrid model higher over task trainer-SP-voice model in regards to all three attitude components: cognitive (95%), affective (87.5%) and behavioral (83.7%). Analysis of qualitative data revealed six themes important to learners and informing learning of PAG examination in HFS. Further analysis of the themes allowed to develop a conceptual model, in which six factors connected to attitude components influenced learning. These factors were: task difficulty, attention, emotional realism of the simulation, patient's emotions, physical realism of the simulation, and technical issues. CONCLUSIONS Participants of our study appreciated learning experience with the HFS hybrid model more, based on attitude questionnaire. Moreover, findings revealed that multiple, various factors connected to attitude may influence learning of PAG examination in HFS with hybrid model, and we propose a conceptual model illustrating relationships between those factors.
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Affiliation(s)
- Anna Torres
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-094 Lublin, Poland
- Pediatric and Adolescent Gynecology Unit, University Children’s Hospital, Medical University of Lublin, Chodźki 4, 20-094 Lublin, Poland
| | - Magdalena Horodeńska
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-094 Lublin, Poland
| | - Grzegorz Witkowski
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-094 Lublin, Poland
| | - Kamil Torres
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-094 Lublin, Poland
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Sabet F, Zoghoul S, Alahmad M, Al Qudah H. The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:98. [PMID: 32234037 PMCID: PMC7110726 DOI: 10.1186/s12909-020-02002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. METHODS A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. RESULTS One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. CONCLUSIONS In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. TRIAL REGISTRATION Non interventional thus not required.
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Affiliation(s)
- Farnaz Sabet
- Formerly at Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad Alahmad
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba Al Qudah
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Sadovnikova A, Chuisano SA, Ma K, Grabowski A, Stanley KP, Mitchell KB, Eglash A, Plott JS, Zielinski RE, Anderson OS. Development and evaluation of a high-fidelity lactation simulation model for health professional breastfeeding education. Int Breastfeed J 2020; 15:8. [PMID: 32066477 PMCID: PMC7026968 DOI: 10.1186/s13006-020-0254-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 02/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A key reason for premature cessation of breastfeeding is inadequate support from healthcare providers. Most physicians and nurses do not feel confident in their ability to support families with breastfeeding initiation or maintenance. Increasing health professional confidence in clinical lactation skills is key to improving maternal and child health outcomes. High-fidelity (realistic) simulators encourage learner engagement, resulting in increased clinical skills competency, confidence, and transfer to patient care. Lactation educators teach with low-fidelity cloth and single breast models. There are no high-fidelity breast simulators for health professional education in clinical lactation. DEVELOPMENT AND EVALUATION OF A HIGH-FIDELITY LACTATION SIMULATION MODEL: In this commentary we describe the development of a high-fidelity Lactation Simulation Model (LSM) and how physician residents, nurse-midwifery students, and clinical lactation experts provided feedback on LSM prototypes. LIMITATIONS The user-testing described in this commentary does not represent comprehensive validation of the LSM due to small sample sizes and the significant conflict of interest. CONCLUSION For breastfeeding rates to improve, mothers need support from their nurses, midwives, pediatricians, obstetricians and gynecologists, and all healthcare staff who interact with pregnant and lactating women. Clinical education with high-fidelity breastfeeding simulators could be the ideal learning modality for trainees and hospital staff to build confidence in clinical lactation skills. The ability of a high-fidelity breastfeeding simulator to increase a learner's lactation knowledge and psychomotor skills acquisition, retention, and transfer to patient care still needs to be tested.
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Affiliation(s)
- Anna Sadovnikova
- LiquidGoldConcept, Inc., 124 Pearl St Suite 404, Ypsilanti, MI, 48197, USA. .,Graduate Group in Nutritional Biology, Physician Scientist Training Program, University of California, Davis, Davis, CA, USA.
| | | | - Kaoer Ma
- LiquidGoldConcept, Inc., 124 Pearl St Suite 404, Ypsilanti, MI, 48197, USA
| | - Aria Grabowski
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kate P Stanley
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Medical School, Michigan Medicine, Ann Arbor, MI, USA
| | - Katrina B Mitchell
- Department of Surgical Oncology, Ridley Tree Cancer Center at Sansum Clinic, Santa Barbara, CA, USA
| | - Anne Eglash
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey S Plott
- LiquidGoldConcept, Inc., 124 Pearl St Suite 404, Ypsilanti, MI, 48197, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ruth E Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Olivia S Anderson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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Lateef F, Too XY. The 2019 WACEM Expert Document on Hybrid Simulation for Transforming Health-care Simulation Through "Mixing and Matching". J Emerg Trauma Shock 2019; 12:243-247. [PMID: 31798236 PMCID: PMC6883504 DOI: 10.4103/jets.jets_112_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/04/2022] Open
Abstract
With the multitude of options available under the umbrella of "simulation" today, we have a larger repertoire of choices in our educational journey and outreach. These provide a platform for us to really transform health-care simulation from the traditional, unimodality simulation, to more complex, high fidelity, integrated, and engaging multimodality techniques. The main thrust must be to enhance clinical decision-making in patient care, to solve real-world clinical problems. Hybrid simulation (HS) utilizes at least two different simulation modalities, whereby combining them will enable one type of simulation modality to enhance the other, with the proper alignment, coordination, and interfacing between the modalities. Although the term is often used interchangeably, HS is slightly different from multimodality simulation. The latter refers to the use of multiple types of simulation in the same scenario or place. The main objectives for using HS have to be as follows: (1) for the acquisition of knowledge and skills by the best combination of methodologies, (2) for clinical performance improvement at all levels of care through the creation of as close as possible to real-world situation and problems, (3) to be able to sustain motivation and passion of our spectrum learners in their educational continuum, and (4) to provide a rich, exciting, and stimulating learning platform and environment, which can trigger deep learning and understanding. This article will also share some examples and cases utilizing HS in transforming health-care simulation.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Founder Member, World Academic Council of Emergency Medicine
| | - Xin Yi Too
- Singhealth Duke-NUS Institute of Medical Simulation, Singapore
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Veitch DE, Bochner M, Molenbroek JFM, Goossens RHM, Owen H. Breast Cancer Detection: The Development and Pilot Study of a "Tactile Landscape" as a Standardized Testing Tool. Simul Healthc 2019; 14:201-207. [PMID: 30969270 PMCID: PMC6587231 DOI: 10.1097/sih.0000000000000365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION There is still a need for competent breast lump detection palpation skills, especially in developing countries. Our goal is to design, develop, and establish a test to determine whether students can, by touch alone, identify and discriminate between a range of different simulated lesions at different adiposity levels. METHODS Common lesions, breast cancers, and cysts were physically simulated and hidden in a test object referred to as the "tactile landscape" (TL). Ribs, intercostal muscle, and nodularity-normal anatomical features-increased their realistic complexity. Varying depths of features simulated varying degrees of adiposity. A testing protocol was created to determine the testee's ability to identify and discriminate different commonly occurring breast masses using palpation. Five experts (four breast surgeons and one general practitioner) and 20 inexperienced medical students were recruited and tested. Results were compared. RESULTS The TL has been based on previously verified breast models and has softness similar to 53% of women's breasts and nodularity similar to 60% as assessed in a breast clinic by breast surgeons. The five experts indicated that the simulated lesions felt like those they might encounter in clinical practice and all of them identified the lesions and nonlesions hidden in the TL 100% correctly, thus indicating the value of the model. In contrast, only one student was able to identify all the lesions. One student identified none of them. The remaining students mean score was 65%. CONCLUSIONS All students but one performed poorly in comparison to the experts. This indicates that the test could be useful to test students' ability to identify and discriminate breast masses. If successful, it will add previously missing capability to the mix of assessment instruments already used, thus potentially improving clinical breast examination training and assessment.
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Affiliation(s)
- Daisy E Veitch
- From the Faculty of Industrial Design Engineering (D.E.V.), Delft University of Technology (TU Delft), Delft, the Netherlands; Breast Endocrine and Surgical Oncology Unit (M.B.), Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Industrial Design Engineering (J.F.M.M., R.H.M.G.), Delft University of Technology (TU Delft), Delft, the Netherlands; and College of Medicine and Public Health (H.O.), Flinders University, Adelaide, SA, Australia
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Elder CJ, Langley J, Stanton A, De Silva S, Akbarian-Tefaghi L, Wales JKH, Wright NP. A simulation study assessing the accuracy and reliability of orchidometer estimation of testicular volume. Clin Endocrinol (Oxf) 2019; 90:623-629. [PMID: 30585647 DOI: 10.1111/cen.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT Measuring testicular volume (TV) by orchidometer is the standard method of male pubertal staging. A paucity of evidence exists as to its inter- and intra-observer reliability and the impact of clinicians' gender, training and experience on accuracy. OBJECTIVE Prosthetic testicular models were engineered to investigate accuracy and reliability of TV estimation. DESIGN Simulation study. SETTING Conducted over three-day 2015 British Society for Paediatric Endocrinology and Diabetes (BSPED) meeting. PARTICIPANTS Two hundred fifteen meeting delegates (161F, 54M): 50% consultants, 30% trainees, 9% clinical nurse specialists, 11% other professionals. INTERVENTION Three child-sized mannequins displayed latex scrotum containing prosthetic testicles of 3, 4, 5, 10 and 20 mL. Demographic data, paediatric endocrinology experience, TV examination training, examination technique and TV estimations were collected. Delegates were asked to repeat their measurements later during the meeting. Scrotum order was changed daily. MAIN OUTCOME MEASURES Accuracy by variance from the simulated TV. Inter- and intra-observer variability. RESULTS One thousand two hundred eighty four individual estimations were obtained. Eighty-five participants repeated measurements. Delegates measured TV accurately on 33.4% (±2.6) of occasions: overestimations 37% (±2.3), underestimations 28% (±1.8) (Fleiss' Kappa score 0.04). The accuracy of assessing a 4 mL testis was 36%-39%. Observers underestimated the volume when paired with a 3 mL testis and overestimated when paired with a 5 mL testis demonstrating a tendency impose biological symmetry. Intra-observer reliability was lacking; individuals giving different estimations for the same size testicle on 61% (±4.2) of occasions, 20% (±3.5) of estimations were more than 1 size outside the previous measurement. On only 39% (±4.2) of occasions did individuals agree with their previous estimation (irrespective of whether or not it was initially accurate). Training did not impact on results but experience did improve accuracy. CONCLUSIONS Overall TV estimation accuracy was poor. Considerable variation exists between and within subjects. Seniority slightly improved measurement estimation.
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Affiliation(s)
- Charlotte J Elder
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Joe Langley
- Lab4Living: Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Andrew Stanton
- Lab4Living: Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Shamani De Silva
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Jerry K H Wales
- Univeristy of Queensland Clinical Unit, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Neil P Wright
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Nassif J, Sleiman AK, Nassar AH, Naamani S, Sharara-Chami R. Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:194-200. [PMID: 29019167 DOI: 10.1007/s13187-017-1287-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N = 82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p = 0.889). Hybrid simulation improved lesion identification grades (p < 0.001) without increasing false positives. Hybrid simulation relieved the fear of missing a lesion on CBE (p = 0.043) and increased satisfaction with the teaching method among students (p = 0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.
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Affiliation(s)
- Joseph Nassif
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul-Karim Sleiman
- Simulation Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Duke Eye Center, Duke University, Durham, NC, USA
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Naamani
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Rana Sharara-Chami
- Duke Eye Center, Duke University, Durham, NC, USA.
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
- American University of Beirut, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Turc G, Terrier B, Bats AS, Ngo C, Ranque B, Calvet D. [Acquisition of clinical observation skills by medical students improves with discipline-based teaching. The example of neurological examination]. Rev Med Interne 2018; 39:905-911. [PMID: 30290964 DOI: 10.1016/j.revmed.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Since 2014-2015, practical teaching of clinical observation skills for 2nd year medical students at our faculty has been discipline-based; previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study. METHODS Pre-reform 3rd and post-reform 2nd and 3rd year medical students (n=62, n=71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2nd year was different between students who had received neurological teaching from a neurologist (n=29) or another specialist (n=102). RESULTS The median [interquartile range] number of items acquired by post-reform 3rd year students (4 [2-5]) was higher than that of pre-reform 3rd year students (2 [1-3]; P<0.001), but lower than that of post-reform 2nd year students (5 [4-6]; P=0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist. CONCLUSION Acquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills; (2) a training of clinical lecturers to teach a limited list of educational objectives; and (3) the introduction of a practical test at the end of the 2nd year of medical studies. However, there was a decline in clinical observation skills between 2nd and 3rd year medical students.
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Affiliation(s)
- G Turc
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité Inserm U894, centre de psychiatrie et neurosciences, Paris, France
| | - B Terrier
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A-S Bats
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - C Ngo
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - B Ranque
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de médecine interne, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - D Calvet
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité Inserm U894, centre de psychiatrie et neurosciences, Paris, France.
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[Simulation-based learning and internal medicine: Opportunities and current perspectives for a national harmonized program]. Rev Med Interne 2018; 39:414-420. [PMID: 29548580 DOI: 10.1016/j.revmed.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
Simulation-based learning (SBL) is developing rapidly in France and the question of its use in the teaching of internal medicine (IM) is essential. While HAS encourages its integration into medical education, French Young Internists (AJI) set up a working group to reflect on the added-value of this tool in our specialty. Different sorts of SBL exist: human, synthetic and electronic. It enables student to acquire and evaluate technical skills (strengths, invasive procedures, etc.) and non-technical skills (relational, reasoning…). The debriefing that follows the simulation session is an essential time in pedagogical terms. It enables the acquisition of knowledge by encouraging the students' reflection to reshape their reasoning patterns by self-correcting. IM interns are supportive of its use. The simulation would allow young internists to acquire skills specific to our specialty such as certain gestures, complex consulting management, the synthesis of difficult clinical cases. SBL remains confronted with human and financial cost issues. The budgets allocated to the development and maintenance of simulation centres are uneven, making the supply of training unequal on the territory. Simulation sessions are time-consuming and require teacher training. Are faculties ready to train and invest their time in simulation, even though the studies do not allow us to conclude on its pedagogical validity?
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Design and Evaluation of a Low-Cost Speculum Examination Training Model. Simul Healthc 2017; 12:414-421. [DOI: 10.1097/sih.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hugon-Rodin J, Sonigo C, Drummond D, Grynberg M, Rodin T, Plu-Bureau G, Tesniere A. [Learning the gynecological examination on low-fidelity simulation: Impact on the feelings of medical students]. ACTA ACUST UNITED AC 2017; 45:291-298. [PMID: 28461236 DOI: 10.1016/j.gofs.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/21/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The use of anatomic model is particularly suitable for teaching gynecological examination. Although simulation training was proved to be effective in improving medical students' technical skills, its interest in reducing their apprehension about pelvic examination was poorly evaluated. The aim of the present study was to evaluate low-fidelity simulation sessions to reduce the discomfort and apprehension of medical students towards gynecological examination. The secondary objective was to appreciate student satisfaction with these sessions. METHODS Descriptive analysis of simulation-based teaching of breast and pelvic examination on Ilumens platform at the university Paris 5 among 3rd and 4th year medical students. It consisted in a before/after evaluation, using an anonymous questionnaire of self-evaluation and satisfaction at the beginning and at the end of the session. RESULTS Four hundred and thirty-two students answered both questionnaires. Seventy-two percent apprehended the pelvic examination initially and 62% were uncomfortable with the idea of performing it. Among the students who had never performed pelvic examination, more than 80% felt less uncomfortable with the idea of performing pelvic examination and were less apprehensive about it at the end of the simulation session. CONCLUSION The benefits of low-fidelity simulation in gynecology extend to the well-being of medical students who are less apprehensive about performing gynecological examination.
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Affiliation(s)
- J Hugon-Rodin
- Unité de gynécologie-endocrinologie, hôpital Port-Royal, 75014 Paris, France; Faculté de médecine Paris Descartes, hôpital universitaire Paris centre, 75006 Paris, France
| | - C Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier, Bondy, France
| | - D Drummond
- Département de simulation en santé iLumens, université Paris Descartes, 45, rue des Saints-Peres, 75006 Paris, France
| | - M Grynberg
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier, Bondy, France
| | - T Rodin
- Département de médecine physique et réadaptation, hôpital privé des Peupliers, Paris, France
| | - G Plu-Bureau
- Unité de gynécologie-endocrinologie, hôpital Port-Royal, 75014 Paris, France; Faculté de médecine Paris Descartes, hôpital universitaire Paris centre, 75006 Paris, France
| | - A Tesniere
- Faculté de médecine Paris Descartes, hôpital universitaire Paris centre, 75006 Paris, France; Département de simulation en santé iLumens, université Paris Descartes, 45, rue des Saints-Peres, 75006 Paris, France; Service d'anesthésie et de réanimation chirurgicale, hôpital Cochin, Paris, France.
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Reporting Guidelines for Health Care Simulation Research: Extensions to the CONSORT and STROBE Statements. Simul Healthc 2017; 11:238-48. [PMID: 27465839 DOI: 10.1097/sih.0000000000000150] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Simulation-based research (SBR) is rapidly expanding but the quality of reporting needs improvement. For a reader to critically assess a study, the elements of the study need to be clearly reported. Our objective was to develop reporting guidelines for SBR by creating extensions to the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statements. METHODS An iterative multistep consensus-building process was used on the basis of the recommended steps for developing reporting guidelines. The consensus process involved the following: (1) developing a steering committee, (2) defining the scope of the reporting guidelines, (3) identifying a consensus panel, (4) generating a list of items for discussion via online premeeting survey, (5) conducting a consensus meeting, and (6) drafting reporting guidelines with an explanation and elaboration document. RESULTS The following 11 extensions were recommended for CONSORT item 1 (title/abstract), item 2 (background), item 5 (interventions), item 6 (outcomes), item 11 (blinding), item 12 (statistical methods), item 15 (baseline data), item 17 (outcomes/estimation), item 20 (limitations), item 21 (generalizability), and item 25 (funding). The following 10 extensions were recommended for STROBE: item 1 (title/abstract), item 2 (background/rationale), item 7 (variables), item 8 (data sources/measurement), item 12 (statistical methods), item 14 (descriptive data), item 16 (main results), item 19 (limitations), item 21 (generalizability), and item 22 (funding). An elaboration document was created to provide examples and explanation for each extension. CONCLUSIONS We have developed extensions for the CONSORT and STROBE Statements that can help improve the quality of reporting for SBR.
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Dugoff L, Pradhan A, Casey P, Dalrymple JL, Abbott JF, Buery-Joyner SD, Chuang A, Cullimore AJ, Forstein DA, Hampton BS, Kaczmarczyk JM, Katz NT, Nuthalapaty FS, Page-Ramsey SM, Wolf A, Hueppchen NA. Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors. BMC MEDICAL EDUCATION 2016; 16:314. [PMID: 27986086 PMCID: PMC5162080 DOI: 10.1186/s12909-016-0835-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 12/01/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Learning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions. METHODS Ob/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire. RESULTS The response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent. CONCLUSIONS Pelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training-overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner.
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Affiliation(s)
- Lorraine Dugoff
- University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 2 Silverstein Building, Philadelphia, PA 19104 USA
| | - Archana Pradhan
- Department of Obstetrics and Gynecology, Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Petra Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN USA
| | - John L. Dalrymple
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Jodi F. Abbott
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Needham, MA USA
| | - Samantha D. Buery-Joyner
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine Inova Campus, Falls-Church, VA USA
| | - Alice Chuang
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Amie J. Cullimore
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, SC USA
| | - Brittany S. Hampton
- Department of Obstetrics and Gynecology, Brown Alpert Medical School, Providence, RI USA
| | - Joseph M. Kaczmarczyk
- Department of Obstetrics and Gynecology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA
| | - Nadine T. Katz
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Francis S. Nuthalapaty
- Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, SC USA
| | - Sarah M. Page-Ramsey
- Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX USA
| | - Abigail Wolf
- Department of Obstetrics and Gynecology, Jefferson Medical College, Philadelphia, PA USA
| | - Nancy A. Hueppchen
- Department of Obstetrics and Gynecology, Johns Hopkins Medical Institutions, Baltimore, MD USA
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McBain L, Pullon S, Garrett S, Hoare K. Genital examination training: assessing the effectiveness of an integrated female and male teaching programme. BMC MEDICAL EDUCATION 2016; 16:299. [PMID: 27876033 PMCID: PMC5120523 DOI: 10.1186/s12909-016-0822-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Learning to undertake intimate female and male examinations is an important part of medical student training but opportunities to participate in practical, supervised learning in a safe environment can be limited. A collaborative, integrated training programme to provide such learning was developed by two university teaching departments and a specialist sexual health service, utilising teaching associates trained for intimate examinations in a simulated clinical educational setting. The objective of this research was to determine changes in senior medical students' self- reported experience and confidence in performing male and female genital examinations, before and after participating in a new clinical teaching programme. METHODS A quasi-experimental mixed methods design, using pre and post programme questionnaires and focus groups, was used to assess the effectiveness of the programme. RESULTS The students reported greatly improved skill, confidence and comfort levels for both male and female genital examination following the teaching programme. Skill, confidence and comfort regarding male examinations were rated particularly low on the pre-teaching programme self- assessment, but post-programme was rated at similar levels to the female examination. CONCLUSIONS This integrated female-male teaching programme (utilising trained teaching associates as simulated patients in a supervised clinical teaching environment) was successful in increasing senior medical students' skills and levels of confidence in performing genital examinations. There were differences between female and male medical students in their learning. Suggestions for improvement included providing more detailed instruction to some clinical supervisors about their facilitation role in the session.
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Affiliation(s)
- Lynn McBain
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Susan Pullon
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Sue Garrett
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Kath Hoare
- Education Unit, Dean’s Department, University of Otago, Wellington, New Zealand
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Kobayashi L, Gosbee JW, Merck DL. Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 10:91-104. [PMID: 27815527 DOI: 10.1177/1937586716673829] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification. BACKGROUND Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue. METHOD Simulation, HFE, and computer science experts created a novel simulation methodology to study alarm fatigue. Featuring multiple interconnected simulated patient scenarios with scripted timeline, "distractor" patient care tasks, and triggered true and false alarms, the methodology incorporated objective metrics to assess provider and system performance. Developed materials were implemented during institutional review board-approved study sessions that assessed and compared an experimental multiparametric alerting system with a standard monitor telemetry system for subject response, use characteristics, and end-user feedback. RESULTS A four-patient simulation setup featuring objective metrics for participant task-related performance and response to alarms was developed along with accompanying structured HFE assessment (questionnaire and interview) for monitor systems use testing. Two pilot and four study sessions with individual nurse subjects elicited true alarm and false alarm responses (including diversion from assigned tasks) as well as nonresponses to true alarms. In-simulation observation and subject questionnaires were used to test the experimental system's approach to suppressing false alarms and alerting providers. CONCLUSIONS A novel investigative methodology applied simulation and HFE techniques to replicate and study alarm fatigue in controlled settings for systems assessment and experimental research purposes.
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Affiliation(s)
- Leo Kobayashi
- 1 Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,2 Lifespan Medical Simulation Center, Providence, RI, USA
| | - John W Gosbee
- 3 Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,4 Red Forest Consulting, Ann Arbor, MI, USA
| | - Derek L Merck
- 5 Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
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Bouet PE, Jeanneteau P, Legendre G, El Hachem H, Richard I, Granry JC, Descamps P, Sentilhes L. Formation des externes à l’examen gynécologique : intérêt de l’enseignement sur modèles anatomiques. ACTA ACUST UNITED AC 2016; 45:679-84. [DOI: 10.1016/j.jgyn.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
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Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, Duval-Arnould J, Lin Y, Cook DA, Pusic M, Hui J, Moher D, Egger M, Auerbach M. Reporting Guidelines for Health Care Simulation Research. Clin Simul Nurs 2016. [DOI: 10.1016/j.ecns.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, Duval-Arnould J, Lin Y, Cook DA, Pusic M, Hui J, Moher D, Egger M, Auerbach M. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Adv Simul (Lond) 2016; 1:25. [PMID: 29449994 PMCID: PMC5806464 DOI: 10.1186/s41077-016-0025-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Simulation-based research (SBR) is rapidly expanding but the quality of reporting needs improvement. For a reader to critically assess a study, the elements of the study need to be clearly reported. Our objective was to develop reporting guidelines for SBR by creating extensions to the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statements. METHODS An iterative multistep consensus-building process was used on the basis of the recommended steps for developing reporting guidelines. The consensus process involved the following: (1) developing a steering committee, (2) defining the scope of the reporting guidelines, (3) identifying a consensus panel, (4) generating a list of items for discussion via online premeeting survey, (5) conducting a consensus meeting, and (6) drafting reporting guidelines with an explanation and elaboration document. RESULTS The following 11 extensions were recommended for CONSORT: item 1 (title/abstract), item 2 (background), item 5 (interventions), item 6 (outcomes), item 11 (blinding), item 12 (statistical methods), item 15 (baseline data), item 17 (outcomes/ estimation), item 20 (limitations), item 21 (generalizability), and item 25 (funding). The following 10 extensions were recommended for STROBE: item 1 (title/abstract), item 2 (background/rationale), item 7 (variables), item 8 (data sources/measurement), item 12 (statistical methods), item 14 (descriptive data), item 16 (main results), item 19 (limitations), item 21 (generalizability), and item 22 (funding). An elaboration document was created to provide examples and explanation for each extension. CONCLUSIONS We have developed extensions for the CONSORT and STROBE Statements that can help improve the quality of reporting for SBR (Sim Healthcare 00:00-00, 2016).
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Affiliation(s)
- Adam Cheng
- Section of Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary KidSim-ASPIRE Research Program, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8 Canada
| | - David Kessler
- Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Ralph Mackinnon
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Todd P. Chang
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA USA
| | - Vinay M. Nadkarni
- The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | | | | | - Yiqun Lin
- Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - David A. Cook
- Multidisciplinary Simulation Center, Mayo Clinic Online Learning, and Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Martin Pusic
- Institute for Innovations in Medical Education, Division of Education Quality and Analytics, NYU School of Medicine, New York, NY USA
| | - Joshua Hui
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - David Moher
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marc Auerbach
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT USA
| | - for the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) Reporting Guidelines Investigators
- Section of Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary KidSim-ASPIRE Research Program, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8 Canada
- Columbia University College of Physicians and Surgeons, New York, NY USA
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA USA
- The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Multidisciplinary Simulation Center, Mayo Clinic Online Learning, and Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA
- Institute for Innovations in Medical Education, Division of Education Quality and Analytics, NYU School of Medicine, New York, NY USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT USA
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Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, Duval-Arnould J, Lin Y, Cook DA, Pusic M, Hui J, Moher D, Egger M, Auerbach M. Reporting guidelines for health care simulation research: Extensions to the CONSORT and STROBE statements. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:51-60. [DOI: 10.1136/bmjstel-2016-000124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abdulghani HM, Haque S, Irshad M, Al-Zahrani N, Al-Bedaie E, Al-Fahad L, Al-Eid M, Al-Mohaimeed A. Students' perception and experience of intimate area examination and sexual history taking during undergraduate clinical skills training: A study from two Saudi medical colleges. Medicine (Baltimore) 2016; 95:e4400. [PMID: 27472734 PMCID: PMC5265871 DOI: 10.1097/md.0000000000004400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study explores the experiences of Saudi undergraduate medical students about intimate-area examination (IAE) and sexual history taking (SHT) skills and assesses the barriers and their impacts on students' learning. This survey-based study was performed at 2 Saudi university medical colleges and revealed that most of the students never performed IAE, that is, female breast, male genital, female genital, female pelvic, male rectal, and female rectal. We found that 42.3% students had never taken any sexual history during their course. Both, male and female students reported barriers of patient refusal, mismatched sex, cultural background, ethical factors, lack of supervision, lack of training, and lack of skills. Among the currently used pedagogical techniques, majority of the students were satisfied with real patient-based learning, followed by video and manikin-based learning. The study indicates that Saudi students do not have sufficient experience of IAE and SHT because of above-mentioned barriers along with religious issues. This study suggests that teachers provide positive support to students and that they develop novel, competent teaching-and-learning techniques to meet the skills training of students without compromising on religious, sociocultural, and ethical values of the kingdom.
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Affiliation(s)
- Hamza Mohammad Abdulghani
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
- Correspondence: Hamza M. Abdulghani, Professor & Consultant Family Physician, Head, Assessment & Evaluation Centre, Department of Medical Education, College of Medicine, King Saud University, PO Box: 230155, Riyadh 11321, Saudi Arabia (e-mail: ; )
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan
| | - Mohammad Irshad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Noor Al-Zahrani
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Eman Al-Bedaie
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Latifah Al-Fahad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Manar Al-Eid
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Abdulrahman Al-Mohaimeed
- Department of Family & Community Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia
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A prospective study into the benefits of simulation training in teaching obstetric vaginal examination. Int J Gynaecol Obstet 2016; 133:380-4. [DOI: 10.1016/j.ijgo.2015.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 07/27/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
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Burns RB, Potter JE, Ricciotti HA, Reynolds EE. Screening Pelvic Examinations in Adult Women: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center. Ann Intern Med 2015; 163:537-47. [PMID: 26436618 DOI: 10.7326/m15-1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pelvic examinations have historically been a part of regular preventive care. However, because women can now be screened for cervical cancer at intervals up to every 5 years, the question of whether women need to be seen annually for routine pelvic examinations has arisen. In July 2014, the American College of Physicians (ACP) issued a guideline presenting the available evidence on screening for pathologic conditions using pelvic examination in adult, asymptomatic women at average risk. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice had previously issued a committee opinion in August 2012 on the need for annual examinations and provided guidelines on important elements of this procedure, including when to examine asymptomatic women. ACOG reaffirmed its initial position after publication of the ACP guideline. The guidelines differ-the ACP guideline recommends against and the ACOG committee opinion recommends in favor of routine annual pelvic examination. This paper summarizes a discussion between an internist and a gynecologist on how they would balance these recommendations in general and what they would suggest for an individual patient.
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Fairbank C, Reid K, Minzenmay K. Women's experiences of working as a Clinical Teaching Associate teaching sensitive examinations: a qualitative study. MEDICAL TEACHER 2015; 37:47-52. [PMID: 24935727 DOI: 10.3109/0142159x.2014.923564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Increasingly, professional patient programs are used for training medical students to perform pelvic examinations, yet we know little of the experiences of women who teach medical students these sensitive examination skills. AIM To describe the experiences of women working as Clinical Teaching Associates (CTAs) teaching medical students the technical and communication skills required to perform pelvic examinations. METHODS Twelve women employed as CTAs participated in semi-structured interviews. Individual interviews were used to identify major themes in women's experiences of teaching sensitive examinations to medical students. RESULTS CTAs identified unique difficulties in their work including negative attitudes from others towards their role and the unpleasantness of the examination, although other challenges (such as teamwork issues or providing negative feedback to colleagues) were characteristic of many work situations. Effective communication was identified as central to the CTA role and the women described growth in their communication skills and assertiveness that they applied to other aspects of their work and personal lives. CTAs were motivated to join the program and remained in the program because of an interest in women's health and a desire for meaningful work, which they believed improved the examination and communication skills of future doctors. Positive interactions with work colleagues were a valued part of the role and a primary motivator to remain in the program. CONCLUSIONS Highlighting the experiences of women working as CTAs validates the significant teaching role these women perform and, from a pragmatic perspective, may increase understanding of the best way to attract and retain women to these important teaching roles.
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Affiliation(s)
- Christine Fairbank
- Medical Education Unit, Melbourne Medical School, The University of Melbourne , Australia
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46
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Steichen O, Georgin-Lavialle S, Grateau G, Ranque B. [Assessment of clinical observation skills of last year medical students]. Rev Med Interne 2014; 36:312-8. [PMID: 25458867 DOI: 10.1016/j.revmed.2014.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 07/06/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Clinical examination skills are poorly evaluated by theoretical tests. We observed the clinical examination of real patients by 6th year medical students. METHODS Four internists involved in teaching activities defined 11 clinical examination items, with two objective performance criteria each. The students were evaluated in two internal medicine departments during the rotation preceding or following their national graduation test. Scores by item and by criterion and an overall score were calculated and correlated with their rank at the national graduation test. RESULTS Thirty-two students were evaluated in one department and 18 in the other; each evaluation lasted approximately 30 minutes. The results were similar in both departments. Only 2 items got a score over 75% in this students' sample (acute respiratory failure, peripheral pulses); 4 items were satisfied at less than 50% (lymph nodes, right heart failure, liver failure, and attention). The mean overall score was 6.5/11 (standard deviation 1.5). National rankings were good (median 1605/8001, interquartile 453-3036) but uncorrelated with the global score (Spearman coefficient -0.13; P=0.39). CONCLUSION Bedside evaluation of the students reveals substantial deficiencies, a few months or weeks before taking their position as residents. Several elementary skills are mastered by a minority of them (search for an asterixis, distended jugular veins, deep tendon reflexes), even among those successful at the national graduation test. Bedside evaluation of clinical examination skills should be more systematically performed.
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Affiliation(s)
- O Steichen
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France; Inserm, U1142, LIMICS, 75006 Paris, France.
| | - S Georgin-Lavialle
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - G Grateau
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - B Ranque
- Département de médecine interne, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
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Li Y, Li N, Han Q, He S, Bae RS, Liu Z, Lv Y, Shi B. Performance of physical examination skills in medical students during diagnostic medicine course in a University Hospital of Northwest China. PLoS One 2014; 9:e109294. [PMID: 25329685 PMCID: PMC4198092 DOI: 10.1371/journal.pone.0109294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
This study was conducted to evaluate the performance of physical examination (PE) skills during our diagnostic medicine course and analyze the characteristics of the data collected to provide information for practical guidance to improve the quality of teaching. Seventy-two fourth-year medical students were enrolled in the study. All received an assessment of PE skills after receiving a 17-week formal training course and systematic teaching. Their performance was evaluated and recorded in detail using a checklist, which included 5 aspects of PE skills: examination techniques, communication and care skills, content items, appropriateness of examination sequence, and time taken. Error frequency and type were designated as the assessment parameters in the survey. The results showed that the distribution and the percentage in examination errors between male and female students and among the different body parts examined were significantly different (p<0.001). The average error frequency per student in females (0.875) was lower than in males (1.375) although the difference was not statistically significant (p = 0.167). The average error frequency per student in cardiac (1.267) and pulmonary (1.389) examinations was higher than in abdominal (0.867) and head, neck and nervous system examinations (0.917). Female students had a lower average error frequency than males in cardiac examinations (p = 0.041). Additionally, error in examination techniques was the highest type of error among the 5 aspects of PE skills irrespective of participant gender and assessment content (p<0.001). These data suggest that PE skills in cardiac and pulmonary examinations and examination techniques may be included in the main focus of improving the teaching of diagnostics in these medical students.
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Affiliation(s)
- Yan Li
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Na Li
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Qunying Han
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Shuixiang He
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Ricard S. Bae
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Zhengwen Liu
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
- * E-mail:
| | - Yi Lv
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Bingyin Shi
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
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Dabson AM, Magin PJ, Heading G, Pond D. Medical students' experiences learning intimate physical examination skills: a qualitative study. BMC MEDICAL EDUCATION 2014; 14:39. [PMID: 24575827 PMCID: PMC3943277 DOI: 10.1186/1472-6920-14-39] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/20/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Intimate physical examination skills are essential skills for any medical graduate to have mastered to an appropriate level for the safety of his or her future patients. Medical schools are entrusted with the complex task of teaching and assessing these skills for their students. The objectives of this study were to explore a range of medical students' experiences of learning intimate physical examination skills and to explore their perceptions of factors which impede or promote the learning of these skills. METHODS Individual semi-structured interviews (N = 16) were conducted with medical students in years two to five from the University of Newcastle, as part of a larger research project investigating how medical students develop their attitudes to gender and health. This was a self-selected sample of the entire cohort who were all invited to participate. A thematic analysis of the transcribed data was performed. RESULTS Students reported differing levels of discomfort with their learning experiences in the area of intimate physical examination and differing beliefs about the helpfulness of these experiences. The factors associated with levels of discomfort and the helpfulness of the experience for learning were: satisfaction with teaching techniques, dealing with an uncomfortable situation and perceived individual characteristics in both the patients and the students. The examination causing the greatest reported discomfort was the female pelvic examination by male students. CONCLUSIONS Student discomfort with the experience of learning intimate physical examination skills may be common and has ongoing repercussions for students and patients. Recommendations are made of ways to modify teaching technique to more closely match students' perceived needs.
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Affiliation(s)
- Andra M Dabson
- School of Medicine and Population Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia
| | - Parker J Magin
- School of Medicine and Population Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia
- GP Training Valley-to Coast, Gavey St, Mayfield West, NSW 2308, Australia
| | - Gaynor Heading
- Health Education and Training Institute, Victoria Rd, Gladesville, NSW 2111, Australia
| | - Dimity Pond
- School of Medicine and Population Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia
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