Using Learner-Centered, Simulation-Based Training to Improve Medical Students' Procedural Skills

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum

BACKGROUND

The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.

METHODS

Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.

RESULTS

Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.

CONCLUSIONS

Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices

INTRODUCTION

Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs.

METHODS

RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence.

RESULTS

Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources.

CONCLUSION

The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.

Procedural simulation in venipuncture for medical undergraduates and its transfer to the bedside: a cluster randomized study

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

Novice providers' success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle

BACKGROUND

Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents' clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap.

METHODS

This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions.

RESULTS

With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful (p < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases (p = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it.

CONCLUSIONS

The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

Implementation and Mixed-Methods Assessment of an Early Mobility Interprofessional Education Simulation

INTRODUCTION

Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body.

BACKGROUND

Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV.

METHODS

Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers.

RESULTS

Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies.

DISCUSSION

This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies.

CONCLUSION

Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BACKGROUND

The effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.

METHODS

A prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student's communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).

RESULTS

Fifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].

CONCLUSION

Simulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

"Sawbones": A pilot study assessing simulation-based orthopedic training for medical students

Intro

Simulation-based training has become a valuable new tool in medical education across the country. The Orthopedic Surgery Interest Group (OSIG) at the University of Miami Miller School of Medicine organized a benchtop training workshop known as "Sawbones" to give medical students essential exposure to basic techniques and instruments commonly used in orthopedic surgery. This pilot study seeks to investigate the participating students' perceptions of this workshop as part of a potential longitudinal intervention.

Methods

A total of 30 medical students (MS1-MS4) with a documented interest in orthopedic surgery were randomly selected via email invitation to participate in this workshop. Students first had a lecture-based training session with faculty on an overview of screw fixation. Participants then formed groups that were headed by an orthopedic resident or attending and took turns fixing fractures on model bones made of synthetic material. Following the session, students were sent an anonymous Qualtrics survey to assess their satisfaction with the workshop.

Results

A total of 22 students (73%), responded to the survey. On a ten-point scale, the average reported interest in orthopedics was 9.2 (SD 0.4). All students (n = 22, 100%) reported that they would like more hands-on orthopedic experiences as a component of their medical education. Nineteen students (86.4%) reported that this training increased their interest in pursuing a career in orthopedic surgery and twenty-one (95.5%) further stated that they would recommend this training to other students.

Discussion

Based on the results of this pilot study, Sawbones was promising at engaging students in orthopedics, providing a team environment, and introducing students to orthopedic skills and instrumentation. Providing these sessions in a longitudinal manner could provide opportunities for mentorship and better prepare students for a residency in orthopedics. We recommend a program like Sawbones to better address the lack of Orthopedic exposure in medical school.

Using electroencephalography to explore neurocognitive correlates of procedural proficiency: A pilot study to compare experts and novices during simulated endotracheal intubation

The objective of this study was to explore the use of EEG as a measure of neurocognitive engagement during a procedural task. In this observational study, self-reported cognitive load, observed performance, and EEG signatures in experts and novices were compared during simulated endotracheal intubation. Twelve medical students (novices) and eight senior anesthesiology trainees (experts) were included in the study. Experts reported significantly lower cognitive load (P < 0.001) and outperformed novices based on the observational checklist (P < 0.001). EEG signatures differed significantly between the experts and novices. Experts showed a greater increase in delta and theta band amplitudes, especially in temporal and frontal locations and in right occipital areas for delta. A machine learning algorithm showed 83.3 % accuracy for expert-novice skill classification using the selected EEG features. Performance scores were positively correlated (P < 0.05) with event-related amplitudes for delta and theta bands at locations where experts and novices showed significant differences. Increased delta and frontal/midline theta oscillations on EEG suggested that experts had better attentional control than novices. This pilot study provides initial evidence that EEG may be a useful, noninvasive measure of neurocognitive engagement in operational settings and that it has the potential to complement traditional clinical skills assessment.

Deconstructing forearm casting task by videos with step-by-step simulation teaching improved performance of medical students: is making working student's memory work better similar to a process of artificial intelligence or just an improvement of the prefrontal cortex homunculus?

PURPOSE

To compare two teaching methods of a forearm cast in medical students through simulation, the traditional method (Trad) based on a continuous demonstration of the procedure and the task deconstruction method (Decon) with the procedure fragmenting into its constituent parts using videos.

METHODS

During simulation training of the below elbow casting technique, 64 medical students were randomized in two groups. Trad group demonstrated the entire procedure without pausing. Decon group received step-wise teaching with educational videos emphasizing key components of the procedure. Direct and video evaluations were performed immediately after training (day 0) and at six months. Performance in casting was assessed using a 25-item checklist, a seven item global rating scale (GRS Performance), and a one item GRS (GRS Final Product).

RESULTS

Fifty-two students (Trad n = 24; Decon n = 28) underwent both day zero and six month assessments. At day zero, the Decon group showed higher performance via video evaluation for OSATS (p = 0.035); GRS performance (p < 0.001); GRS final product (p < 0.001), and for GRS performance (p < 0.001) and GRS final product (p = 0.011) via direct evaluation. After six months, performance was decreased in both groups with ultimately no difference in performance between groups via both direct and video evaluation. Having done a rotation in orthopaedic surgery was the only independent factor associated to higher performance.

CONCLUSIONS

The modified video-based version simulation led to a higher performance than the traditional method immediately after the course and could be the preferred method for teaching complex skills.

To sim or not to sim-choosing wisely for procedural skills training in paediatrics

Objectives

Simulation is a commonly used modality to teach paediatric procedural skills, however, it is resource intensive. Which paediatric skills are best taught using simulation is not known. This study aims to examine what skills to simulate, allowing for the best use of resources in ever expanding curricula.

Method

We administered a questionnaire to community and hospitalist general paediatricians in Canada asking them to rate the importance of maintaining competency in each paediatric procedural skill and the frequency with which they perform the skill in their practice.

Results

Skills that were rated as highly important and also high frequency were: bag-mask ventilation (BMV), lumbar puncture, neonatal cardiopulmonary resuscitation (CPR), specimen procurement for infectious diseases, immunization, and ear curettage. Skills that were rated as highly important but low frequency were: paediatric CPR, intraosseous needle insertion, neonatal intubation, defibrillation, gathering specimens for evidence of child maltreatment, paediatric intubation, cervical spine immobilization, and oral/nasogastric tube placement.

Conclusion

Paediatric procedural skills are rated variably in terms of importance and frequency of use in general paediatric practice. Eight skills of high importance are infrequently performed and should be targeted for teaching via simulation.

The Use of Hybrid Lumbar Puncture Simulation to Teach Entrustable Professional Activities During a Medical Student Neurology Clerkship

This article was migrated. The article was marked as recommended. Background: In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Entrustable Professional Activities (EPAs) that medical school graduates should be able to perform upon starting residency. The University of Pittsburgh School of Medicine (UPSOM) has surveyed our neurology clerkship students in regard to EPAs since 2017; according to this data we have been deficient in addressing EPAs 4 (enter and discuss orders/prescriptions), 11 (obtain informed consent for tests and/or procedures), and 12 (perform general procedures of a physician). We therefore developed a hybrid simulation experience encompassing these three skills, centered around lumbar puncture (LP). Methods: We created a hybrid LP simulation for students on the neurology clerkship encompassing EPAs 4, 11, and 12. Students first obtained informed consent for LP from a Standardized Patient, then performed LP on a specialized manikin. They then entered orders on CSF into a simulated patient chart. Real-time feedback was provided for all three components. Students filled out surveys to assess their perceived confidence and skill with these activities both pre- and post-simulation. Results: The percentage of students who increased their confidence with LP from minimal or less to average or more was 58.24%, 38.47%, and 26.38% for LP, informed consent, and order entry, respectively. The percentage of students who improved from not being able to perform/needing significant supervision to being able to perform with minimal supervision/ independently was 25.27%, 47.25% and 28.58%, for LP, informed consent, and order entry, respectively. These differences were all statistically significant (p Conclusions/Significance: Hybrid LP simulation was effective in increasing medical student confidence and perceived skill with EPAs 4, 11, and 12.

Curricular integration of the pharmacists' patient care process

INTRODUCTION

The Accreditation Council for Pharmacy Education Standard 10 specifies the need to prepare students to provide patient-centered collaborative care. The aim of this study is to assess the impact of a newly introduced Pharmacists' Patient Care Process (PPCP) based laboratory course on students' perception of their preparedness to apply PPCP steps in introductory pharmacy practice experiences (IPPEs).

METHODS

The PPCP was introduced into the Pharmaceutical Care and Dispensing Laboratory course during the second professional year. Students' self-perception of preparedness to apply the PPCP was assessed via a survey composed of questions related to PPCP skillsets. The pre-PPCP laboratory cohort (control group) took the survey after the completion of their IPPEs. The PPCP laboratory cohort (intervention group) took the same survey prior to taking the course, at the end of the course, and following the completion of their IPPEs. Pearson's and McNemar chi-square tests were used for statistical analyses.

RESULTS

The findings indicate that the PPCP-based laboratory significantly improved students' perception of their preparedness to apply a standardized pharmacist care process to verify prescriptions, to collect relevant patient information, and to develop an individual patient-centered care plan. This significant impact of the PPCP-based laboratory course on students' perception was maintained through the following year when assessed after IPPEs.

CONCLUSIONS

Introduction of the PPCP model within a dispensing laboratory course, prior to students' IPPEs, develops students' perception of preparedness. Incorporating the PPCP via active learning and simulation narrows the gap between the didactic and experiential curriculum.

Pediatric emergency medicine fellowship point-of-care ultrasound training in 2020

OBJECTIVES

The primary objective was to survey pediatric emergency medicine (PEM) leaders and fellows regarding point-of-care ultrasound (POCUS) training in PEM fellowship programs, including teaching methods, training requirements, and applications taught. Secondary objectives were to compare fellows' and program leaders' perceptions of fellow POCUS competency and training barriers.

METHODS

This was a cross-sectional survey of U.S. PEM fellows and fellowship program leaders of the 78 fellowship programs using two online group-specific surveys exploring five domains: program demographics; training strategies and requirements; perceived competency; barriers, strengths, and weaknesses of POCUS training; and POCUS satisfaction.

RESULTS

Eighty-three percent (65/78) of programs and 53% (298/558) of fellows responded. All participating PEM fellowship programs included POCUS training in their curriculum. Among the 65 programs, 97% of programs and 92% of programs utilized didactics and supervised scanning shifts as educational techniques, respectively. Sixty percent of programs integrated numerical benchmarks and 49% of programs incorporated real-time, hands-on demonstration as training requirements. Of the 19 POCUS applications deemed in the literature as core requirements for fellows, at least 75% of the 298 fellows reported training in 13 of those applications. Although less than half of fellows endorsed competency for identifying intussusception, ultrasound-guided pericardiocentesis, and transvaginal pregnancy evaluation, a higher proportion of leaders reported fellows as competent for these applications (40% vs. 68%, p ≤ 0.001; 21% vs. 39%, p = 0.003; and 21% vs. 43%, p ≤ 0.001). Forty-six percent of fellows endorsed a lack of PEM POCUS evidence as a training barrier compared to 31% of leaders (p = 0.02), and 39% of leaders endorsed a lack of local financial support as a training barrier compared to 23% of fellows (p = 0.01).

CONCLUSIONS

Although most PEM fellowship programs provide POCUS training, there is variation in content and requirements. Training does conform to many of the expert recommended guidelines; however, there are some discrepancies and perceived barriers to POCUS training remain.

Determinants of Confidence in Overall Knowledge About COVID-19 Among Healthcare Workers in South Africa: Results From an Online Survey

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated with HCWs' confidence in their overall knowledge about COVID-19 in South Africa in the early stages of the epidemic.

Methods: Data utilized in this paper were from an online survey conducted among HCWs using a structured questionnaire on a data free online platform. The study population were all the medical fraternity in South Africa including medical and nurse practitioners as well as other healthcare professionals. Bivariate and multivariate logistic regression models were performed to examine the factors associated with confidence in HCWs' overall knowledge about COVID-19.

Results: Overall, just below half (47.4%) of respondents indicated that they had confidence in their overall knowledge about COVID-19. Increased odds of having confidence in the knowledge about COVID-19 were significantly associated with being male [aOR = 1.31 95% CI (1.03–1.65), p < 0.05], having a doctorate degree [aOR = 2.01 (1.23–3.28), p < 0.05], being satisfied with the information about COVID-19 guidelines [aOR = 6.01 (4.89–7.39), p < 0.001], having received training in 6–8 areas [aOR = 2.54 (1.89–3.43), p < 0.001] and having received training in 9–11 areas [aOR = 5.33 (3.81–7.47), p < 0.001], and having already treated COVID-19 patients [aOR = 1.43 (1.08–1.90), p < 0.001]. Those who were highly concerned with the levels of training of HCWs [aOR = 0.47 (0.24–0.92), p < 0.05] had decreased odds of having confidence in their overall knowledge about COVID-19.

Conclusion: This study sheds light on the importance of capacitating HCWs with knowledge and adequate relevant training as part of infection prevention control measures during pandemics. Future training and information sharing should be sensitive to knowledge gaps by age, gender, qualifications, professional categories, and experience.

Medical Student Comfort With Procedural Skills Performance Based on Elective Experience and Career Interest

Introduction

Despite increased efforts, studies suggest that exposure to procedural skills in undergraduate medical training is insufficient. As medical students have low self-reported competence in many skills, a significant concern is that medical students are underprepared for a clerkship. Furthermore, pre-clerkship electives selected based on student career interests can provide students with additional skills learning opportunities. The impact of career interest and elective choice on student comfort with procedural skills is unclear. This study examines the relationship between student procedural skills comfort, career interest, and elective choices.

Materials and methods

An evidence-based questionnaire was synthesized following a literature search using PubMed, Embase, and Google Scholar. Surveys were completed by second-year medical students. A Likert scale was used to evaluate students’ exposure, comfort, and motivation to learn common procedural skills. Descriptive, Pearson’s chi-square and Spearman’s rho correlation coefficient analyses were performed to evaluate the relationship between career interests, elective exposure, and procedural skills.

Results

Medical students (>60%) reported poor comfort levels for most skills, despite >80% of students displaying high motivation to learn. Elective choice impacted student comfort levels as students who completed electives in anesthesiology were more comfortable with performing intubation (23% vs 10%, p = 0.026) and IV insertion (38% vs 13%, p = 0.002). Those with surgical career interests were less comfortable performing Foley catheter insertion in males (7% vs 5%, p = 0.033) and in females (7% vs 5%, p = 0.008).

Conclusions

This study supports that medical students feel low levels of comfort with performing procedural skills despite high motivation for learning. Comfort was influenced by both career interest and elective experience. Programs aiming to increase students’ comfort levels in performing procedural skills should adapt curricula toward increasing early exposure to these skills.

Peer assessment platform of clinical skills in undergraduate medical education

Objective

The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills.

Methods

A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data.

Results

Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex.

Conclusions

The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students.

Learning Styles in Pathology: A Comparative Analysis and Implications for Learner-Centered Education

Initiatives like “American Medical Association (AMA)-Reimagining Residency” and “Accreditation Council for Graduate Medical Education (ACGME)-Next Accreditation System” are examples of a paradigm shift toward learner-centered pedagogy in resident education. Such interventions require an understanding of the basics of the learning process itself. This study aimed to identify preferred learning styles in pathology with the intent to use specialty-specific pattern data, if any, to improve pathology training modalities. Kolb’s learning tool questionnaire was sent to pathology-inclined medical students, pathology residents, fellows, and faculty in 5 academic programs. Data from 84 respondents (6 students, 37 residents, 12 fellows, 29 attendings) were analyzed. There was remarkable similarity in learning styles of fellows and faculty, revealing a dominance of observational learning styles (“assimilating” and “diverging”) that was consistent with pathology being a visual field. In contrast, residents showed dominance of “learn by doing” styles (“converging” and “accommodating”). Residents’ stratification by training year showed a scattered distribution with an upward trend toward “learn by doing” behavior. While the difference in styles between residents and faculty/fellows may be due to a generational gap, transition from medical school, or acquisition of technical skills required for grossing specimens, this is an opportunity for adopting blended learning models and active learning processes to cater to residents’ different styles and to allow for flexibility to use all styles as and when needed. Based on these findings, we hypothesize that partnering juniors and seniors with similar styles has a potential for successful mentorship and exploration of other psychometrics is recommended for further understanding and improvement of pathology training.

Effective and Feasible Simulation-Based Procedural Training for Medical Students: Instructional Video-Guided Deliberate Practice Versus Training with Expert Feedback

Limited opportunity for teaching patient-care skills in clinical settings has increased the need for simulation training in medical education. However, this modality may be hard to sustain because of extensive time requirements and potential scheduling conflicts. The authors conducted a pilot randomized study to compare the immediate and long-term effects of using instructional video with self-directed practice to those of using simulation training with expert feedback. The results are promising for the use of instructional video-guided, self-directed deliberate practice; however, future studies with a larger sample from multiple institutions should replicate this study to confirm these results.

Development and Utilization of 3D Printed Material for Thoracotomy Simulation

Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).