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Leone CCLD, Bueno GC, Boteon AP, Martins DDS, Cruvinel T, Honório HM, Wang L, Braga MM, Rios D. Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:857-864. [PMID: 38706419 DOI: 10.1111/eje.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method. MATERIALS AND METHODS This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05). RESULTS There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570). CONCLUSION The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.
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Affiliation(s)
- Camilla Cristina Lira Di Leone
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Gabriela Carvalho Bueno
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Ana Paula Boteon
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Daiana da Silva Martins
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Linda Wang
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo-USP, São Paulo, Brazil
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
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Pervaiz A, Daoud A, Alchakaki A, Ganti S, Venkat D, Lee S, Sankari A. A Pilot Standardized Simulation-Based Mechanical Ventilation Curriculum Targeting Pulmonary and Critical Care Medicine and Critical Care Medicine Fellows. Avicenna J Med 2023; 13:176-181. [PMID: 37799185 PMCID: PMC10550363 DOI: 10.1055/s-0043-1773792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Introduction The mastery of mechanical ventilation (MV) management is challenging, as it requires the integration of physiological and technological knowledge with critical thinking. Our aim was to create a standardized curriculum with assessment tools based on evidence-based practices to identify the skill deficit and improve knowledge in MV management. Methods For 3 years, 3 hours of standardized curriculum for each first-year pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellows was integrated into the orientation (chronologically): (1) a baseline knowledge pretest; (2) a 1-hour one-on-one case-based simulation session with debriefing. A 34-item competency checklist was used to assess critically thinking and skills and guide the debriefing; (3) a 1-hour group didactic on respiratory mechanics and physiology; (4) a 45-minute hands-on session in small groups of one to three fellows for basic knobology, waveforms, and various modes of mechanical ventilators; (5) a 15-minute group bedside teaching of vented patients covering topics such as techniques to alleviate dyssynchrony and advanced ventilator modes; (6) a one-on-one simulation reassessment session; (7) a knowledge posttest. Fellows' performances at baseline, 1-month posttest, and end-of-first year post-test were compared. Results Fellows ( n = 24) demonstrated significant improvement at 1-month posttest in knowledge (54.2% ± 11.0 vs. 76.6 ± 11.7%, p < 0.001) and MV competency (40.7 ± 11.0% vs. 69.7 ± 9.3%, p < 0.001), compared with pretest. These improvements were retained at the end-of-year reassessments (knowledge 75.1 ± 14.5% and MV competency 85.5 ± 8.7%; p < 0.001). Conclusion Standardized simulation-based MV curriculum may improve the medical knowledge competency, and confidence of first-year PCCM and CCM fellows toward MV management before encountering actual ventilated patients.
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Affiliation(s)
- Amina Pervaiz
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Asil Daoud
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States
| | - Abdulrazak Alchakaki
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States
- Department of Pulmonary, Critical Care and Sleep Medicine, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Shyam Ganti
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Department of Pulmonary, Critical Care and Sleep Medicine, Appalachian Regional Healthcare Hospital, Harlan, Kentucky, United States
| | - Divya Venkat
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States
| | - Sarah Lee
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States
- Department of Education, John D. Dingell VA Medical Center, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio, United States
| | - Abdulghani Sankari
- Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States
- Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States
- Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, United States
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Simulation-based Assessment to Measure Proficiency in Mechanical Ventilation among Residents. ATS Sch 2022; 3:204-219. [PMID: 35924199 PMCID: PMC9341499 DOI: 10.34197/ats-scholar.2021-0130oc] [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: 11/05/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022] Open
Abstract
Background Mechanical ventilation (MV) skills are essential for clinicians caring for critically ill patients, yet few training programs use structured curricula and appropriate assessments. Objective structured clinical exams (OSCEs) have been used to assess clinical competency in many areas, but there are no OSCE models focused on MV. Objective To develop and validate a simulation-based assessment (SBA) with an OSCE structure to assess baseline MV competence among residents and identify knowledge gaps. Methods We developed an SBA using a lung simulator and a mechanical ventilator, and an OSCE structure, with six clinical scenarios in MV. We included internal medicine residents at the beginning of their rotation in the respiratory intensive care unit (ICU) of a university-affiliated hospital. A subset of residents was also evaluated with a validated multiple-choice exam (MCE) at the beginning and at the end of the ICU rotation. Scores on both assessments were normalized to range from 0 to 10. We used Cronbach’s α coefficient to assess reliability and Spearman correlation to estimate the correlation between the SBA and the MCE. Results We included 80 residents, of whom 42 also completed the MCE examinations. The final version of the SBA had 32 items, and the Cronbach’s α coefficient was 0.72 (95% confidence interval [CI], 0.64–0.81). The average SBA score was 6.2 ± 1.3, and performance was variable across items, with 80% correctly adjusting initial ventilatory settings and only 12% correctly identifying asynchrony. The MCE had 24 questions, and the average score was 7.6 ± 2.4 at the beginning of the rotation and 8.2 ± 2.3 at the end of the rotation (increase of 0.6 points; 95% CI, 0.30–0.90; P < 0.001). There was moderate correlation between the SBA and the MCE (rho = 0.41; P = 0.002). Conclusion We developed and validated an objective structured assessment on MV using a pulmonary simulator and a mechanical ventilator addressing the main competencies in MV. The performance of residents in the SBA at the beginning of an ICU rotation was lower than the performance in MCE, highlighting the need for greater emphasis on practical skills in MV during residency.
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