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Vergara-Escudero E, Gherciuc A, Buyck D, Eid A, Arango S, Richardson S, Perry TE. Initial Experience of Using First-Person Wearable Video Recording Technology During Central Venous Catheter Placement in the Cardiac Operating Room. J Cardiothorac Vasc Anesth 2024; 38:1409-1416. [PMID: 38503625 DOI: 10.1053/j.jvca.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The aim of this study was to use wearable video-recording technology to measure precisely the timing of discrete events during perioperative central venous catheter (CVC) placements. DESIGN A single-center, observational, exploratory study on the use of wearable video-recording technology during intraoperative CVC placement. SETTING The study was conducted at a University Hospital. PARTICIPANTS Clinical anesthesia residents, cardiothoracic anesthesia fellows, and attending anesthesiologists participated in this study. INTERVENTIONS Participants were asked to use eye-tracking glasses prior to the placement of a CVC in the cardiac operating rooms. No other instruction was given to the participants. MEASUREMENTS AND MAIN RESULTS The authors measured the total time to complete the CVC placement, phase-specific time, and specific times of interest. They compared these times across 3 training levels and tested differences with analysis of variance. The authors' findings indicated significant differences in total CVC placement time when the procedure included a pulmonary artery catheter insertion (1,170 ± 364, 923 ± 272, and 596 ± 226 seconds; F2,63 = 12.71, p < 0.0001). Additionally, they found differences in interval times and times of interest. The authors observed a reduction of variability with increasing experience during the CVC placement phase. CONCLUSIONS In this observational study, the study authors describe their experience using first-person wearable video-recording technology to precisely measure the timing of discrete events during CVC placement by anesthesia residents and anesthesiologists. Future work will leverage the eye-tracking capabilities of the existing hardware to identify areas of inefficiency to develop actionable targets for interventions that could improve trainee performance and patient safety.
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Affiliation(s)
- Enrique Vergara-Escudero
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN.
| | | | | | - Aya Eid
- University of Minnesota Medical School, Minneapolis, MN
| | - Susana Arango
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Stephen Richardson
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
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Nagarajappa A, Kaur S. Simulation in contemporary medical education: Current practices and the way forward. Indian J Anaesth 2024; 68:17-23. [PMID: 38406335 PMCID: PMC10893808 DOI: 10.4103/ija.ija_1203_23] [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: 12/13/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 02/27/2024] Open
Abstract
Integration of theoretical knowledge and practical skills is critical for effective medical education. Simulation is crucial in bridging the gap to prepare medical professionals for high-quality patient care in a safe environment. Simulation-based teaching has become the standard practice in medical education, especially in postgraduate courses like Anaesthesia. However, undergraduate medical education and other doctoral courses are still nascent. In line with the current National Medical Commission guidelines, it is imperative to complement the existing curriculum with a simulation-based approach as early as the first year of medical school. This review focuses on the current practices related to simulation-based medical education during undergraduate and postgraduate courses, particularly on anaesthesiology. We aim to discuss different types of simulation, the advantages of integration, students' perspectives, and the role of simulation in assessment and feedback. Finally, recommendations for future advancements of simulation in medical education and the way forward will be laid.
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Affiliation(s)
- Abhishek Nagarajappa
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Kaur
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Vage A, Spence AD, Gormley GJ, McKeown G, Murphy P, Hamilton PK. Untapped resource: the simulation-based healthcare environment as a means to study human stress. THE ULSTER MEDICAL JOURNAL 2024; 92:157-166. [PMID: 38292502 PMCID: PMC10824135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The effects of 'stress' within the healthcare professions are wide-reaching, not least of all within the field of simulation-based healthcare education. Whilst this popular method of experiential learning offers a 'safe space' for participants to develop their skillset, it also has a more surreptitious action; namely, the incubation of simulation-related stress. Currently, research concerning the complex relationship between stress, learning, and performance is ambiguous, leaving fertile ground for simulationists to debate what level of stress is appropriate for an optimised educational experience. In this narrative review, we examine the human response to stress and outline the various methods that have been used by researchers to measure stress in a quantifiable and standardised way. We then provide a brief overview of simulation-based healthcare education before describing why stress responses have been of interest to healthcare educationalists for some time. Finally, we outline how simulation education environments might provide an ideal environment for studying the human response to stress generally, with ramifications extending beyond the field of medical education.
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Affiliation(s)
- Aaron Vage
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Andrew D Spence
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Gerard J Gormley
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Gary McKeown
- School of Psychology, Queen’s University Belfast, David Keir Building, Malone Road, Belfast, BT9 5BN
| | - Paul Murphy
- School of Arts, English and Languages, Queen’s University Belfast, University Square, Belfast, BT7 1NN
| | - Paul K Hamilton
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
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Richard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. MEDICAL EDUCATION ONLINE 2023; 28:2199469. [PMID: 37073473 PMCID: PMC10120456 DOI: 10.1080/10872981.2023.2199469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Suicide is a major cause of preventable death worldwide. Adequate training in risk assessment and intervention is key to suicide prevention. The use of simulation (role plays, simulated patients, virtual reality…) for practical training is a promising tool in mental health. The purpose of this study was to assess the effectiveness of simulation training in suicide risk assessment and intervention for healthcare professionals and gatekeepers. METHODS We conducted a systematic review in Medline and PsycINFO up to 31 July 2021 of randomized controlled trials (RCTs), non-randomized controlled trials, and pre/post-test studies. RCTs were furthermore included in a meta-analysis. We assessed the methodological quality of all studies with the Medical Education Research Study Quality Instrument, and the Cochrane Risk of Bias tool 2.0 for RCTs. Primary outcomes were changes in Kirkpatrick criteria: attitudes, skills, knowledge, behaviors, and patient outcomes. RESULTS We included 96 articles representing 43,656 participants. Most pre/post-test (n = 65) and non-randomized controlled (n = 14) studies showed significant improvement in attitudes, skills, knowledge, and behaviors. The meta-analysis of 11 RCTs showed positive changes in attitudes immediately after training and at 2-4 months post-training; in self-perceived skills at 6 months post-training; but not in factual knowledge. Studies assessing benefits for patients are still limited. CONCLUSIONS The heterogeneity of methodological designs, interventions, and trained populations combined with a limited number of RCTs and studies on patients' outcomes limit the strength of the evidence. However, preliminary findings suggest that simulation is promising for practical training in suicidal crisis intervention and should be further studied.
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Affiliation(s)
- Océane Richard
- Department of child and adolescent psychiatry,Université Paris Cité, AP-HP, Academic Hospital Necker-Enfants Malades, Reference center for autism and learning disorders, Paris, France
| | - Fabrice Jollant
- Department of psychiatry, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France; Department of psychiatry, CHU Nimes, Nimes, France; Department of Psychiatry, School of Medicine, Paris-Saclay University, le Kremlin-Bicêtre, France; McGill University, McGill Group for Suicide Studies, Montreal, Canada; Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
| | - Grégoire Billon
- Mental helath simulation center, Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Attoe
- Mental helath simulation center, Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominique Vodovar
- Université Paris Cité, UFR de médecine, 75010 Paris; UMRS 1144, Faculté de pharmacie, 75006 Paris; Centre AntiPoison de Paris, Paris
| | - Marie-Aude Piot
- Department of child and adolescent psychiatry, Université Paris Cité, AP-HP, Academic Hospital Necker-Enfants Malades Reference center for autism and learning disorders; Ilumens, Simulation Center; Paris-Saclay University, Paris, France
- CONTACT Marie-Aude Piot Department of child and adolescent psychiatry, Academic Hospital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
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Aksoy ME, Kocaoglu B, İzzetoglu K, Agrali A, Yoner SI, Polat MD, Kayaalp ME, Yozgatli TK, Kaya A, Becker R. Assessment of learning in simulator-based arthroscopy training with the diagnostic arthroscopy skill score (DASS) and neurophysiological measures. Knee Surg Sports Traumatol Arthrosc 2023; 31:5332-5345. [PMID: 37743389 DOI: 10.1007/s00167-023-07571-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Virtual arthroscopic training has become increasingly popular. However, there is a lack of efficiency-based tracking of the trainee, which may be critical for determining the specifics of training programs and adapting them for the needs of each trainee. This study aims to evaluate and compare the measures obtained with a non-invasive neurophysiological method with The Diagnostic Arthroscopy Skill Score (DASS), a commonly used assessment tool for evaluating arthroscopic skills. METHODS The study collected simulator performance scores, consisting of "Triangulation Right Hand", "Triangulation Left Hand", "Catch the Stars" and "Three Rings" and DASS scores from 22 participants (11 novices, 11 experts). These scores were obtained while participants underwent a structured program of exercises for the fundamentals of arthroscopic surgery training (FAST) and knee module using a simulator-based arthroscopy device. During the evaluation, data on oxy-hemoglobin and deoxy-hemoglobin levels in the prefrontal cortex were collected using the Functional Near-Infrared Spectroscopy (fNIRS) imaging system. Performance scores, DASS scores, and fNIRS data were subsequently analyzed to determine any correlation between performance and cortex activity. RESULTS The simulator performance scores and the DASSPart2 scores were significantly higher in the expert group compared to the novice group (200.1 ± 28.5 vs 172.5 ± 48.9, p = 0.04 and 9.4 ± 5.6 vs. 5.4 ± 5.6 p = 0.02). In the expert group, fNIRS data showed a significantly lower prefrontal cortex activation during fundamental tasks in the FAST module, indicating significantly more efficient mental resource use. CONCLUSION The analysis of cognitive workload changes during simulation-based arthroscopy training revealed a significant correlation between the trainees' DASS scores and fNIRS data. This correlation suggests the potential use of fNIRS data and DASS scores as additional metrics to create adaptive training protocols for each participant. By incorporating these metrics, the training process can be optimized, leading to more efficient arthroscopic training and better preparedness for clinical operations. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mehmet Emin Aksoy
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- CASE (Center of Advanced Simulation and Education), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Baris Kocaoglu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Kurtulus İzzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, 19104, USA
| | - Atahan Agrali
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Serhat Ilgaz Yoner
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mert Deniz Polat
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, 19104, USA
| | - Mahmut Enes Kayaalp
- Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA
- Orthopedics and Traumatology, Istanbul Kartal Research and Training Hospital, Istanbul, Turkey
- Center of Orthopedics and Traumatology, University of Brandenburg, Brandenburg/Havel, Germany
| | - Tahir Koray Yozgatli
- Department of Orthopedics and Traumatology, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Alper Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Roland Becker
- Center of Orthopedics and Traumatology, University of Brandenburg, Brandenburg/Havel, Germany
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Griffith PB, Mariani B, Kelly MM. Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment. Nurs Educ Perspect 2023; 44:E18-E24. [PMID: 37404060 DOI: 10.1097/01.nep.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
AIM The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection. BACKGROUND Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy. METHOD Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored. RESULTS Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants. CONCLUSION Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.
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Affiliation(s)
- Patricia B Griffith
- About the Authors Patricia B. Griffith, PhD, CRNP, ACNP-BC, is advanced senior lecturer, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Bette Mariani, PhD, RN, ANEF, FAAN, is vice dean of academic affairs and a professor, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania. Michelle M. Kelly, PhD, CRNP, CNE, FAANP, is associate professor, Villanova University M. Louise Fitzpatrick College of Nursing. Dr. Mariani, Research Briefs editor for Nursing Education Perspectives , had no role in the review or selection of this article. This work was supported by the National League for Nursing Education Scholarship and the Pennsylvania Higher Education Nursing Schools Association Nursing Education Research funding. For more information, contact Dr. Griffith at
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Fink MC, Heitzmann N, Reitmeier V, Siebeck M, Fischer F, Fischer MR. Diagnosing virtual patients: the interplay between knowledge and diagnostic activities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1245-1264. [PMID: 37052740 PMCID: PMC10099021 DOI: 10.1007/s10459-023-10211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
Clinical reasoning theories agree that knowledge and the diagnostic process are associated with diagnostic success. However, the exact contributions of these components of clinical reasoning to diagnostic success remain unclear. This is particularly the case when operationalizing the diagnostic process with diagnostic activities (i.e., teachable practices that generate knowledge). Therefore, we conducted a study investigating to what extent knowledge and diagnostic activities uniquely explain variance in diagnostic success with virtual patients among medical students. The sample consisted of N = 106 medical students in their third to fifth year of university studies in Germany (6-years curriculum). Participants completed professional knowledge tests before diagnosing virtual patients. Diagnostic success with the virtual patients was assessed with diagnostic accuracy as well as a comprehensive diagnostic score to answer the call for more extensive measurement of clinical reasoning outcomes. The three diagnostic activities hypothesis generation, evidence generation, and evidence evaluation were tracked. Professional knowledge predicted performance in terms of the comprehensive diagnostic score and displayed a small association with diagnostic accuracy. Diagnostic activities predicted comprehensive diagnostic score and diagnostic accuracy. Hierarchical regressions showed that the diagnostic activities made a unique contribution to diagnostic success, even when knowledge was taken into account. Our results support the argument that the diagnostic process is more than an embodiment of knowledge and explains variance in diagnostic success over and above knowledge. We discuss possible mechanisms explaining this finding.
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Affiliation(s)
- Maximilian C Fink
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
- Department for Education, University of the Bundeswehr Munich, Institute of Education, Learning and Teaching with Media, Werner-Heisenberg-Weg 39, 85577, Neubiberg, Germany
| | - Nicole Heitzmann
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Victoria Reitmeier
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Frank Fischer
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany.
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany.
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Soenarto RF, Sukmono B, Findyartini A, Susilo AP. Improvement in medical students' knowledge on chronic pain assessment through integrative learning approaches: a randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1210370. [PMID: 37663306 PMCID: PMC10469308 DOI: 10.3389/fpain.2023.1210370] [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: 04/22/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction This study aimed to compare the knowledge and skills of medical students in chronic pain assessment after being trained using the PQRST (P, provoke and palliate; Q, quality; R, region and radiation; S, severity; T, time) and ACT-UP (A, activity; C, coping; T, think; U, upset; P, people) mnemonics with those using only the PQRST mnemonic. Methods A double-blind, randomized controlled trial was conducted at the Faculty of Medicine, Universitas Indonesia, including forty students who participated in a simulation-based chronic pain assessment workshop. Pre- and post-test scores were used to assess participants' knowledge. Two independent raters assessed the students' skills. Results No significant differences in knowledge or skills were observed between the groups; however, a significant improvement in the post-test scores (85.71 [71.43-95.24]) compared to the pre-test scores (61.90 [25.87-90.48]) was observed. The students reported high satisfaction with the workshop. Conclusions Training with the PQRST and ACT-UP mnemonics is not better than training with the PQRST mnemonic alone in improving students' knowledge and skills in chronic pain assessment. Nevertheless, this pain education workshop was beneficial for student learning. Learning of patient-oriented chronic pain assessment should be provided in a repetitive and integrative fashion using different approaches, such as lectures, demonstrations, simulations, and interactions with patients experiencing chronic pain. To conclude, mnemonics are helpful but not a primary learning tool.
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Affiliation(s)
- Ratna Farida Soenarto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Besthadi Sukmono
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education & Medical Education Center IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Astrid Pratidina Susilo
- Department of Medical Education and Bioethics, Faculty of Medicine, Universitas Surabaya, Surabaya, Indonesia
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Gershov S, Braunold D, Spektor R, Ioscovich A, Raz A, Laufer S. Automating medical simulations. J Biomed Inform 2023; 144:104446. [PMID: 37467836 DOI: 10.1016/j.jbi.2023.104446] [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: 12/19/2022] [Revised: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE This study aims to explore speech as an alternative modality for human activity recognition (HAR) in medical settings. While current HAR technologies rely on video and sensory modalities, they are often unsuitable for the medical environment due to interference from medical personnel, privacy concerns, and environmental limitations. Therefore, we propose an end-to-end, fully automatic objective checklist validation framework that utilizes medical personnel's uttered speech to recognize and document the executed actions in a checklist format. METHODS Our framework records, processes, and analyzes medical personnel's speech to extract valuable information about performed actions. This information is then used to fill the corresponding rubrics in the checklist automatically. RESULTS Our approach to activity recognition outperformed the online expert examiner, achieving an F1 score of 0.869 on verbal tasks and an ICC score of 0.822 with an offline examiner. Furthermore, the framework successfully identified communication failures and medical errors made by physicians and nurses. CONCLUSION Implementing a speech-based framework in medical settings, such as the emergency room and operation room, holds promise for improving care delivery and enabling the development of automated assistive technologies in various medical domains. By leveraging speech as a modality for HAR, we can overcome the limitations of existing technologies and enhance workflow efficiency and patient safety.
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Affiliation(s)
- Sapir Gershov
- Technion Autonomous Systems Program, Technion - Israel Institute of Technology, Haifa, Israel.
| | | | - Robert Spektor
- Faculty of Industrial Engineering & Management, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Aeyal Raz
- Rambam Health Care Campus, Haifa, Israel
| | - Shlomi Laufer
- Faculty of Industrial Engineering & Management, Technion - Israel Institute of Technology, Haifa, Israel
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Phillips Z, Wong L, Crotty K, Horlick M, Johnston R, Altshuler L, Zabar S, Jay M, Dembitzer A. Implementing an Experiential Telehealth Training and Needs Assessment for Residents and Faculty at a Veterans Affairs Primary Care Clinic. J Grad Med Educ 2023; 15:456-462. [PMID: 37637347 PMCID: PMC10449358 DOI: 10.4300/jgme-d-22-00868.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The transition to telehealth during the COVID-19 pandemic revealed a lack of preexisting telehealth training for clinicians. As a workplace-based simulation methodology designed to improve virtual clinical skills, announced standardized patients (ASPs) may help meet evolving educational needs to sustain quality telehealth care. Objective We describe the development and implementation of an ASP program to assess and provide feedback to resident and faculty clinicians in virtual practice, and report on performance, feasibility, and acceptability. Methods From June 2021 to April 2022, resident and faculty clinicians at a VA primary care clinic participated in a video visit in which an ASP portrayed either a 70-year-old man with hearing loss and hypertension or a 60-year-old man with hypertension and financial stress. Following the visit, ASPs provided verbal feedback and completed a behaviorally anchored checklist to rate telehealth and communication skills, chronic disease management, and use of resources. Domain summary scores were calculated as the mean percentage of "well done" items. Participants completed a feedback survey on their experience. Results Seventy-six televisits (60 primary care residents [postgraduate year 1-3], 16 internal medicine faculty) were conducted from August 2021 to April 2022. Clinicians performed well in communication skills: information gathering (79%, 60 of 76, well done), relationship development (67%, 51 of 76), education and counseling (71%, 54 of 76), and patient satisfaction (86%, 65 of 76). They performed less well in telemedicine skills (38%, 29 of 76). Participants agreed that the experience was a good use of their time (88%, 67 of 76). Conclusions An ASP-facilitated training for resident and faculty clinicians assessed telehealth skills and clinical practice and identified areas for intervention. Clinicians responded well to the training and feedback.
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Affiliation(s)
- Zoe Phillips
- Zoe Phillips, BA, is Research Data Associate, New York University Grossman School of Medicine
| | - Laura Wong
- Laura Wong, BA, is Program Manager, New York Harbor Veterans Health Affairs, and New York University Grossman School of Medicine
| | - Kelly Crotty
- Kelly Crotty, MD, is Assistant Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Margaret Horlick
- Margaret Horlick, MD, is Associate Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Rhonda Johnston
- Rhonda Johnston, PhD, is Director, Veterans Health Administration Office of Connected Care
| | - Lisa Altshuler
- Lisa Altshuler, PhD, is Assistant Professor, New York University Grossman School of Medicine
| | - Sondra Zabar
- Sondra Zabar, MD, is Professor of Medicine, New York University Grossman School of Medicine
| | - Melanie Jay
- Melanie Jay, MD, is Clinician Investigator and Staff Physician, New York Harbor Veterans Health Affairs, and Associate Professor of Medicine and Population Health, New York University Grossman School of Medicine; and
| | - Anne Dembitzer
- Anne Dembitzer, MD, is Staff Physician, New York Harbor Veterans Health Affairs, and Assistant Professor, New York University Grossman School of Medicine
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Blier RG, Carroll BA, Contreras NE. Can Simulation Scenarios Be Designed to Assess Ongoing Nursing Competence? J Nurses Prof Dev 2023; 39:214-220. [PMID: 37390342 DOI: 10.1097/nnd.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Learner-centered verification methods are at the core of Donna Wright's model for competency assessment. Using Wright's framework, an academic medical center studied the use of simulation as a verification method for their annual ongoing nursing competency assessment. Of the 10 pilot participants, 60% used simulation as a verification method to successfully show competence. Assuming adequate professional development practitioner and facility resources, simulation can be used as an option for ongoing competency assessment.
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Kotlyar I, Sharifi T, Fiksenbaum L. Assessing Teamwork Skills: Can a Computer Algorithm Match Human Experts? INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE IN EDUCATION 2022. [DOI: 10.1007/s40593-022-00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shokrollahi S, Ashrafi F, Iraj B, Omid A, Mansouri V. A comparative study of the effects of multimedia training materials on mini CEX scores of internal medicine residents in Isfahan University of Medical Sciences. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:322. [PMID: 36568003 PMCID: PMC9768699 DOI: 10.4103/jehp.jehp_867_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/27/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Role of multimedia training materials on Mini-CEX scores of internal medicine residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores of internal medicine residents of Isfahan University of Medical Sciences. SETTINGS AND DESIGN A quasi-experimental action research study on 1st, 2nd, and 3rd-year internal medicine residents were implemented. MATERIALS AND METHODS The Mini-CEX test measures students' performance in six core skills necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017-2018 were compared before and after the training with prepared multimedia materials. We used repeated measured ANOVA and Mann-Whitney U test to compare the distribution of Mini-CEX scores across corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics for Windows. Armonk, NY, USA: IBM Corp). RESULTS The median Mini-CEX score (IQR) of students in preintervention and postintervention groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant increase in mini-CEX scores of the groups who used the multimedia learning material compared to those who did not use it (P < 0.001). CONCLUSIONS Multimedia learning resources demonstrated a promising influence on internal residents' mini-CEX scores in this study. They demonstrate significantly greater performance after using multimedia learning materials compared to their same-year residents who did not benefit from it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as obtaining a history or performing a physical examination.
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Affiliation(s)
- Soheila Shokrollahi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Ashrafi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Athar Omid
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Mansouri
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Guerrero JG, Rosales NS, Castro GMT. Impact of high-fidelity simulation exposure of nursing students with their objective structured clinical examination: A quasi-experimental study. Nurs Open 2022; 10:765-772. [PMID: 36030532 PMCID: PMC9834540 DOI: 10.1002/nop2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/11/2022] [Accepted: 08/10/2022] [Indexed: 01/19/2023] Open
Abstract
AIM The study aimed to establish the impact of high-fidelity simulation (HFS) in the objective structured clinical examination (OSCE) of nursing students enrolled in four undergraduate courses (medical-surgical, critical-care, maternal-health and paediatric nursing). DESIGN This quasi-experimental research study was performed during the midterm and final OSCEs of nursing students at the institution, and their OSCE performance was assessed. METHODS The students were divided into two: those who were exposed to HFS in addition to their clinical training and the other group who underwent clinical training without HFS exposure. RESULTS The combined mean midterm and final OSCE results of the group of nursing students with HFS exposure and those without HFS exposure were 92.58 and 82.66, respectively, with a mean between-group difference of 9.92% (p < .01). Our findings reveal that the HFS exposure in addition to clinical training enhanced the students' OSCE performance.
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Simulation-based clinical assessment identifies threshold competence to practise physiotherapy in Australia: a crossover trial. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:21. [PMID: 35897084 PMCID: PMC9327219 DOI: 10.1186/s41077-022-00215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although evidence exists for the efficacy of high-fidelity simulation as an educational tool, there is limited evidence for its application in high-stakes professional threshold competency assessment. An alternative model of simulation-based assessment was developed by the Australian Physiotherapy Council (APC), using purpose-written standardised patients, mapped to the appropriate threshold level. The aim of this two-phase study was to investigate whether simulation-based clinical assessments resulted in equivalent outcomes to standard, real-life assessments for overseas-trained physiotherapists seeking registration to practice in Australia. METHODS A randomised crossover trial comparing simulation-based assessment to real-life assessment was completed. Participants were internationally trained physiotherapists applying for registration to practice in Australia, voluntarily recruited from the Australian Physiotherapy Council (APC) assessment waiting list: study 1 n = 25, study 2 n = 144. Study 1 participants completed usual APC real-life assessments in 3 practice areas, completed on different days at APC partner healthcare facilities. Participants also underwent 3 practice area-matched simulation-based assessments, completed on the same day at purpose-designed simulation facilities. Study 2 participants completed 3 simulation-based assessments and 1 real-life assessment that was randomly allocated for order and practice area. Assessment of competency followed the standard APC procedure of 90-minute examinations using The Moderated Assessment Form (MAF). RESULTS The overall pass rate was higher for real-life assessments in both studies: study 1, 50% versus 42.7%; study 2, 55.6% versus 44.4%. Chi-square analysis showed a high to moderate level of exact matching of pass/fail grades across all assessments: study 1, 73.4% (p < 0.001); study 2, 58.3% (p = 0.027). Binary logistic regression showed that the best predictors of real-life pass/fail grade were simulation-based MAF pass/fail grade (study 1, OR 7.86 p < 0.001; study 2, OR 2.037, p = 0.038) and simulation-based total MAF score (study 1, OR 1.464 p < 0.001; study 2, OR 1.234, p = 0.001). CONCLUSION Simulation-based assessment is a significant predictor of clinical performance and can be used to successfully identify high stakes threshold competence to practice physiotherapy in Australia.
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Glosser LD, Lombardi CV, Hopper WA, Chen Y, Young AN, Oberneder E, Veria S, Talbot BA, Bodi SM, Matus CD. Impact of educational instruction on medical student performance in simulation patient. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:158-170. [PMID: 35752175 PMCID: PMC9911140 DOI: 10.5116/ijme.62a5.96bf] [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: 02/13/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effects, and timing of, a video educational intervention on medical student performance in manikin-based simulation patient encounters. METHODS This prospective mixed-methods study was conducted as part of the University of Toledo College of Medicine and Life Sciences undergraduate medical curriculum. One hundred sixty-six students second-year students participated in two simulations on a single day in September 2021. A 7-minute video intervention outlining the clinical diagnostic approach to pulmonary complaints was implemented. Students were randomized into 32 groups which were divided into two cohorts. One received the video prior to simulation-1 (n=83) and the other between simulation-1 and simulation-2 (n=83). Each simulation was recorded and assessed using a 44-point standardized checklist. Comparative analysis to determine differences in performance scores was performed using independent t-tests and paired t-tests. RESULTS Independent t-tests revealed the video-prior cohort performed better in simulation-1 (t(30)= 2.27, p= .03), however in simulation-2 no significant difference was observed between the cohorts. Paired t-test analysis revealed the video-between cohort had significant improvement from simulation-1 to simulation-2 (t(15)= 3.06, p = .01); no significant difference was found for the video-prior cohort. Less prompting was seen in simulation-2 among both the video-prior (t(15)= -2.83, p= .01) and video-between cohorts (t(15)= -2.18, p= .04). CONCLUSIONS Simulation training, and targeted educational interventions, facilitate medical students to become clinically competent practitioners. Our findings indicate that guided video instruction advances students' clinical performance greater than learning through simulation alone. To confirm these findings, similar investigations in other clinical training exercises should be considered.
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Affiliation(s)
- Logan D. Glosser
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Conner V. Lombardi
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Wade A. Hopper
- Department of Medical Education, Edward Via College of Osteopathic Medicine, USA
| | - Yixing Chen
- Lloyd A. Jacobs Interprofessional Immersive Simulation Center, USA
| | - Alexander N. Young
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | | | - Sprio Veria
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Benjamin A. Talbot
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Shirley M. Bodi
- Department of Family Medicine University of Toledo College of Medicine and Life Sciences, USA
| | - Coral D. Matus
- Department of Family Medicine University of Toledo College of Medicine and Life Sciences, USA
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O'Connor E, Doyle E. A Scoping Review of Assessment Methods Following Undergraduate Clinical Placements in Anesthesia and Intensive Care Medicine. Front Med (Lausanne) 2022; 9:871515. [PMID: 35449804 PMCID: PMC9016165 DOI: 10.3389/fmed.2022.871515] [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: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Anesthesia and intensive care medicine are relatively new undergraduate medical placements. Both present unique learning opportunities and educational challenges to trainers and medical students. In the context of ongoing advances in medical education assessment and the importance of robust assessment methods, our scoping review sought to describe current research around medical student assessment after anesthesia and intensive care placements. Methods Following Levac's 6 step scoping review guide, we searched PubMed, EMBASE, EBSCO, SCOPUS, and Web of Science from 1980 to August 2021, including English-language original articles describing assessment after undergraduate medical placements in anesthesia and intensive care medicine. Results were reported in accordance with PRISMA scoping review guidelines. Results Nineteen articles published between 1983 and 2021 were selected for detailed review, with a mean of 119 participants and a median placement duration of 4 weeks. The most common assessment tools used were multiple-choice questions (7 studies), written assessment (6 studies) and simulation (6 studies). Seven studies used more than one assessment tool. All pre-/post-test studies showed an improvement in learning outcomes following clinical placements. No studies used workplace-based assessments or entrustable professional activities. One study included an account of theoretical considerations in study design. Discussion A diverse range of evidence-based assessment tools have been used in undergraduate medical assessment after anesthesia and intensive care placements. There is little evidence that recent developments in workplace assessment, entrustable activities and programmatic assessment have translated to undergraduate anesthesia or intensive care practice. This represents an area for further research as well as for curricular and assessment developments.
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Affiliation(s)
- Enda O'Connor
- Department of Anesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
| | - Evin Doyle
- Department of Anesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
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Kamenšek T. Uporaba virtualnih simulacij ali virtualnih pacientov pri izobraževanju študentov v zdravstveni negi. OBZORNIK ZDRAVSTVENE NEGE 2022. [DOI: 10.14528/snr.2022.56.1.3136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Epidemija covida-19 je omejila praktično usposabljanje študentov zdravstvene nege. V zdravstveni negi simulacije niso novost, razmeroma novo področje izobraževanja pa so virtualne simulacije ali virtualni pacienti. Namen pregleda je bil preučiti najnovejše empirične ugotovitve o učinkovitosti oziroma uspešnosti uporabe virtualnih simulacij ali virtualnih pacientov pri študiju zdravstvene nege po svetu.Metode: Pregledani so bili znanstveni članki, objavljeni med letoma 2016 in 2021 v bibliografskih bazah CINAHL, MEDLINE, ERIC ter v kataložno-bibliografski bazi podatkov COBIB. Proučevani so bili članki, ki so obravnavali študente zdravstvene nege, pri katerih sta bila virtualna simulacija ali virtualni pacient uporabljena za način učenja in ne kot način preverjanja usvojenega znanja druge učne metode. Sinteza rezultatov je bila narejena s tematsko analizo.Rezultati: Vključenih je bilo 12 raziskav, ki so bile večinoma opravljene v razvitih državah. Rezultati so pokazali pozitiven vpliv virtualnih simulacij ali virtualnih pacientov na kognitivno in afektivno domeno znanja, praktično izvedbo intervencij, oceno samoučinkovitosti, kompetentnosti in zadovoljstva študentov.Diskusija in zaključek: Kadar kliničnega usposabljanja za študente zdravstvene nege ni mogoče zagotoviti, so virtualne simulacije ali virtualni pacienti lahko eno izmed možnih okolij za trening kliničnih odločitev, ki bi jih študent sicer pridobil v klinični praksi, ne morejo pa nadomestiti kliničnega usposabljanja in izkušenj, ki jih študent pridobi ob pacientu.
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Kotlyar I, Krasman J. Virtual simulation: New method for assessing teamwork skills. INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT 2021. [DOI: 10.1111/ijsa.12368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Igor Kotlyar
- Faculty of Business and IT University of Ontario Institute of Technology Oshawa Ontario Canada
| | - Joe Krasman
- Faculty of Business and IT University of Ontario Institute of Technology Oshawa Ontario Canada
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20
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Iancu I, Pozniak E, Draznin B. Virtual patient simulation platforms challenging traditional CME: Identification of gaps in knowledge in the management of Type 2 diabetes and Hyperlipidaemia. J Eur CME 2021; 10:1993430. [PMID: 34868735 PMCID: PMC8635625 DOI: 10.1080/21614083.2021.1993430] [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] [Indexed: 11/01/2022] Open
Abstract
As any other aspect of contemporary life, an old and established field of CME undergoes a transformation into a "digital age." Virtual patient simulation (VPS) has shown to be an interactive and efficient way of engaging healthcare professionals (HCP) in continuing medical education. VPS can identify gaps in knowledge and improve competence, using engaging, online tools. The Edocate VPS Platform has been developed by a group of physicians, education experts, and computer specialists. In this communication, we report the experience of several hundreds of HCP using the Edocate VPS application in the fields of type 2 diabetes (T2DM) and hyperlipidemia. The Edocate VPS application, displaying both simple and complex clinical situations, was presented to an international group of HCPs who had the task to perform physical exams, order lab and imaging tests, update the medical record with the right diagnoses, prescribe medications, and perform long-term follow-up through multiple visits. The HCPs received personalized, guideline-based, feedback on their actions. The analytical capabilities of the Edocate VPS platform run very deep and allow in-depth analysis of learners' competence in achieving the best outcomes, while teaching to apply a personalized approach, avoiding side effects of medications, and providing instantaneous access to the most current references in the field. The data collected from the program has shown significant gaps in knowledge and adherence to guidelines in the areas of management of T2DM and hyperlipidemia. Only about 50% of all participants achieved guideline-compatible glycemic control - namely HbA1c below 7%. Furthermore, only 41% of practicing physicians and 23% of family medicine residents achieved levels of LDL below 70 mg/dl in their virtual patients. In conclusion, the data presented in this communication strongly suggests that this novel simulation platform can enable medical organizations to create immersive VPS cases for their primary educational and CME efforts.
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Affiliation(s)
| | | | - Boris Draznin
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
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21
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Heward M, Board M, Spriggs A, Blagden D, Murphy J. Barriers and enablers to implementing 'DEALTS2' simulation-based train-the-trainer dementia training programme in hospital settings across England: a qualitative study. BMC Health Serv Res 2021; 21:946. [PMID: 34503509 PMCID: PMC8431877 DOI: 10.1186/s12913-021-06977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite approaches to provide effective dementia training in acute care settings, little is known about the barriers and enablers to implement and embed learning into practice. We were commissioned by Health Education England to develop and evaluate a new dementia training intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), an innovative simulation toolkit to support delivery of dementia training in acute care across England. This study aimed to explore barriers and enablers experienced by trainers implementing DEALTS2 and extent to which it impacted on delivery of training and staff clinical practice. Methods We conducted twelve one-day DEALTS2 train-the-trainer (TTT) workshops across England in 2017 for National Health Service Trust staff employed in dementia training roles (n = 199 trainers); each receiving a simulation toolkit. Qualitative data were collected through telephone interviews 6–8 months after TTT workshops with 17 of the trainers. Open ended questions informed by the Kirkpatrick model enabled exploration of implementation barriers, enablers, and impact on practice. Results Thematic analysis revealed six themes: four identified interrelated factors that influenced implementation of DEALTS2; and two outlined trainers perceived impact on training delivery and staff clinical practice, respectively: (i) flexible simulation and implementation approach (ii) management support and adequate resources (iii) time to deliver training effectively (iv) trainer personal confidence and motivation (v) trainers enriched dementia teaching practice (vi) staff perceived to have enhanced approach to dementia care. Trainers valued the DEALTS2 TTT workshops and adaptability of the simulation toolkit. Those supported by management with adequate resources and time to deliver effective dementia training, were likely to implement DEALTS2. Trainers described positive impacts on their teaching practice; and perceived staff had enhanced their approach to caring for people with dementia. Conclusions Trainers explained individual and organisational barriers and enablers during implementation of DEALTS2. The flexible simulation and implementation approach were key to supporting adherence of DEALTS2. To ensure wider implementation of DEALTS2 nationally, Trusts need to allocate appropriate time to deliver effective dementia training. Future research should measure staff behaviour change, patient perspectives of the intervention, and whether and how DEALTS2 has improved health and care outcomes.
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Affiliation(s)
- Michelle Heward
- Ageing and Dementia Research Centre, Faculty of Health & Social Sciences, Bournemouth University, 10 St Pauls Lane, BH8 8GP, Bournemouth, UK.
| | - Michele Board
- Ageing and Dementia Research Centre, Faculty of Health & Social Sciences, Bournemouth University, 10 St Pauls Lane, BH8 8GP, Bournemouth, UK
| | - Ashley Spriggs
- Nursing for Long-Term Health Research Centre, Faculty of Health & Social Sciences, Bournemouth University, 10 St Pauls Lane, BH8 8GP, Bournemouth, UK
| | - Dina Blagden
- Ageing and Dementia Research Centre, Faculty of Health & Social Sciences, Bournemouth University, 10 St Pauls Lane, BH8 8GP, Bournemouth, UK
| | - Jane Murphy
- Ageing and Dementia Research Centre, Faculty of Health & Social Sciences, Bournemouth University, 10 St Pauls Lane, BH8 8GP, Bournemouth, UK
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22
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Valle LF, Kundu P, Yoon SM, Pennington JD, Cao M, Lee PP, Kishan AU. Simulated consult and treatment exercise improves radiation oncology trainee confidence and knowledge. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:218. [PMID: 34395655 PMCID: PMC8318145 DOI: 10.4103/jehp.jehp_1061_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/19/2020] [Indexed: 06/13/2023]
Abstract
Malignant epidural spinal cord compression (MESCC) represents the most common indication for emergent radiotherapy. First-year residents must quickly gain competence in managing this condition prior to taking call for the department. We sought to develop a hybrid didactic/simulation exercise to assist first-year radiation oncology residents in developing a skillset relevant to treating a MESCC case in an emergency situation. This was a prospective, qualitative survey study conducted at the University of California, Los Angeles, during the years 2014-2016. Following an introductory lecture during orientation for academic years 2014-2016, residents completed a simulated consultation on a patient with suspected MESCC. Subsequently, they worked with radiation therapists to complete the clinical treatment procedure (including field placement and manual calculation of monitor units needed to deliver the prescribed dose) to a phantom placed on a linear accelerator. Residents were then surveyed about whether the exercise increased confidence in their ability to successfully complete a consult, and urgent treatment if needed, for MESCC. All residents agreed or strongly agreed that this exercise had improved this ability, and all agreed or strongly agreed that the exercise was valuable and should be retained in the curriculum. Simulated consultation and treatment of MESCC provides new residents with increased confidence and knowledge regarding this relatively common indication for emergent radiation.
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Affiliation(s)
- Luca F Valle
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Palak Kundu
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Stephanie M Yoon
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - J Daniel Pennington
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Percy P Lee
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
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Arrogante O, González-Romero GM, López-Torre EM, Carrión-García L, Polo A. Comparing formative and summative simulation-based assessment in undergraduate nursing students: nursing competency acquisition and clinical simulation satisfaction. BMC Nurs 2021; 20:92. [PMID: 34103020 PMCID: PMC8186200 DOI: 10.1186/s12912-021-00614-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Formative and summative evaluation are widely employed in simulated-based assessment. The aims of our study were to evaluate the acquisition of nursing competencies through clinical simulation in undergraduate nursing students and to compare their satisfaction with this methodology using these two evaluation strategies. METHODS Two hundred eighteen undergraduate nursing students participated in a cross-sectional study, using a mixed-method. MAES© (self-learning methodology in simulated environments) sessions were developed to assess students by formative evaluation. Objective Structured Clinical Examination sessions were conducted to assess students by summative evaluation. Simulated scenarios recreated clinical cases of critical patients. Students´ performance in all simulated scenarios were assessed using checklists. A validated questionnaire was used to evaluate satisfaction with clinical simulation. Quantitative data were analysed using the IBM SPSS Statistics version 24.0 software, whereas qualitative data were analysed using the ATLAS-ti version 8.0 software. RESULTS Most nursing students showed adequate clinical competence. Satisfaction with clinical simulation was higher when students were assessed using formative evaluation. The main students' complaints with summative evaluation were related to reduced time for performing simulated scenarios and increased anxiety during their clinical performance. CONCLUSION The best solution to reduce students' complaints with summative evaluation is to orient them to the simulated environment. It should be recommended to combine both evaluation strategies in simulated-based assessment, providing students feedback in summative evaluation, as well as evaluating their achievement of learning outcomes in formative evaluation.
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Affiliation(s)
- Oscar Arrogante
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036, Madrid, Spain.
| | - Gracia María González-Romero
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036, Madrid, Spain
| | - Eva María López-Torre
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036, Madrid, Spain
| | - Laura Carrión-García
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036, Madrid, Spain
| | - Alberto Polo
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036, Madrid, Spain
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Humphrey-Murto S, Walker K, Aggarwal S, Dhillon NPK, Rauscher S, Wood TJ. The impact of local health professions education grants: is it worth the investment? CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:44-53. [PMID: 34249190 PMCID: PMC8263034 DOI: 10.36834/cmej.71357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Local grants programs are important since funding for medical education research is limited. Understanding which factors predict successful outcomes is highly relevant to administrators. The purpose of this project was to identify factors that contribute to the publication of local medical education grants in a Canadian context. METHODS Surveys were distributed to previous Department of Innovation in Medical Education (DIME) and Department of Medicine (DOM) grant recipients (n = 115) to gather information pertaining to PI demographics and research outcomes. A backward logistic regression was used to determine the effects several variables on publication success. RESULTS The overall publication rate was 64/115 (56%). Due to missing data, 91 grants were included in the logistic regression. Variables associated with a higher rate of publication; cross departmental compared to single department OR = 2.82 (p = 0.04), being presented OR = 3.30 (p = 0.01), and multiple grant acquisition OR = 3.85 (p = 0.005). CONCLUSION Although preliminary, our data suggest that increasing research publications from local grants may be facilitated by pooling funds across departments, making research presentations mandatory, and allowing successful researchers to re-apply.
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Affiliation(s)
| | - Kyle Walker
- Department Medicine, University of Ottawa, Ontario, Canada
| | | | | | - Scott Rauscher
- Department of Innovation in Medical Education Research Support Unit, University of Ottawa, Ontario, Canada
| | - Timothy J Wood
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ontario, Canada
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Sinz E, Banerjee A, Steadman R, Shotwell MS, Slagle J, McIvor WR, Torsher L, Burden A, Cooper JB, DeMaria S, Levine AI, Park C, Gaba DM, Weinger MB, Boulet JR. Reliability of simulation-based assessment for practicing physicians: performance is context-specific. BMC MEDICAL EDUCATION 2021; 21:207. [PMID: 33845837 PMCID: PMC8042680 DOI: 10.1186/s12909-021-02617-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. METHODS Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters. RESULTS The behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability. CONCLUSIONS The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.
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Affiliation(s)
- Elizabeth Sinz
- Penn State University College of Medicine, Hershey, PA, 17033, USA.
| | - Arna Banerjee
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Jason Slagle
- Center for Research and Innovation in Systems Safety, Vanderbilt University, Nashville, TN, USA
| | - William R McIvor
- WISER Simulation Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Amanda Burden
- Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| | - Jeffrey B Cooper
- Harvard Medical School, Massachusetts General Hospital, Senior Fellow, Center for Medical Simulation, Boston, MA, USA
| | - Samuel DeMaria
- Icahn School of Medicine at the Mt Sinai Medical Center, New York, NY, USA
| | - Adam I Levine
- Icahn School of Medicine at the Mt Sinai Medical Center, New York, NY, USA
| | - Christine Park
- Department of Medical Education, Simulation and Integrative Learning Institute, University of Illinois College of Medicine, Chicago, IL, USA
| | - David M Gaba
- Stanford University and Staff Physician and Founder/Co-Director Simulation Center, VA Palo Alto, Palo Alto, CA, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John R Boulet
- Foundation for the Advancement of International Medical Education and Research (FAIMER), Philadelphia, PA, USA
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Arrogante O, López-Torre EM, Carrión-García L, Polo A, Jiménez-Rodríguez D. High-Fidelity Virtual Objective Structured Clinical Examinations with Standardized Patients in Nursing Students: An Innovative Proposal during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:355. [PMID: 33804700 PMCID: PMC8004020 DOI: 10.3390/healthcare9030355] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 12/28/2022] Open
Abstract
In response to the cancellation of in-person objective structured clinical examinations (OSCEs) prompted by confinement due to the COVID-19 pandemic, we designed a solution to adapt our traditional OSCEs to this new reality in nursing education. We implemented an innovative teaching proposal based on high-fidelity virtual OSCEs with standardized patients. The purposes of our study were to describe this innovative teaching proposal and compare nursing competence acquisition in final year nursing students through virtual and in-person OSCE modalities. The study included 234 undergraduate students: 123 students were assessed through high-fidelity virtual OSCEs during May 2020, whereas 111 students were assessed through in-person OSCEs during May 2019. The structure of OSCEs, including its stations, clinical simulated scenarios, and checklists, was the same in both OSCE modalities. The effect size of the differences among the competence categories of checklists, including their total scores, was small. Regarding our virtual OSCEs was similarly successful to in-person OSCEs, this online format was found to be useful, feasible, and cost-saving when in-person OSCE was not possible. Therefore, high-fidelity virtual OSCEs with standardized patients could be considered as another choice of OSCE not only in the current COVID-19 pandemic but could also be extended to normal situations, even post-pandemic.
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Affiliation(s)
- Oscar Arrogante
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036 Madrid, Spain; (E.M.L.-T.); (L.C.-G.); (A.P.)
| | - Eva María López-Torre
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036 Madrid, Spain; (E.M.L.-T.); (L.C.-G.); (A.P.)
| | - Laura Carrión-García
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036 Madrid, Spain; (E.M.L.-T.); (L.C.-G.); (A.P.)
| | - Alberto Polo
- Fundación San Juan de Dios, Centro de Ciencias de la Salud San Rafael, Universidad de Nebrija, Paseo de La Habana, 70, 28036 Madrid, Spain; (E.M.L.-T.); (L.C.-G.); (A.P.)
| | - Diana Jiménez-Rodríguez
- Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, 04120 Almería, Spain;
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Koster MA, Soffler M. Navigate the Challenges of Simulation for Assessment: A Faculty Development Workshop. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11114. [PMID: 33768146 PMCID: PMC7970643 DOI: 10.15766/mep_2374-8265.11114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Given barriers to learner assessment in the authentic clinical environment, simulated patient encounters are gaining attention as a valuable opportunity for competency assessment across the health professions. Simulation-based assessments offer advantages over traditional methods by providing realistic clinical scenarios through which a range of technical, analytical, and communication skills can be demonstrated. However, simulation for the purpose of assessment represents a paradigm shift with unique challenges, including preservation of a safe learning environment, standardization across learners, and application of valid assessment tools. Our goal was to create an interactive workshop to equip educators with the knowledge and skills needed to conduct assessments in a simulated environment. METHODS Participants engaged in a 90-minute workshop with large-group facilitated discussions and small-group activities for practical skill development. Facilitators guided attendees through a simulated grading exercise followed by in-depth analysis of three types of assessment tools. Participants designed a comprehensive simulation-based assessment encounter, including selection or creation of an assessment tool. RESULTS We have led two iterations of this workshop, including an in-person format at an international conference and a virtual format at our institution during the COVID-19 pandemic, with a total of 93 participants. Survey responses indicated strong overall ratings and impactfulness of the workshop. DISCUSSION Our workshop provides a practical, evidence-based framework to guide educators in the development of a simulation-based assessment program, including optimization of the environment, design of the simulated case, and utilization of meaningful, valid assessment tools.
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Affiliation(s)
- Megan A. Koster
- Instructor in Medicine, Harvard Medical School and Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital
| | - Morgan Soffler
- Instructor in Medicine, Harvard Medical School and Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center; Director of Simulation Research, Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center
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Roehr M, Wu T, Maykowski P, Munter B, Hoebee S, Daas E, Kang P. The Feasibility of Virtual Reality and Student-Led Simulation Training as Methods of Lumbar Puncture Instruction. MEDICAL SCIENCE EDUCATOR 2021; 31:117-124. [PMID: 34457871 PMCID: PMC8368585 DOI: 10.1007/s40670-020-01141-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture. METHODS Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45 min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency. RESULTS At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (p < 0.001) and time required to complete (p = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34 s over the VR group when controlling for baseline measures. CONCLUSIONS Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01141-6.
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Affiliation(s)
- Mark Roehr
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Teresa Wu
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
- Department of Emergency Medicine, Banner University Medical Center – Phoenix, Phoenix, AZ USA
| | - Philip Maykowski
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Bryce Munter
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Shelby Hoebee
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Eshaan Daas
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Paul Kang
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
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Križmarić M, Maver U, Zdravković M, Mekiš D. Effects of the reservoir bag disconnection on inspired gases during general anesthesia: a simulator-based study. BMC Anesthesiol 2021; 21:32. [PMID: 33522905 PMCID: PMC7848043 DOI: 10.1186/s12871-021-01256-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fresh gas decoupling is a feature of the modern anesthesia workstation, where the fresh gas flow (FGF) is diverted into the reservoir bag and is not added to the delivered tidal volume, which thus remains constant. The present study aimed to investigate the entraining of the atmospheric air into the anesthesia breathing circuit in case the reservoir bag was disconnected. METHODS We conducted a simulator-based study, where the METI HPS simulator was connected to the anesthesia workstation. The effect of the disconnected reservoir bag was evaluated using oxygen (O2) and air or oxygen and nitrous oxide (N2O) as a carrier gas at different FGF rates. We disconnected the reservoir bag for 10 min during the maintenance phase. We recorded values for inspiratory O2, N2O, and sevoflurane. The time constant of the exponential process was estimated during reservoir bag disconnection. RESULTS The difference of O2, N2O and sevoflurane concentrations, before, during, and after reservoir bag disconnection was statistically significant at 0.5, 1, and 2 L/min of FGF (p < 0.001). The largest decrease of the inspired O2 concentrations (FIO2) was detected in the case of oxygen and air as the carrier gas and an FGF of 1 L/min, when oxygen decreased from median [25th-75th percentile] 55.00% [54.00-56.00] to median 39.50% [38.00-42.50] (p < 0.001). The time constant for FIO2 during reservoir bag disconnection in oxygen and air as the carrier gas, were median 2.5, 2.5, and 1.5 min in FGF of 0.5, 1.0, and 2 L/min respectively. CONCLUSIONS During the disconnection of the anesthesia reservoir bag, the process of pharmacokinetics takes place faster compared to the wash-in and wash-out pharmacokinetic properties in the circle breathing system. The time constant was affected by the FGF rate, as well as the gradient of anesthetic gases between the anesthesia circle system and atmospheric air.
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Affiliation(s)
- Miljenko Križmarić
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Uroš Maver
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Marko Zdravković
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia
| | - Dušan Mekiš
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia
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Koukourikos K, Tsaloglidou A, Kourkouta L, Papathanasiou IV, Iliadis C, Fratzana A, Panagiotou A. Simulation in Clinical Nursing Education. Acta Inform Med 2021; 29:15-20. [PMID: 34012208 PMCID: PMC8116070 DOI: 10.5455/aim.2021.29.15-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Simulation constitutes a teaching method and a strategy for learning and understanding theoretical knowledge and skills in the nursing and medical field. Objective: To review and present modern data related to this issue. Methods: Literature review of data related to the issue derived from Medline, Cinhal, and Scopus databases, in English, using the following keywords: nursing, simulation, simulator, nursing laboratory. Results: The implementation of simulation enables students to practice their clinical and decision-making skills for some significant issues they may face in their daily work. The protected environment and the sense of security enhance students’ self-esteem and confidence, thus promoting learning. In this way, the gap between theory and practice is substantially reduced. Conclusion: The further development of simulation, along with other instructional techniques, can significantly help the efforts made by the students to become integrated and successful healthcare professionals.
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Affiliation(s)
- Konstantinos Koukourikos
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece.,Nursing Department, University of Peloponnese, Tripoli, Greece
| | - Areti Tsaloglidou
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Lambrini Kourkouta
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece
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Use of Augmented and Virtual Reality in Remote Higher Education: A Systematic Umbrella Review. EDUCATION SCIENCES 2020. [DOI: 10.3390/educsci11010008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this systematic umbrella review we aggregate the current knowledge of how virtual and augmented reality technologies are applicable to and impact remote learning in higher education; specifically, how they impact such learning outcomes as performance and engagement in all stages of higher education from course preparation to student evaluation and grading. This review was done as part of a state wide research effort of Latvia, to mitigate the impact of COVID-19 and specifically to provide a framework for a technological transformation of education in this context. In this work we search the Scopus and Web of Science databases for articles describing the use of virtual and/or augmented reality technologies in remote learning for higher education and their impact on learning outcomes. We identified 68 articles from which, after multiple screening and eligibility phases, nine review articles were left for extraction phase in which 30 structural elements with corresponding interventions and measured effects were extracted. Of these, 24 interventions had a measured effect on student performance (11 positive, seven negative, six no impact) and six interventions had a measured effect on student engagement (all six positive).
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Lucero KS, Spyropoulos J, Blevins D, Warters M, Norton A, Cohen J. Virtual Patient Simulation in Continuing Education: Improving the Use of Guideline-Directed Care in Venous Thromboembolism Treatment. J Eur CME 2020; 9:1836865. [PMID: 33178492 PMCID: PMC7594728 DOI: 10.1080/21614083.2020.1836865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Results of a CME-certified activity completed by a total of 986 cardiologists and 783 haematologists-oncologists (haem-oncs) from around the world were examined to determine whether virtual patient simulation could improve decision-making and performance within the simulation related to patient evaluation, tailoring anticoagulant therapy, and patient management to improve adherence using patient-centred care strategies. Results showed a significant overall impact of education from pre- to post-clinical guidance (CG) on correct decisions made in both cases for cardiologists, with a relative improvement of 22% for Case 1 (45% pre- to 55% post-CG, n = 475, t(474) = 14.12, P<.001, Cohen’s d =.46) and 19% for Case 2 (62% pre- to 74% post-CG, n = 245, t(244) = 11.95, P<.001, Cohen’s d =.59). Impact also was seen for haem-oncs, with a relative improvement of 27% for Case 1 (45% pre- to 57% post-CG, n = 280, t(279) = 11.91, P <.001, Cohen’s d =.60) and 19% for Case 2 (63% pre- to 75% post-CG, n = 147, t(146) = 9.52, P <.001, Cohen’s d =.58). Virtual patient simulation improved cardiologists’ and haem-oncs management of patients with pulmonary embolism in a simulated environment.
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Affiliation(s)
| | | | | | - Martin Warters
- Learner Experience and Instructional Design, Medscape, LLC, New York, NY, USA
| | | | - Jacob Cohen
- Outcomes and Insights Manager, Medscape, LLC, New York, NY, USA
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Mak V, Sandhu AK, Krishnan S. Using Simulation to Teach Methods for Improving Patient Literacy about Medicines. PHARMACY 2020; 8:E192. [PMID: 33081062 PMCID: PMC7720145 DOI: 10.3390/pharmacy8040192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Pharmacists have a role in educating patients on the self-management of their medications, using accurate medicines lists. Thus, pharmacy students need to be adequately trained and assessed in health-literacy skills to be competent for future patient-education consultations using medicines lists. Performance-based assessments using patient simulation are often utilized to examine students' competence in clinical knowledge and communication skills. Due to COVID-19, education systems changed to remote online delivery utilizing video conferencing platforms (i.e., ZoomTM), which proved challenging for performance-based assessments. These challenges include difficulty in observing non-verbal cues over ZoomTM and not having adequate internet access. Adaptations to reduce reliance on internet access were made where students submitted a video-recording task wherein they educated a simulated patient on a medicines list, under lockdown restrictions during the pandemic. A total of 304 submissions were received where students performed the role-play with a simulated patient, such as their family members, housemates or peers either at home in person or via ZoomTM. Although it was not an original goal of the task, the collaborative effort between pharmacy instructors, students and the public helped increase awareness of medicines lists through this task.
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Affiliation(s)
- Vivienne Mak
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Anisha Kaur Sandhu
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia; (A.K.S.); (S.K.)
| | - Sunanthiny Krishnan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia; (A.K.S.); (S.K.)
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Roussin C, Sawyer T, Weinstock P. Assessing competency using simulation: the SimZones approach. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:262-267. [PMID: 35517396 DOI: 10.1136/bmjstel-2019-000480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 01/22/2023]
Abstract
Introduction Competency-based medical education (CBME) is a system of medical training that focuses on a structured approach to developing the clinical abilities of medical education graduates and practicing physicians. CBME requires a robust and multifaceted system of assessment in order to both measure and guide the progress of learners toward pre-established goals. Simulation has been proposed as one method for assessing competency in healthcare workers. However, a longitudinal framework for assessing competency using simulation has not been developed. Methods Conjecture mapping methodology was used to map Miller's framework for competency assessment-'knows', 'knows how', 'shows how', and 'does'-to the five SimZones described by Roussin and Weinstock. The SimZones describe a system of organising the development and delivery of simulation-based education and offer a foundation for both guiding and organising assessment in a simulation context. Results A conceptualised alignment of the SimZones with Miller's pyramid of assessment was developed, as well as a detailed conjecture map. SimZone 0 (auto-feedback) and SimZone 1 (foundational instruction) mapped to 'knows' and 'knows how'. SimZone 2 (acute care instruction) mapped to 'shows how'. SimZone 3 (team and system development) mapped to 'shows how'. SimZone 4 (real-life debriefing and development) mapped to 'does'. Conclusion The SimZones system of competency assessment offers a robust, flexible, and multifaceted system to guide both formative and summative assessment in CBME. The SimZones approach adds to the many methods of competency assessment available to educators. Adding SimZones to the vocabulary of CBME may be helpful for the full deployment of CBME.
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Affiliation(s)
| | - Taylor Sawyer
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Peter Weinstock
- Anaesthesia, Harvard University, Cambridge, Massachusetts, USA
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Hough J, Levan D, Steele M, Kelly K, Dalton M. Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients. BMC MEDICAL EDUCATION 2019; 19:463. [PMID: 31842864 PMCID: PMC6915888 DOI: 10.1186/s12909-019-1894-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/27/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy. METHODS Three interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session. RESULTS For the 164 participants included in this study, self-efficacy survey response rate varied from 77 to 96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p < 0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified 'experience' as the primary theme. CONCLUSION SBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.
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Affiliation(s)
- Judith Hough
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia.
- Mater Research - The University of Queensland, South Brisbane, Queensland, Australia.
| | - Daniel Levan
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia
| | - Michael Steele
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia
| | - Kristine Kelly
- Office of the Executive Director of Allied Health, South Brisbane, Queensland, Australia
| | - Megan Dalton
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia
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Jawaid M, Bakhtiar N, Masood Z, Mehar AK. Effect of Paper- and Computer-based Simulated Instructions on Clinical Reasoning Skills of Undergraduate Medical Students: A Randomized Control Trial. Cureus 2019; 11:e6071. [PMID: 31832289 PMCID: PMC6892578 DOI: 10.7759/cureus.6071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022] Open
Abstract
Background and objectives Skilled clinical reasoning is a critical tool for physicians. Educators agree that this skill should be formally taught and assessed. Objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools and licensing bodies. We conducted this study to assess the differences in clinical reasoning skills in medical students following paper- and computer-based simulated instructions. Materials and methods A total of 52 sixth semester medical students of the Dow University of Health Sciences were included in this study. A tutorial was delivered to all students on clinical reasoning and its importance in clinical practice. Students were divided randomly into two groups: group A received paper-based instructions while group B received computer-based instructions (as Flash-based scenarios developed with Articulate Storyline software [https://articulate.com/p/storyline-3]) focused on clinical reasoning skills in history-taking of acute and chronic upper abdominal pain. After one week, both groups were tested at two objective structured clinical examination (OSCE) stations to assess acute and chronic pain history-taking skills in relation to clinical reasoning. Results There were 27 students in group A and 25 students in group B. The mean OSCE score for group A (paper-based) was 28.6 ± 9.4 and that for group B (computer-based) was 38.5 ± 6.0. Group B's mean score was statistically significantly greater (p < 0.001) than group A's mean score for clinical reasoning skills. Conclusion A computer simulation program can enhance clinical reasoning skills. This technology could be used to acquaint students with real-life experiences and identify potential areas for more training before facing real patients.
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Affiliation(s)
| | - Nighat Bakhtiar
- General Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Zubia Masood
- General Surgery, Ziauddin Medical University, Karachi, PAK
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Croft H, Gilligan C, Rasiah R, Levett-Jones T, Schneider J. Current Trends and Opportunities for Competency Assessment in Pharmacy Education-A Literature Review. PHARMACY 2019; 7:E67. [PMID: 31216731 PMCID: PMC6630227 DOI: 10.3390/pharmacy7020067] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 01/17/2023] Open
Abstract
An increasing emphasis on health professional competency in recent times has been matched by an increased prevalence of competency-based education models. Assessments can generate information on competence, and authentic, practice-based assessment methods are critical. Assessment reform has emerged as an academic response to the demands of the pharmacy profession and the need to equip graduates with the necessary knowledge, skills and attributes to face the challenges of the modern workforce. The objective of this review was to identify and appraise the range of assessment methods used in entry-level pharmacy education and examine current trends in health professional assessment. The initial search located 2854 articles. After screening, 36 sources were included in the review, 13 primary research studies, 12 non-experimental pharmacy research papers, and 11 standards and guidelines from the grey literature. Primary research studies were critically appraised using the Medical Education Research Study Quality Instrument (MERSQI). This review identified three areas in pharmacy practice assessment which provide opportunities for expansion and improvement of assessment approaches: (1) integrated approaches to performance assessment; (2) simulation-based assessment approaches, and; (3) collection of validity evidence to support assessment decisions. Competency-based assessment shows great potential for expanded use in pharmacy, but there is a need for further research and development to ensure its appropriate and effective use.
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Affiliation(s)
- Hayley Croft
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Conor Gilligan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Rohan Rasiah
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia.
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Jennifer Schneider
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia.
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Coyne L, Merritt TA, Parmentier BL, Sharpton RA, Takemoto JK. The Past, Present, and Future of Virtual Reality in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7456. [PMID: 31065173 PMCID: PMC6498191 DOI: 10.5688/ajpe7456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/24/2019] [Indexed: 05/02/2023]
Abstract
Objective. To characterize how virtual reality (VR) has been and is being used in pharmacy education, and evaluate the projected utility of VR technology in pharmacy education in the future. Findings. Virtual reality technology has been used in pharmacy education for many years to provide engaging learning experiences. Although these learning experiences were not available in the three-dimensional digital environments provided by current VR, they demonstrated improvements in learning. Recent technological advancements have substantially increased the potential usefulness of VR for pharmacy education by providing immersive educational activities that mimic real world experiences to reinforce didactic and laboratory concepts. Virtual reality training that uses head-mounted displays is just beginning in pharmacy education, but more educational VR programs are becoming available. Further research will be necessary to fully understand the potential impact of VR on pharmacy education. Summary. Virtual reality technology can provide an immersive and interactive learning environment, overcoming many of the early challenges faced by instructors who used virtual activities for pharmacy education. With further technological and software development, VR has the potential to become an integral part of pharmacy education.
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Affiliation(s)
- Leanne Coyne
- Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Thayer A Merritt
- Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Brittany L Parmentier
- Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Rachel A Sharpton
- Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Jody K Takemoto
- Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
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40
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Wan WH, Lam AHY. The Effectiveness of Virtual Reality-Based Simulation in Health Professions Education Relating to Mental Illness: A Literature Review. Health (London) 2019. [DOI: 10.4236/health.2019.116054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Buijs-Spanjers KR, Hegge HH, Jansen CJ, Hoogendoorn E, de Rooij SE. A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial. JMIR Serious Games 2018; 6:e17. [PMID: 30368436 PMCID: PMC6229519 DOI: 10.2196/games.9886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient’s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students’ skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture.
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Affiliation(s)
- Kiki R Buijs-Spanjers
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harianne Hm Hegge
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Carolien J Jansen
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Sophia E de Rooij
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Melling M, Duranai M, Pellow B, Lam B, Kim Y, Beavers L, Miller E, Switzer-McIntyre S. Simulation Experiences in Canadian Physiotherapy Programmes: A Description of Current Practices. Physiother Can 2018; 70:262-271. [PMID: 30275651 DOI: 10.3138/ptc.2017-11.e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Although health care professional education programmes around the world are increasingly using sophisticated simulation technology, the scope of simulation use in Canadian physiotherapy programmes is currently undefined. The current study explores the definitions of simulation, its current use, and the perceived benefits and barriers in Canadian entry-to-practice physiotherapy programmes. Method: Using a qualitative, descriptive study approach, we contacted Canadian physiotherapy programmes to identify faculty members with simulation experience. Using a semi-structured interview format, we asked participants to discuss their perspectives of simulation in their physiotherapy programmes. Interviews were audio recorded, transcribed, and analyzed for themes. Results: Of 13 eligible Canadian physiotherapy programmes, participants from 8 were interviewed. The interviews revealed three major themes: (1) variability in the definition of fidelity in simulation, (2) variability in simulation use, and (3) the benefits of and barriers to the use of simulation. Conclusions: Variability in the definition of fidelity in simulation among Canadian physiotherapy programmes is consistent with the current literature, highlighting a spectrum of complexity from low fidelity to high fidelity. Physiotherapy programmes are using a variety of simulations, with the aim of creating a bridge from theoretical knowledge to clinical practice. This study describes the starting point for characterizing simulation implementation in Canadian physiotherapy programmes and reflects the diversity that exists across the country.
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Affiliation(s)
| | | | | | | | | | - Lindsay Beavers
- Department of Physical Therapy.,Ontario Internationally Educated Physical Therapy Bridging Program, University of Toronto, Toronto
| | - Erin Miller
- Department of Physical Therapy.,Ontario Internationally Educated Physical Therapy Bridging Program, University of Toronto, Toronto
| | - Sharon Switzer-McIntyre
- Department of Physical Therapy.,Ontario Internationally Educated Physical Therapy Bridging Program, University of Toronto, Toronto
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Husebø SE, Silvennoinen M, Rosqvist E, Masiello I. Status of Nordic research on simulation-based learning in healthcare: an integrative review. Adv Simul (Lond) 2018; 3:12. [PMID: 30002918 PMCID: PMC6032768 DOI: 10.1186/s41077-018-0071-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Based on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research. Methods An integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis. Results The Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety. Conclusion This review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings. Electronic supplementary material The online version of this article (10.1186/s41077-018-0071-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sissel Eikeland Husebø
- 1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,2Department of Surgery, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Social Sciences, University of Southeast Norway, Porsgrunn, Norway
| | - Minna Silvennoinen
- 4School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland.,5Department of Teacher Education, University of Jyväskylä, Jyväskylä, Finland
| | - Eerika Rosqvist
- 6Department of Education and Science, The Center of Medical Expertise, Central Finland Healthcare District, Jyväskylä, Finland
| | - Italo Masiello
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Kottmann A, Carron PN, Theiler L, Albrecht R, Tissi M, Pasquier M. Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement. Scand J Trauma Resusc Emerg Med 2018; 26:54. [PMID: 29973290 PMCID: PMC6033290 DOI: 10.1186/s13049-018-0520-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts. METHODS This 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported. RESULTS Our analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period. CONCLUSIONS Our data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.
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Affiliation(s)
- Alexandre Kottmann
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | | | - Lorenz Theiler
- Swiss Air Ambulance, Rega, Zürich, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Mario Tissi
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Bartlett RD, Radenkovic D, Mitrasinovic S, Cole A, Pavkovic I, Denn PCP, Hussain M, Kogler M, Koutsopodioti N, Uddin W, Beckley I, Abubakar H, Gill D, Smith D. A pilot study to assess the utility of a freely downloadable mobile application simulator for undergraduate clinical skills training: a single-blinded, randomised controlled trial. BMC MEDICAL EDUCATION 2017; 17:247. [PMID: 29228934 PMCID: PMC5725819 DOI: 10.1186/s12909-017-1085-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Medical simulators offer an invaluable educational resource for medical trainees. However, owing to cost and portability restrictions, they have traditionally been limited to simulation centres. With the advent of sophisticated mobile technology, simulators have become cheaper and more accessible. Touch Surgery is one such freely downloadable mobile application simulator (MAS) used by over one million healthcare professionals worldwide. Nevertheless, to date, it has never been formally validated as an adjunct in undergraduate medical education. METHODS Medical students in the final 3 years of their programme were recruited and randomised to one of three revision interventions: 1) no formal revision resources, 2) traditional revision resources, or 3) MAS. Students completed pre-test questionnaires and were then assessed on their ability to complete an undisclosed male urinary catheterisation scenario. Following a one-hour quarantined revision period, all students repeated the scenario. Both attempts were scored by allocation-blinded examiners against an objective 46-point mark scheme. RESULTS A total of 27 medical students were randomised (n = 9 per group). Mean scores improved between baseline and post-revision attempts by 8.7% (p = 0.003), 19.8% (p = 0.0001), and 15.9% (p = 0.001) for no resources, traditional resources, and MAS, respectively. However, when comparing mean score improvements between groups there were no significant differences. CONCLUSIONS Mobile simulators offer an unconventional, yet potentially useful adjunct to enhance undergraduate clinical skills education. Our results indicate that MAS's perform comparably to current gold-standard revision resources; however, they may confer significant advantages in terms of cost-effectiveness and practice flexibility. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | | | - Andrew Cole
- UCL Medical School, University College London, London, UK
| | - Iva Pavkovic
- UCL School of Pharmacy, University College London, London, UK
| | | | | | | | | | - Wasima Uddin
- UCL School of Pharmacy, University College London, London, UK
| | - Ivan Beckley
- UCL Medical School, University College London, London, UK
| | - Hana Abubakar
- UCL School of Pharmacy, University College London, London, UK
| | - Deborah Gill
- UCL Medical School, University College London, London, UK
- Academic Centre for Medical Education, University College London, London, UK
| | - Daron Smith
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Middleton K. Simulation-an invaluable tool in the respiratory therapist's tool kit. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2017; 53:66-68. [PMID: 30996637 PMCID: PMC6422220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin Middleton
- Simulation and Outreach Program, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Department of Pediatrics, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Governance Committee, Centre for Simulation-Based Learning, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Adjedj J, Ducrocq G, Bouleti C, Reinhart L, Fabbro E, Elbez Y, Fischer Q, Tesniere A, Feldman L, Varenne O. Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment. JMIR Serious Games 2017; 5:e11. [PMID: 28512082 PMCID: PMC5449650 DOI: 10.2196/games.7033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/08/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
Background The gold standard for evaluating medical students’ knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students’ medical skills. Objectives The study aimed to compare MCQs with SG for medical student evaluation. Methods We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction. Results A total of 68 medical students were included. The score variability was significantly higher in the SG group (σ2 =265.4) than the MCQs group (σ2=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R2=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001). Conclusions Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students.
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Affiliation(s)
- Julien Adjedj
- AP-HP, Hôpital Cochin, Cardiology, Paris, France.,Université Paris Descartes, Paris, France.,iLUMENS, Department of Simulation, University of Sorbonne Paris Cité, Paris, France
| | - Gregory Ducrocq
- Université Paris Diderot, Paris, France.,AP-HP, Hôpital Bichat, Cardiology, Université Paris Diderot, Paris, France.,FACT, French Alliance for Cardiovascular Trials, DHU FIRE, Cardiology department of Bichat hospital, Université Paris Diderot, Paris, France
| | - Claire Bouleti
- Université Paris Diderot, Paris, France.,AP-HP, Hôpital Bichat, Cardiology, Université Paris Diderot, Paris, France.,FACT, French Alliance for Cardiovascular Trials, DHU FIRE, Cardiology department of Bichat hospital, Université Paris Diderot, Paris, France
| | | | - Eleonora Fabbro
- iLUMENS, Department of Simulation, University of Sorbonne Paris Cité, Paris, France
| | - Yedid Elbez
- FACT, French Alliance for Cardiovascular Trials, DHU FIRE, Cardiology department of Bichat hospital, Université Paris Diderot, Paris, France.,URC-Est, AP-HP, Paris, France
| | | | - Antoine Tesniere
- Université Paris Descartes, Paris, France.,iLUMENS, Department of Simulation, University of Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Cochin, Anesthesiology, Paris, France
| | - Laurent Feldman
- Université Paris Diderot, Paris, France.,AP-HP, Hôpital Bichat, Cardiology, Université Paris Diderot, Paris, France
| | - Olivier Varenne
- AP-HP, Hôpital Cochin, Cardiology, Paris, France.,Université Paris Descartes, Paris, France.,iLUMENS, Department of Simulation, University of Sorbonne Paris Cité, Paris, France
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