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Martin AT, Giffen KP. Twelve tips for orienting preclinical healthcare students to simulation education. MEDICAL TEACHER 2024; 46:1291-1295. [PMID: 38478983 DOI: 10.1080/0142159x.2024.2323176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/21/2024] [Indexed: 09/28/2024]
Abstract
Simulation-based education (SBE) is common in healthcare education and is increasingly being incorporated in preclinical curriculum. Preclinical students typically have had little exposure to the clinical setting (i.e. hospital patient rooms, equipment) and often feel uncomfortable when first placed in the simulated clinical environment. Prebriefing, a standard of best practice in simulation, prepares learners for simulation exercises. To successfully integrate SBE in preclinical education, we recommend expanding the prebriefing to include: multiple activities that orient learners to the learning space and the structure of a simulation activity, the goals of simulation as a learning process, faculty modeling of a simulated patient encounter, and expected learner outcomes. This approach increases student familiarity with the simulation learning environment and performance expectations, which can reduce cognitive load and improve learning outcomes. We describe 12 tips for increasing the scope of the prebriefing to promote effective learner participation and development during preclinical SBE.
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Affiliation(s)
- Aimee T Martin
- Faculty of Medical Sciences, University of Georgia, Augusta University/University of Georgia Medical Partnership, Athens, Georgia, USA
| | - Kimberlee P Giffen
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University/University of Georgia Medical Partnership, Athens, Georgia, USA
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2
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Davidson D, Vasey N, Mundell A, Richardson CL, Rathbone AP. A novel experiential work-based learning model in paediatric secondary care using entrustable professional activities to develop clinical knowledge and communication skills. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:102125. [PMID: 38955064 DOI: 10.1016/j.cptl.2024.102125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Initial education and training standards for pharmacists in Great Britain require early clinical exposure to patients using experiential work-based learning. However, there is poor evidence of this approach in some settings, such as paediatric care. The aim of this study was therefore to explore a novel model of experiential work-based learning for student pharmacists in a paediatric setting. METHODS Fourth-year student pharmacists enrolled on a Master of Pharmacy programme were allocated five three-hour placement sessions at a paediatric hospital. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and their carers, followed by a debriefing session with a clinical supervisor. Data were collected relating to the ward, patient details, student reported activities, learning outcomes and if follow up was required by a member of the clinical team. Data were cleaned, quality checked, then descriptive statistical analysis and inductive content analysis were conducted. MAIN FINDINGS Seventy-four students took part in 28 individual sessions and 233 consultations were recorded. Consultations included a best-possible medical history (76%, n = 177), a satisfactory drug history (45%, n = 104), or discussed hospital discharge (11%, n = 26). Students were exposed to patients with diagnosed acute conditions (41%, n = 96) and chronic conditions (33%, n = 76), as well as children awaiting diagnosis (13%, n = 30). Students reported learning about the pathology, diagnosis and symptoms of paediatric conditions (48%, n = 81), medicines used in children (24%, n = 41), patient experiences of recieving care (15%, n = 25), carer experiences (2%, n = 3), the hospital environment (2%, n = 4), career progression (2%, n = 4), and experiences of social care (11%, n = 18). Findings were synthesised with existing entrustable professional activities from the literature to generate novel EPAs specific to paediatric settings. CONCLUSIONS A paediatric setting offers a suitable environment to host experiential work-based learning in pharmacy education. Standards of initial education and training which require pharmacists to prescribe in Great Britain must recognise the importance of exposure to the health needs and experiences of children, young people's and carers prior to graduation.
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Affiliation(s)
- Dylan Davidson
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, UK
| | - Nicola Vasey
- Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals Foundation Trust, UK
| | - Amy Mundell
- Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals Foundation Trust, UK
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Mathew R, Ramakrishnan N, Boland F, Pawlikowska T, Holland JC. Learning cardiac embryology on YouTube-What videos are there to view? ANATOMICAL SCIENCES EDUCATION 2024; 17:1495-1508. [PMID: 39073248 DOI: 10.1002/ase.2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/12/2023] [Accepted: 05/20/2024] [Indexed: 07/30/2024]
Abstract
In modern medical curricula, embryology is typically taught through lectures, with a few institutions providing tutorials. The use of 3-D videos or animations enables students to study these embryological structures and how they change with time. The aim of this study was to assess the quality of cardiac embryology videos available on YouTube. A systematic literature review regarding the use of YouTube in teaching or learning cardiac embryology identified no papers that examined this specific question, and next, a systematic search of YouTube was performed. A total of 1200 cardiac embryology videos were retrieved using 12 specific search terms, with 370 videos retrieved under two or more search terms and excluded. A further 511 videos were excluded under additional, specific criteria. The remaining 319 videos were evaluated with the YouTube Video Assessment Criteria (UTvAC), with 121 rated as "useful." Videos on YouTube are uploaded with a wide audience in mind, from children to cardiologists, and content control is imperfect. Multiple videos were identified as duplicates of videos from original channels, typically without attribution. While 49 videos showed operations or human material, none contained an ethical statement regarding consent, and only 10 of these included an age restriction or graphical advisory. While there are useful videos for medical students studying cardiac embryology on YouTube, intuitive search strategies will also identify many with irrelevant content and of variable quality. Digital competence and search strategies are not innate skills, so educators should teach students to assess information so as to avoid overload or "filter failure."
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Affiliation(s)
- Ruth Mathew
- Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Niveta Ramakrishnan
- Medical Graduate, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jane C Holland
- Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Liao SC, Shao SC, Gao SY, Lai ECC. Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load. BMC MEDICAL EDUCATION 2024; 24:1058. [PMID: 39334275 PMCID: PMC11429828 DOI: 10.1186/s12909-024-05998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Augmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings. METHODS This randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1-4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration. RESULTS We found AR technology reduced the time required for critical steps in CVC placement, while minimizing users' neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees' effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees' effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant. CONCLUSIONS AR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education. TRIAL REGISTRATION The trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT06055400.
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Affiliation(s)
- Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Taiwan, No.1, University Road, Tainan City 701, Tainan, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Taiwan, No.1, University Road, Tainan City 701, Tainan, Taiwan.
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan.
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5
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Lee A, Goodman S, Chen CM, Landau R, Chatterji M. Electronic feedback alone vs. electronic feedback plus in-person debriefing, for a serious game designed to teach novice anesthesiology residents to perform general anesthesia for cesarean delivery: a randomized controlled trial. JMIR Serious Games 2024. [PMID: 39288282 DOI: 10.2196/59047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND EmergenCSimTM, is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia (GA) for emergent cesarean delivery (CD) for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well-studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared to using electronic feedback alone. OBJECTIVE We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. METHODS Novice 1st year anesthesiology residents (CA-1) (n=51) (i) watched a recorded lecture on GA for emergent CD, (ii) took a 26-item multiple-choice question (MCQ) pre-test, and (iii) played EmergenCSimTM (maximum score 196.5). They were randomized to either the control group which experienced the electronic feedback alone (Group EF, n=26) or the intervention group, which experienced the SG-embedded electronic feedback and an in-person debriefing (Group IPD+EF, n=25). All subjects played the SG a 2nd time, with instructions to try to increase their score, then they took a 26-item MCQ post-test. Pre-and post-tests (maximum score of 26 points each), were validated parallel forms. RESULTS For Groups EF and IPD+EF respectively, mean pre-test scores were18.6 (SD 2.5) and 19.4 (SD 2.3), and mean post-test scores were 22.6 (SD 2.2) and 22.1 (SD 1.6); F=1.8, P =.19. SG scores for Groups EF and IPD+EF respectively were - mean 1st play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean 2nd play SG scores were 163.1 (SE 2.9) and 173.3 (SE 2.9); F= 137.7, P < .001. CONCLUSIONS Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools. CLINICALTRIAL None.
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Affiliation(s)
- Allison Lee
- University of Pennsylvania, 3400 Spruce StSuite 680 Dulles, Philadelphia, US
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Murray B. Getting back on the curve: Reimagining individualized, sustainable residency training for the critical care pharmacist. Am J Health Syst Pharm 2024; 81:843-850. [PMID: 38761105 DOI: 10.1093/ajhp/zxae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Indexed: 05/20/2024] Open
Affiliation(s)
- Brian Murray
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Kremer I, Halimi W, Walshe A, Cerf M, Mainar P. Predicting cognitive load with EEG using Riemannian geometry-based features. J Neural Eng 2024; 21:056002. [PMID: 39059443 DOI: 10.1088/1741-2552/ad680b] [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: 01/23/2024] [Accepted: 07/26/2024] [Indexed: 07/28/2024]
Abstract
Objective. We show that electroencephalography (EEG)-based cognitive load (CL) prediction using Riemannian geometry features outperforms existing models. The performance is estimated using Riemannian Procrustes Analysis (RPA) with a test set of subjects unseen during training.Approach. Performance is evaluated by using the Minimum Distance to Riemannian Mean model trained on CL classification. The baseline performance is established using spatial covariance matrices of the signal as features. Various novel features are explored and analyzed in depth, including spatial covariance and correlation matrices computed on the EEG signal and its first-order derivative. Furthermore, each RPA step effect on the performance is investigated, and the generalization performance of RPA is compared against a few different generalization methods.Main results. Performances are greatly improved by using the spatial covariance matrix of the first-order derivative of the signal as features. Furthermore, this work highlights both the importance and efficiency of RPA for CL prediction: it achieves good generalizability with little amounts of calibration data and largely outperforms all the comparison methods.Significance. CL prediction using RPA for generalizability across subjects is an approach worth exploring further, especially for real-world applications where calibration time is limited. Furthermore, the feature exploration uncovers new, promising features that can be used and further experimented within any Riemannian geometry setting.
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Affiliation(s)
- Iris Kremer
- Logitech, Lausanne, Switzerland
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | | | - Moran Cerf
- Columbia University, New York, NY, United States of America
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Sheffield V, Finta M, Erinc A, Sonn TL, Lukela JR. Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education. Clin Obstet Gynecol 2024; 67:512-523. [PMID: 38722202 DOI: 10.1097/grf.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Despite the growing presence of women and historically underrepresented groups in academic medicine, significant disparities remain. This article examines a key aspect of these disparities: biases in assessment and learning environments. Reviewing current literature, including in OBGYN, reveals persistent gender and racial biases in subjective clinical narrative assessments. The paper then outlines a 2-pronged approach for change: first, enhancing the learning environment, and subsequently, providing targeted recommendations for individuals, academic leaders, and healthcare institutions to effectively address these biases.
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Affiliation(s)
- Virginia Sheffield
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Medicine Service, VA Ann Arbor Healthcare System
| | - Mary Finta
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abigail Erinc
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tammy L Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Reilly Lukela
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Adams KR, Kolb WH, Geiser MB, Dolphin M. A novel model for developing thrust joint manipulation skills: a teaching and learning perspective. J Man Manip Ther 2024; 32:412-420. [PMID: 38213135 PMCID: PMC11257007 DOI: 10.1080/10669817.2023.2299184] [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: 06/25/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test-retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.
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Affiliation(s)
- Kyle R. Adams
- Doctor of Physical Therapy Department, Baylor University, Waco, TX, USA
| | - William H. Kolb
- Department of Physical Therapy, Radford University, Roanoke, VA, USA
| | | | - Michelle Dolphin
- Department of Physical Therapy, Upstate Medical University, Syracuse, NY, USA
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Shi Y, Stanmore E, McGarrigle L, Wang X, Wang X, Li Y, Todd C. Development of a community intervention combining social media-based health education plus exercise programme (SHEEP) to improve muscle function among young-old adults with possible sarcopenia: Co-design approach. Maturitas 2024; 186:108027. [PMID: 38820935 DOI: 10.1016/j.maturitas.2024.108027] [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: 02/14/2024] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES There is no precedent for the use of social media in preventing sarcopenia. The aim of this study is to develop a social media-based intervention programme for the young-old population in the community in China to improve their awareness and behaviours regarding sarcopenia prevention. STUDY DESIGN Using guidelines for developing complex interventions, this study was divided into two main phases: a co-development phase and a preliminary test phase. Both were carried out in Changsha, China. The development phase employed co-design methodology with relevant stakeholders, including two rounds of consultation with patient and public involvement (12 members) and two rounds of focus groups (30 participants); this was followed by the three-week preliminary test phase (22 participants). MAIN OUTCOME MEASURES This study evaluated the consultation with patient and public involvement, and mainly collected qualitative data from the two rounds of focus group interviews and a final semi-structured interview following the preliminary test, so as to explore the participants' experiences, comments, and suggestions for revising the social media-based intervention. Handgrip strength was also evaluated. RESULTS The health education included seven videos of 4-6 min each related to sarcopenia, including information on the concept, influencing factors, adverse effects, manifestations, screening methods, and preventions. The exercise video consisted of four types of training (warm-up, aerobic, resistance, and flexibility training) and lasted 30 min, with a suggested engagement of at least 3 days/week. The specific contents and "dosage" of the final intervention were unanimously favourable to the diverse stakeholders involved (older adults with possible sarcopenia, experts, researchers). After the preliminary test, an improvement in handgrip strength was observed, from M15.92±SD5.22 kg to M19.13±SD5.44 kg (T = -5.44, P < 0.001). Subgroup analysis revealed that this improvement was evident in both men and women. CONCLUSIONS The social media-based intervention was universally endorsed by the participants and showed indications of a positive influence on sarcopenia. A feasibility study is now needed.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL Manchester, UK; School of Nursing, School of Public Health, Yangzhou University, 225009 Yangzhou, Jiangsu Province, China; School of Health Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, M13 9PL Manchester, UK.
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL Manchester, UK; School of Health Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, M13 9PL Manchester, UK; Manchester University NHS Foundation Trust, M13 9WL Manchester, UK.
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL Manchester, UK; School of Health Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, M13 9PL Manchester, UK.
| | - Xiuhua Wang
- Xiangya School of Nursing, Central South University, 410013 Changsha, Hunan Province, China.
| | - Xiaoqing Wang
- Department of Geriatrics, the Second Xiangya Affiliated Hospital, Central South University, 410011 Changsha, Hunan Province, China
| | - Yuhua Li
- Xiangya School of Nursing, Central South University, 410013 Changsha, Hunan Province, China
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL Manchester, UK; School of Health Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, M13 9PL Manchester, UK; Manchester University NHS Foundation Trust, M13 9WL Manchester, UK.
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Dong SW, Walker J, Nematollahi S, Nolan NS, Ryder JH. The ID Digital Institute: Building a digital education toolset and community. Transpl Infect Dis 2024; 26:e14297. [PMID: 38884941 DOI: 10.1111/tid.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/18/2024]
Abstract
Organic digital education (ODE) includes online medical education content that can take various forms, such as blogs, social media, videos, podcasts, or infographics. Multimedia ODE platforms have unique benefits and have quickly become an essential part of medical education. Modern medical educators with competency in digital teaching modalities can leverage these for teaching as well as career development and dissemination of scientific research. The ID Digital Institute is a digital education program with a curriculum designed to equip infectious diseases (ID) professionals with the skills to appraise, create, curate, and integrate ODE into their teaching and career. We share the structure, content, and lessons learned from the ID Digital Institute program. We also illustrate how digital education skills can present unique opportunities to align with current and future transplant and immunocompromised host infectious diseases education efforts.
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Affiliation(s)
- Sara W Dong
- Division of Infectious Diseases, Departments of Medicine and Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jeremey Walker
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Saman Nematollahi
- Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Jonathan H Ryder
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Spijkerman S, Manning DM, Green-Thompson LP. A Cognitive Load Theory Perspective of the Undergraduate Anesthesia Curricula in South Africa. Anesth Analg 2024:00000539-990000000-00875. [PMID: 39046910 DOI: 10.1213/ane.0000000000007033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Safe anesthesia is indispensable to achieve global safe surgery and equitable health care access. The disease burden and lack of specialists in South Africa (SA) require junior, nonspecialist doctors to be fit-for-purpose from day 1 when they provide anesthetic services in peripheral hospitals with limited supervision. Graduating students report low self-perceived preparedness for administering anesthesia, but it is not known how their curricular experiences influence their learning. Cognitive load theory defines intrinsic, extraneous, and germane cognitive loads (subtypes). Intrinsic load relates to learning tasks, extraneous load to distractions, and germane load to students' learning processes. This study used a cognitive load theory lens to explore SA students' experiences of their undergraduate anesthesia training. METHODS In a constructivist cross-sectional descriptive study, we explored the qualitative factors that influenced students' curricular experience of undergraduate anesthesia training in SA. Two investigators analyzed the data independently in an initial coding round. An emerging theme of lack of time to achieve the expected outcomes, prompted the use of cognitive load theory as a conceptual framework for further analysis by the 3 authors. The subsequent analysis informed the development and refinement of a final cognitive load theory framework for anesthesia training, the COLOAD (COgnitive LOad in Anesthesia eDucation) framework. RESULTS Data were collected between November 2017 and February 2019. The 1336 respondents (79% participation) reported a variety of determinants of learning pertaining to all 3 cognitive load subtypes. Participants were novices in an inherently complex environment and experienced a high cognitive load during anesthesia training. The number-, complexity-, and interactivity of tasks influenced intrinsic load, while extraneous load was affected by ineffective instructional methods, external- and internal distractors. Program design, metacognition, and learner motivation impacted germane load. CONCLUSIONS Cognitive load theory provided a useful theoretical basis for understanding students' curricular experiences. The COLOAD framework suggests a microlevel interrelatedness of the constituting elements of the 3 cognitive load subtypes. This has implications for curriculum design, pedagogy, and student support. Learning outcomes development and curriculum mapping are important to ensure a lean curriculum, but measures to enhance germane cognitive load might be equally important to achieve competence. Attention to the hidden curriculum and active promotion of reflective practice might reduce cognitive load in complex learning environments such as anesthesia training.
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Affiliation(s)
- Sandra Spijkerman
- From the Department of Anaesthesiology, University of Pretoria, Pretoria, South Africa
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Sherman L, Aboulsoud S, Leon-Borquez R, Ming K, Yang DYD, Chappell K. An overview of global CME/CPD systems. MEDICAL TEACHER 2024:1-13. [PMID: 39012047 DOI: 10.1080/0142159x.2024.2373879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Engagement in CME/CPD has a positive impact on healthcare professionals' (HCPs) knowledge, skills, and performance, and on patient outcomes, therefore it is critical to better understand the components of CME/CPD systems that foster engagement, high-quality education, and impact. METHODS An assessment of CME/CPD systems was conducted using a mixed-methods approach that included interviews with in-country subject matter experts and qualitative and quantitative data from practicing in-country physicians. RESULTS Results demonstrate areas of consistency in CME/CPD systems across world regions that included: types of educational providers; types of credit; educational formats; self-tracking of participation; high-degree of compliance when education is mandatory; overall satisfaction with available education; strong support for interprofessional education; and lack of alignment or evaluation of engagement in education with population health outcomes. Areas of variation included: whether engagement in education is required as a condition to practice medicine; whether regulations are uniformly applied; if mechanisms to ensure independence existed; and physician perceptions of independence. CONCLUSION Results of this assessment maybe used by a variety of different stakeholders to assess how well country-level CME/CPD systems are meeting the needs of practicing physicians and determine what, if any, changes might need to be implemented to improve outcomes.
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Affiliation(s)
| | | | | | - Kuang Ming
- Zhongshan School of Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Da-Ya David Yang
- First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kathy Chappell
- Accreditation Commission for Education in Nursing, Atlanta, GA, USA
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14
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Lai-Kwon J, Woodward-Kron R, Seignior D, Allen L, McArthur G, Barrett M, Kok DL. Qualitative evaluation of a multidisciplinary master of cancer sciences: impacts on graduates and influencing curricular factors. BMC MEDICAL EDUCATION 2024; 24:734. [PMID: 38977978 PMCID: PMC11229342 DOI: 10.1186/s12909-024-05744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Evaluations of continuing professional development programs typically focus on short-term knowledge and skill acquisition. There is a need for more comprehensive program evaluation methods that assess a broader range of impacts and can elicit how and why these outcomes occurred. We conducted a qualitative study to investigate the impacts of a multidisciplinary, online health professional postgraduate degree and to gain insights into the factors that led to these impacts. METHODS Participants were graduates of the University of Melbourne's Master of Cancer Sciences who could participate in an online interview. Semi-structured, qualitative interviews were conducted exploring a broad range of impacts, including changes in professional practice and career trajectory since graduation, and how the degree influenced these impacts. Data were analysed inductively. RESULTS Fifteen participants (female: 80%, 31-50 years old: 67%) from a range of professions were interviewed. A number of major themes were uncovered. Impacts on career trajectory included expanded career horizons (e.g. increased role diversity and complexity), and increased confidence in their professional identity. Impacts on professional practice included individual improvements in patient care and research, as well as changes in organisational practice. Factors identified as leading to these impacts were: (i) active, interactive and interprofessional learning; (ii) networking, informal mentoring, and role-modelling; and (iii) support at multiple levels. CONCLUSION This study provides preliminary evidence of the positive impact of a Master of Cancer Sciences on graduate career trajectory and professional practice. In addition, the inductive methodology enabled identification of the curricular features (both planned and emergent) that influenced these impacts, facilitating potential transferability of learnings to other teaching programs.
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Affiliation(s)
- Julia Lai-Kwon
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Peter MacCallum Cancer Centre, 300 Grattan St, Melbourne, VIC, 3000, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Seignior
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Louise Allen
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Grant McArthur
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Peter MacCallum Cancer Centre, 300 Grattan St, Melbourne, VIC, 3000, Australia
- Cancer Science Unit, Department of Clinical Pathology, University of Melbourne, Melbourne, Australia
| | - Michelle Barrett
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
| | - David L Kok
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia.
- Peter MacCallum Cancer Centre, 300 Grattan St, Melbourne, VIC, 3000, Australia.
- Cancer Science Unit, Department of Clinical Pathology, University of Melbourne, Melbourne, Australia.
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15
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Abdul-Salam P, Richardson C, Nazar H. Undergraduate pharmacy students' perceptions and experiences of a student-led clinic providing preventative services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:316-321. [PMID: 38815978 DOI: 10.1093/ijpp/riae023] [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: 11/07/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Authentic work-based learning is crucial to facilitate the development and preparedness for training healthcare professionals. Such experiences are challenging to design and secure within the clinical environment. One School of Pharmacy established a student-led clinic to provide undergraduate pharmacy students the opportunity to practise physical assessment and communication skills with members of the public. The aim of this study was to explore students' thoughts and perspectives on this experience. METHODS Undergraduate students were invited to participate in a semi-structured interview after their clinic experience. Transcriptions of the interviews were analysed by reflexive thematic analysis. RESULTS Twelve students agreed to an interview that took place between October and December 2022. Three themes were identified from the qualitative data which related to external factors that influenced student experience of the clinic, for example, organizational issues and impact of the physical environment; interactions within the clinic environment; and internalized learning for example, professional growth and development, and the appreciating the learning opportunity. CONCLUSIONS In the current climate, where securing valuable work-based learning opportunity is challenging, student-led clinics offer an environment that is well-received by students and appears to facilitate student professional development. Student clinics are receiving more attention and investment across undergraduate healthcare programmes around the world given advantages such as these. However, they need to be well integrated and structured into the existing training and education and students need appropriate induction to prepare them for the experience and manage expectations.
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Affiliation(s)
- Prince Abdul-Salam
- School of Pharmacy, Newcastle University, Newcastle-upon-Tyne NE1 7RU, United Kingdom
| | - Charlotte Richardson
- School of Pharmacy, Newcastle University, Newcastle-upon-Tyne NE1 7RU, United Kingdom
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle-upon-Tyne NE1 7RU, United Kingdom
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16
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Yilmaz R, Bakhaidar M, Alsayegh A, Abou Hamdan N, Fazlollahi AM, Tee T, Langleben I, Winkler-Schwartz A, Laroche D, Santaguida C, Del Maestro RF. Real-Time multifaceted artificial intelligence vs In-Person instruction in teaching surgical technical skills: a randomized controlled trial. Sci Rep 2024; 14:15130. [PMID: 38956112 PMCID: PMC11219907 DOI: 10.1038/s41598-024-65716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
Trainees develop surgical technical skills by learning from experts who provide context for successful task completion, identify potential risks, and guide correct instrument handling. This expert-guided training faces significant limitations in objectively assessing skills in real-time and tracking learning. It is unknown whether AI systems can effectively replicate nuanced real-time feedback, risk identification, and guidance in mastering surgical technical skills that expert instructors offer. This randomized controlled trial compared real-time AI feedback to in-person expert instruction. Ninety-seven medical trainees completed a 90-min simulation training with five practice tumor resections followed by a realistic brain tumor resection. They were randomly assigned into 1-real-time AI feedback, 2-in-person expert instruction, and 3-no real-time feedback. Performance was assessed using a composite-score and Objective Structured Assessment of Technical Skills rating, rated by blinded experts. Training with real-time AI feedback (n = 33) resulted in significantly better performance outcomes compared to no real-time feedback (n = 32) and in-person instruction (n = 32), .266, [95% CI .107 .425], p < .001; .332, [95% CI .173 .491], p = .005, respectively. Learning from AI resulted in similar OSATS ratings (4.30 vs 4.11, p = 1) compared to in-person training with expert instruction. Intelligent systems may refine the way operating skills are taught, providing tailored, quantifiable feedback and actionable instructions in real-time.
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Affiliation(s)
- Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada.
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nour Abou Hamdan
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Ali M Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Trisha Tee
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Ian Langleben
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Denis Laroche
- National Research Council Canada, Boucherville, QC, Canada
| | - Carlo Santaguida
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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Steuber TD, Trujillo D, McCoy EK, Pinner NA, Hornsby L, Andrus MR, Kleppinger EL, Eiland LS. Evaluation of Student Academic Performance After Curricular Content Reduction. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100721. [PMID: 38810952 DOI: 10.1016/j.ajpe.2024.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/19/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To evaluate the effect of curricular content reduction in an integrated course sequence spanning 3 years of a Doctor of Pharmacy curriculum on student examination scores and course grades. METHODS This 2-year, prepost study compared student overall average and final examination scores and overall course grades after the transition from a 5-day to a 4-day week of an integrated learning experience (ILE) course sequence. In addition, an anonymous, optional 23-item survey was distributed to first to third year pharmacy students asking about the 4-day week change, how they utilized the non-ILE day, and additional demographic and social characteristics to identify factors influencing success on examination and course performance during the 4-day week. RESULTS There were 533 students included in the overall analysis, with no significant differences in overall course grades in the 5-day vs 4-day week. Examination scores were not significantly different after the transition, except in 2 of 12 courses where scores were higher and final examination scores were not significantly different, except for higher final examination scores in 1 course during the 5-day week. Significant positive influencers of top quartile of examination performance included prepharmacy grade point average ≥ 3.5, age 25 to 29 years, and prepharmacy coursework at the parent institution, whereas using the non-ILE day primarily to sleep negatively influenced outcomes. CONCLUSION Curricular density is a prevalent problem and addressing it at a program level is essential. Reducing curricular content and hours at our institution did not adversely impact student examination and course performance and slight improvement was noted in some areas.
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Affiliation(s)
- Taylor D Steuber
- University of Missouri-Kansas City School of Pharmacy at MU, Columbia, MO, USA.
| | - Daniel Trujillo
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Emily K McCoy
- Auburn University Harrison College of Pharmacy, Mobile, AL, USA
| | - Nathan A Pinner
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Lori Hornsby
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | | | | | - Lea S Eiland
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
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Huang SS, Huang AY, Lin YF, Lin SM, Webster CS, Lin JY, Yang YY, Yang SJH, Lirng JF, Chen CH, Yang AC, Lin CH. Learning pathways composed of core subjects with features of reducing cognitive load have better learning outcomes. J Chin Med Assoc 2024; 87:714-721. [PMID: 38829990 DOI: 10.1097/jcma.0000000000001116] [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] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Changing the course duration or timing of subjects in learning pathways would influence medical students' learning outcomes. Curriculum designers need to consider the strategy of reducing cognitive load and evaluate it continuously. Our institution underwent gradual curricular changes characterized by reducing cognitive load since 2000. Therefore, we wanted to explore the impact of this strategy on our previous cohorts. METHODS This cohort study explored learning pathways across academic years of more than a decade since 2000. Eight hundred eighty-two medical students between 2006 and 2012 were included eventually. Learning outcomes included an average and individual scores of subjects in different stages. Core subjects were identified as those where changes in duration or timing would influence learning outcomes and constitute different learning pathways. We examined whether the promising learning pathway defined as the pathway with the most features of reducing cognitive load has higher learning outcomes than other learning pathways in the exploring dataset. The relationship between features and learning outcomes was validated by learning pathways selected in the remaining dataset. RESULTS We found nine core subjects, constituting four different learning pathways. Two features of extended course duration and increased proximity between core subjects of basic science and clinical medicine were identified in the promising learning pathway 2012, which also had the highest learning outcomes. Other pathways had some of the features, and pathway 2006 without such features had the lowest learning outcomes. The relationship between higher learning outcomes and cognitive load-reducing features was validated by comparing learning outcomes in two pathways with and without similar features of the promising learning pathway. CONCLUSION An approach to finding a promising learning pathway facilitating students' learning outcomes was validated. Curricular designers may implement similar design to explore the promising learning pathway while considering potential confounding factors, including students, medical educators, and learning design of the course.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Anna YuQing Huang
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Yu-Fan Lin
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Sheng-Min Lin
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Craig S Webster
- Department of Anaesthesiology and Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ji-Yang Lin
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Stephen J H Yang
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Jiing-Feng Lirng
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | | | - Chi-Hung Lin
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Khurshid F, Hegazi I, O'Connor E, Noushad B, Thompson R. Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning. TEACHING AND LEARNING IN MEDICINE 2024:1-17. [PMID: 38899987 DOI: 10.1080/10401334.2024.2367670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/10/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.
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Affiliation(s)
- Faraz Khurshid
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
- Dow Institute of Health Professionals Education (DIHPE), Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Iman Hegazi
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
| | - Elizabeth O'Connor
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
| | - Babu Noushad
- College of Health Sciences, University of Buraimi, Al Buraimi, Oman
| | - Rachel Thompson
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
- Institute for Interactive Media and Learning, University of Technology Sydney, Sydney, Australia
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McGuire SS, Finch AS, Thomas JM, Lazaro O, Hevesi SA, Mullan AF, Homme JL. Improving emergency medicine resident pediatric lumbar puncture procedural performance through a brief just-in-time video intervention. BMC MEDICAL EDUCATION 2024; 24:682. [PMID: 38902689 PMCID: PMC11188195 DOI: 10.1186/s12909-024-05654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Emergency medicine (EM) trainee comfort level with lumbar puncture (LP) has decreased over time due to changing practice guidelines, particularly amongst pediatric patients. We implemented a "just in time" (JIT) brief educational video based on a previously published LP Performance Scoring Checklist to improve trainee efficiency and competence in LP performance. METHODS Our pilot quasi-experimental study took place January-June 2022 within a large, academic Midwestern emergency department (ED) with an established 3-year EM residency program. All 9 interns performed a timed diagnostic LP on an infant LP model in January, scored according to the LP Performance Scoring Checklist. In June, interns repeated the timed LP procedure directly after watching a brief educational video based on major checklist steps. The study was deemed exempt by the Institutional Review Board. RESULTS All interns completed both assessments. At baseline, interns had logged performance of median 2 (IQR 0-5) LPs and spent 12.9 (10.3-14.4) minutes performing the procedure. Post-intervention, interns had logged an additional median 2 (0-5) LPs and completed the procedure faster with an average time of 10.3 (9.7-11.3) minutes (p = 0.004). A median of 5 (4-7) major steps were missed at baseline, compared to 1 (1-2) at time of post-intervention assessment (p = 0.015). CONCLUSION Development of a brief educational video improved efficiency and competency amongst our intern class in performing an infant LP when viewed Just-In-Time. Similar efforts may improve education and performance of other rare (or decreasing in frequency) procedures within EM training.
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Affiliation(s)
- Sarayna S McGuire
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Alexander S Finch
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jenna M Thomas
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Octavio Lazaro
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sara A Hevesi
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jim L Homme
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Tabatabaee SS, Jambarsang S, Keshmiri F. Cognitive load theory in workplace-based learning from the viewpoint of nursing students: application of a path analysis. BMC MEDICAL EDUCATION 2024; 24:678. [PMID: 38890747 PMCID: PMC11186199 DOI: 10.1186/s12909-024-05664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The present study aimed to test the relationship between the components of the Cognitive Load Theory (CLT) including memory, intrinsic and extraneous cognitive load in workplace-based learning in a clinical setting, and decision-making skills of nursing students. METHODS This study was conducted at Shahid Sadoughi University of Medical Sciences in 2021-2023. The participants were 151 nursing students who studied their apprenticeship courses in the teaching hospitals. The three basic components of the cognitive load model, including working memory, cognitive load, and decision-making as the outcome of learning, were investigated in this study. Wechsler's computerized working memory test was used to evaluate working memory. Cognitive Load Inventory for Handoffs including nine questions in three categories of intrinsic cognitive load, extraneous cognitive load, and germane cognitive load was used. The clinical decision-making skills of the participants were evaluated using a 24-question inventory by Lowry et al. based on a 5-point scale. The path analysis of AMOS 22 software was used to examine the relationships between components and test the model. FINDINGS In this study, the goodness of fit of the model based on the cognitive load theory was reported (GIF = 0.99, CFI = 0.99, RMSEA = 0.03). The results of regression analysis showed that the scores of decision-making skills in nursing students were significantly related to extraneous cognitive load scores (p-value = 0.0001). Intrinsic cognitive load was significantly different from the point of view of nursing students in different academic years (p = 0.0001). CONCLUSION The present results showed that the CLT in workplace-based learning has a goodness of fit with the components of memory, intrinsic cognitive load, extraneous cognitive load, and clinical decision-making skill as the key learning outcomes in nursing education. The results showed that the relationship between nursing students' decision-making skills and extraneous cognitive load is stronger than its relationship with intrinsic cognitive load and memory Workplace-based learning programs in nursing that aim to improve students' decision-making skills are suggested to manage extraneous cognitive load by incorporating cognitive load principles into the instructional design of clinical education.
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Affiliation(s)
| | - Sara Jambarsang
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Keshmiri
- Department of Medical Education, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Zhou Z, Zhang K, Zhao X, Hu Y, He Y, Wan L, Yao W. Evaluation of a 12-hole clock model for improving bronchoscopic skills in simulated normal and difficult airways among anesthesia residents: A randomized controlled study. Medicine (Baltimore) 2024; 103:e38510. [PMID: 38847658 PMCID: PMC11155588 DOI: 10.1097/md.0000000000038510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Simulation-based training is used to improve fiberoptic bronchoscopic skills for novices. We developed a nonanatomical task trainer (named 12-hole clock model) that focused on training manipulation of bronchoscopes. The aim of this study was to evaluate the training effect of this model on bronchoscopic skills and learning interests in simulated normal and difficult airways among anesthesia residents. METHODS Forty-three anesthesia residents without experience in bronchoscopic intubation were randomly divided into control (n = 22) and intervention groups (n = 21). All participants received standard multimedia learning and a baseline test using a normal airway manikin. Then, the control and intervention groups engaged in 60 minutes of training via a traditional airway manikin or the clock model, respectively. After training, the participants completed bronchoscopic performance assessments in simulated normal and difficult airways, as well as an electronic questionnaire related to the course. RESULTS During training, the total hands-on time of bronchoscopic practice recorded by trainees' themselves was longer in the intervention group than in the control group (1568 ± 478 seconds vs 497 ± 172 s, P < .0001). Posttraining, the time required to visualize the carina in simulated normal airways was longer in the intervention group than in the control group (22.0 [18.0, 29.0] vs 14.0 [10.8, 18.3], P < .0001), while it was shorter for simulated difficult airways (24.0 [16.0, 32.0] s vs 27.0 [21.0, 35.5] s, P = .0425). The survey results indicated that confidence in bronchoscopic intubation increased in both groups, without significant differences in satisfaction, acceptance, or perceived difficulty between the groups. However, the interest ratings were higher in the intervention group than in the control group. CONCLUSIONS The 12-hole clock model is a simple and feasible method for improving bronchoscopic skills and promoting interest among trainees. TRIAL REGISTRATION NCT05327842 at Clinicaltrials.gov.
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Affiliation(s)
- Zhiqiang Zhou
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiwen Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingjie Hu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuqin He
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wan
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenlong Yao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wiltrakis S, Hwu R, Holmes S, Iyer S, Goodwin N, Mathai C, Gillespie S, Hebbar KB, Colman N. Debriefer cognitive load during Traditional Reflective Debriefing vs. Rapid Cycle Deliberate Practice interdisciplinary team training. Adv Simul (Lond) 2024; 9:23. [PMID: 38835053 PMCID: PMC11149316 DOI: 10.1186/s41077-024-00296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Cognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD. METHODS This study was part of a large-scale, interdisciplinary team training program at Children's Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups. RESULTS For all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (- 0.8, p = 0.004 and - 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p < 0.001). For RCDP, perceived performance success increased post-debriefing (+ 3.6, p < 0.001), time demands decreased (- 1.0, p = 0.04), and frustration decreased (- 2.0, p < 0.001). Comparing TRD directly to RCDP, perceived performance success was greater in RCDP than TRD (3.6 vs. 2.4, p = 0.04). Main facilitators had lower effort and mental demand in RCDP and greater perceived success (p < 0.001). CONCLUSION RCDP had greater perceived success than TRD for debriefers. Main facilitators also report reduced effort and baseline mental demand in RCDP. For less experienced debriefers, newer simulation programs, or large team training sessions such as our study, RCDP may be a less mentally demanding debriefing methodology for facilitators.
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Affiliation(s)
- Susan Wiltrakis
- Division of Emergency Medicine, Department of Pediatrics, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Ruth Hwu
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sherita Holmes
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Srikant Iyer
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Scott Gillespie
- Department of Biostatistics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kiran B Hebbar
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nora Colman
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Frasier LL, Cheney M, Burkhardt J, Alderman M, Nelson E, Proctor M, Brown D, Davis WT, Smith MP, Strilka R. Identifying and Reducing Insulin Errors in the Simulated Military Critical Care Air Transport Environment: A Human Factors Approach. Mil Med 2024:usae286. [PMID: 38836595 DOI: 10.1093/milmed/usae286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/11/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach. MATERIALS AND METHODS Of 169 eligible CCAT simulations, 22 were randomly selected for retrospective audio-video review to establish a baseline frequency of insulin medication errors. Using the Human Factors Analysis Classification System, dosing errors, defined as a physician ordering an inappropriate dose, were categorized as decision-based; administration errors, defined as a clinician preparing and administering a dose different than ordered, were categorized as skill-based. Next, 3 a priori interventions were developed to decrease the frequency of insulin medication errors, and these were grouped into 2 study arms. Arm 1 included a didactic session reviewing a sliding-scale insulin (SSI) dosing protocol and a hands-on exercise requiring all CCAT teams to practice preparing 10 units of insulin including a 2-person check. Arm 2 contained arm 1 interventions and added an SSI cognitive aid available to students during simulation. Frequency and type of insulin medication errors were collected for both arms with 93 simulations for arm 1 (January-August 2021) and 139 for arm 2 (August 2021-July 2022). The frequency of decision-based and skill-based errors was compared across control and intervention arms. RESULTS Baseline insulin medication error rates were as follows: decision-based error occurred in 6/22 (27.3%) simulations and skill-based error occurred in 6/22 (27.3%). Five of the 6 skill-based errors resulted in administration of a 10-fold higher dose than ordered. The post-intervention decision-based error rates were 9/93 (9.7%) and 23/139 (2.2%), respectively, for arms 1 and 2. Compared to baseline error rates, both arm 1 (P = .04) and arm 2 (P < .001) had a significantly lower rate of decision-based errors. Additionally, arm 2 had a significantly lower decision-based error rate compared to arm 1 (P = .015). For skill-based preparation errors, 1/93 (1.1%) occurred in arm 1 and 4/139 (2.9%) occurred in arm 2. Compared to baseline, this represents a significant decrease in skill-based error in both arm 1 (P < .001) and arm 2 (P < .001). There were no significant differences in skill-based error between arms 1 and 2. CONCLUSIONS This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment.
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Affiliation(s)
- Lane L Frasier
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Mark Cheney
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Joshua Burkhardt
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Mark Alderman
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Eric Nelson
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Melissa Proctor
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Daniel Brown
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Emergency Medicine, Wright State University, Dayton, OH 45324, USA
| | - William T Davis
- 59th Medical Wing Science and Technology, United States Air Fore En route Care Research Center, JBSA-Fort Sam Houston, TX 78234, USA
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Maia P Smith
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Richard Strilka
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
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Ridha MA, Ventour G, McParlin J, Cartner E, Khalid Z, Zafar AQ, Ismail A, Ross-Thriepland S. Unlocking the Potential of Underutilized Technology: A New Paradigm for Resident Doctor Efficiency. Cureus 2024; 16:e63012. [PMID: 39050337 PMCID: PMC11267489 DOI: 10.7759/cureus.63012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background The precision of clinical documentation in trauma and orthopaedic surgery is pivotal, given its profound implications on patient care and medicolegal risks. This study assessed the impact of an autotext template intervention on the adherence of clinical documentation to the neurovascular assessment standards set by the National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association Standards for Trauma (BOAST). Methods Conducted at a single hospital, this observational study comprised two phases: a retrospective analysis of clinical documentation for 56 fracture patients (n=56) followed by the implementation of an autotext template and subsequent analysis of a new cohort of 57 patients (n=57). The intervention aimed to enhance documentation quality in line with NICE and BOAST guidelines. Results Initial findings revealed a prevalent use of the nonspecific term "NVI" (neurovascularly intact), with only 8.5% (n=5) of pre-intervention documents adhering to detailed motor function assessments and a mere 6.8% (n=4) recording limb colour. Post-intervention analysis showed a significant improvement, with 91.23% (n=52) of documents listing nerves (P < 0.001) and 96.49% (n=55) adhering to motor function documentation using the Medical Research Council (MRC) grading scale (P < 0.001). Despite these advancements, the study acknowledges potential limitations such as the Hawthorne effect and the ongoing challenge of staff rotations. Conclusion The autotext template intervention markedly enhanced the adherence to neurovascular assessment documentation standards, as evidenced by the substantial increases in detailed parameter reporting and supported by statistically significant P-values. This advancement highlights the necessity of equipping clinicians with practical tools to uphold high documentation standards amidst challenging clinical conditions. Future investigations should focus on the long-term sustainability of these improvements across varying medical staff cohorts.
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Affiliation(s)
| | | | | | - Emma Cartner
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | | | | | - Ahmed Ismail
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
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Held N, Neumeier A, Amass T, Harry E, Pomponio R, Peterson RA, Huie TJ, Moss M. Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds. Chest 2024; 165:1448-1457. [PMID: 38184168 DOI: 10.1016/j.chest.2023.12.029] [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: 08/09/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. RESEARCH QUESTION What features of ICU rounds correlate with high provider cognitive load? STUDY DESIGN AND METHODS This was an observational, multisite study of multidisciplinary providers during ICU rounds. Investigators recorded rounding characteristics and hourly extraneous cognitive load events during rounds (defined as distractions, episodes of split-attention or repetition, and deviations from standard communication format). After rounds, investigators measured each provider's cognitive load using the provider task load (PTL), an instrument derived from the National Aeronautics and Space Administration Task Load Index survey that assesses perceived workload associated with complex tasks. Relationships between rounding characteristics, extraneous load, and PTL score were evaluated using mixed-effects modeling. RESULTS A total of 76 providers were observed during 32 rounds from December 2020 to May 2021. The mean rounding census ± SD was 12.5 ± 2.9 patients. The mean rounding time ± SD was 2 h 17 min ± 49 min. The mean extraneous load ± SD was 20.5 ± 4.5 events per hour, or one event every 2 min 51 s. This included 8.6 ± 3.4 distractions, 8.2 ± 4.2 communication deviations, 1.9 ± 1.4 repetitions, and 1.8 ± 1.3 episodes of split-attention per hour. Controlling for covariates, the hourly extraneous load events, number of new patients, and number of higher acuity patients were each associated with increased PTL score (slope, 2.40; 95% CI, 0.76-4.04; slope, 5.23; 95% CI, 2.02-8.43; slope, 3.35; 95% CI, 1.34-5.35, respectively). INTERPRETATION Increased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.
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Affiliation(s)
- Natalie Held
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.
| | - Anna Neumeier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Timothy Amass
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth Harry
- Department of Medicine, Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Raymond Pomponio
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO
| | - Tristan J Huie
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO; Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
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Dewi SP, Wilson A, Duvivier R, Kelly B, Gilligan C. Do the teaching, practice and assessment of clinical communication skills align? BMC MEDICAL EDUCATION 2024; 24:609. [PMID: 38824578 PMCID: PMC11144343 DOI: 10.1186/s12909-024-05596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Evidence indicates that communication skills teaching learnt in the classroom are not often readily transferable to the assessment methods that are applied nor to the clinical environment. An observational study was conducted to objectively evaluate students' communication skills in different learning environments. The study sought to investigate the extent to which the communication skills demonstrated by students in classroom, clinical, and assessment settings align. METHOD A mixed methods study was conducted to observe and evaluate students during the fourth year of a five-year medical program. Participants were videorecorded during structured classroom 'interactional skills' sessions, as well as clinical encounters with real patients and an OSCE station calling upon communication skills. The Calgary Cambridge Observational Guides was used to evaluate students at different settings. RESULT This study observed 28 students and findings revealed that while in the classroom students were able to practise a broad range of communication skills, in contrast in the clinical environment, information-gathering and relationship-building with patients became the focus of their encounters with patients. In the OSCEs, limited time and high-pressure scenarios caused the students to rush to complete the task which focussed solely on information-gathering and/or explanation, diminishing opportunity for rapport-building with the patient. CONCLUSION These findings indicate a poor alignment that can develop between the skills practiced across learning environments. Further research is needed to investigate the development and application of students' skills over the long term to understand supports for and barriers to effective teaching and learning of communication skills in different learning environments.
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Affiliation(s)
- Sari Puspa Dewi
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jatinangor Km. 21 Sumedang West Java, Bandung, Indonesia.
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia.
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
| | - Amanda Wilson
- School of Nursing and Midwifery, The University of Technology Sydney, Ultimo, Australia
| | - Robbert Duvivier
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Center for Education Development and Research in Health Professions (CEDAR), Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brian Kelly
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
| | - Conor Gilligan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Durning SJ, Jung E, Kim DH, Lee YM. Teaching clinical reasoning: principles from the literature to help improve instruction from the classroom to the bedside. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:145-155. [PMID: 38835308 DOI: 10.3946/kjme.2024.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024]
Abstract
Clinical reasoning has been characterized as being an essential aspect of being a physician. Despite this, clinical reasoning has a variety of definitions and medical error, which is often attributed to clinical reasoning, has been reported to be a leading cause of death in the United States and abroad. Further, instructors struggle with teaching this essential ability which often does not play a significant role in the curriculum. In this article, we begin with defining clinical reasoning and then discuss four principles from the literature as well as a variety of techniques for teaching these principles to help ground an instructors' understanding in clinical reasoning. We also tackle contemporary challenges in teaching clinical reasoning such as the integration of artificial intelligence and strategies to help with transitions in instruction (e.g., from the classroom to the clinic or from medical school to residency/registrar training) and suggest next steps for research and innovation in clinical reasoning.
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Affiliation(s)
- Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, MD, USA
| | - Eulho Jung
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, MD, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Do-Hwan Kim
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
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McQuade CN, Simonson MG, Lister J, Olson APJ, Zwaan L, Rothenberger SD, Bonifacino E. Characteristics differentiating problem representation synthesis between novices and experts. J Hosp Med 2024; 19:468-474. [PMID: 38528679 DOI: 10.1002/jhm.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Formulating a thoughtful problem representation (PR) is fundamental to sound clinical reasoning and an essential component of medical education. Aside from basic structural recommendations, little consensus exists on what characterizes high-quality PRs. OBJECTIVES To elucidate characteristics that distinguish PRs created by experts and novices. METHODS Early internal medicine residents (novices) and inpatient teaching faculty (experts) from two academic medical centers were given two written clinical vignettes and were instructed to write a PR and three-item differential diagnosis for each. Deductive content analysis described the characteristics comprising PRs. An initial codebook of characteristics was refined iteratively. The primary outcome was differences in characteristic frequencies between groups. The secondary outcome was characteristics correlating with diagnostic accuracy. Mixed-effects regression with random effects modeling compared case-level outcomes by group. RESULTS Overall, 167 PRs were analyzed from 30 novices and 54 experts. Experts included 0.8 fewer comorbidities (p < .01) and 0.6 more examination findings (p = .01) than novices on average. Experts were less likely to include irrelevant comorbidities (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2-0.8) or a diagnosis (OR = 0.3, 95% CI = 0.1-0.8) compared with novices. Experts encapsulated clinical data into higher-order terms (e.g., sepsis) than novices (p < .01) while including similar numbers of semantic qualifiers (SQs). Regardless of expertise level, PRs following a three-part structure (e.g., demographics, temporal course, and clinical syndrome) and including temporal SQs were associated with diagnostic accuracy (p < .01). CONCLUSIONS Compared with novices, expert PRs include less irrelevant data and synthesize information into higher-order concepts. Future studies should determine whether targeted educational interventions for PRs improve diagnostic accuracy.
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Affiliation(s)
- Casey N McQuade
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael G Simonson
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Julia Lister
- Division of Hospital Medicine, Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
- Division of Hospital Medicine, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Andrew P J Olson
- Division of Hospital Medicine, Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
- Division of Hospital Medicine, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Laura Zwaan
- Erasmus Medical Center, Institute of Medical Education Research Rotterdam, Rotterdam, the Netherlands
| | - Scott D Rothenberger
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Eliana Bonifacino
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Sewell JL. Cognitive Load in the ICU. Chest 2024; 165:1286-1287. [PMID: 38852962 DOI: 10.1016/j.chest.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Justin L Sewell
- Department of Medicine, Division of Gastroenterology, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
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Moelans CB, Geerling JJ, Radersma RD, Moons MJ, van Diest PJ, van der Schaaf MF. Biomedical students' satisfaction with and engagement in laboratory e-learning support are related to their self-regulation. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2024; 52:262-275. [PMID: 38270246 DOI: 10.1002/bmb.21810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/25/2023] [Accepted: 12/30/2023] [Indexed: 01/26/2024]
Abstract
Laboratory e-learning support tools can assist students' learning while preparing for laboratory classes. To successfully work in such virtual experimental environments (VEEs) outside class, students require self-regulated learning (SRL) skills. A deeper understanding of the continuous reciprocal interactions between SRL, satisfaction, and online engagement is needed to develop more effective online learning experiences. This study therefore aimed to explore the interconnection between students' satisfaction with, effort/importance and engagement in an exemplary VEE, and to relate this to their perceived SRL and learning outcomes. Based on surveys in 79 university students, SRL was related to VEE engagement, effort/importance, and satisfaction. VEE engagement and satisfaction were not related to learning outcomes, while SRL and effort were. Students with different SRL also tended to interact differently with the VEE and experienced differing degrees of procedural and feedback support by the e-environment. We conclude that, for optimal learning experience and outcomes, students' effort regulation and SRL need to be supported while interacting with the VEE, preferably by interventions that integrate personalized and adaptive features. This study has implications for designing and optimizing VEEs and indicates that future research should focus on VEEs taking students' SRL and effort regulation into account to support individual learners effectively.
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Affiliation(s)
- C B Moelans
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Geerling
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R D Radersma
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J Moons
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M F van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Mullikin DR, Flanagan RP, Merkebu J, Durning SJ, Soh M. Physiologic measurements of cognitive load in clinical reasoning. Diagnosis (Berl) 2024; 11:125-131. [PMID: 38282337 DOI: 10.1515/dx-2023-0143] [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: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Cognitive load is postulated to be a significant factor in clinical reasoning performance. Monitoring physiologic measures, such as heart rate variability (HRV) may serve as a way to monitor changes in cognitive load. The pathophysiology of why HRV has a relationship to cognitive load is unclear, but it may be related to blood pressure changes that occur in a response to mental stress. METHODS Fourteen residents and ten attendings from Internal Medicine wore Holter monitors and watched a video depicting a medical encounter before completing a post encounter form used to evaluate their clinical reasoning and standard psychometric measures of cognitive load. Blood pressure was obtained before and after the encounter. Correlation analysis was used to investigate the relationship between HRV, blood pressure, self-reported cognitive load measures, clinical reasoning performance scores, and experience level. RESULTS Strong positive correlations were found between increasing HRV and increasing mean arterial pressure (MAP) (p=0.01, Cohen's d=1.41). There was a strong positive correlation with increasing MAP and increasing cognitive load (Pearson correlation 0.763; 95 % CI [; 95 % CI [-0.364, 0.983]). Clinical reasoning performance was negatively correlated with increasing MAP (Pearson correlation -0.446; 95 % CI [-0.720, -0.052]). Subjects with increased HRV, MAP and cognitive load were more likely to be a resident (Pearson correlation -0.845; 95 % CI [-0.990, 0.147]). CONCLUSIONS Evaluating HRV and MAP can help us to understand cognitive load and its implications on trainee and physician clinical reasoning performance, with the intent to utilize this information to improve patient care.
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Affiliation(s)
- Dolores R Mullikin
- Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, USA
| | - Ryan P Flanagan
- Department of Pediatric Cardiology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Jerusalem Merkebu
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
| | - Steven J Durning
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
| | - Michael Soh
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
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Zhang X, Vanstone RJ, Turbitt L, West S, Harty E. Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis. Br J Anaesth 2024; 132:1073-1081. [PMID: 38448267 DOI: 10.1016/j.bja.2024.01.032] [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: 10/20/2023] [Revised: 01/06/2024] [Accepted: 01/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Regional anaesthesia plays an important role in perioperative care, but gaps in proficiency persist among consultants and specialists. This study aimed to assess confidence levels in performing Plan A blocks among this cohort and to examine the barriers and facilitators influencing regional anaesthesia education. METHODS Utilising a mixed-methods design, we performed a quantitative survey to gauge self-reported confidence in performing Plan A blocks, coupled with qualitative interviews to explore the complexities of educational barriers and facilitators. UK consultant and specialist anaesthetists were included in the study. RESULTS A total of 369 survey responses were analysed. Only 22% of survey respondents expressed confidence in performing all Plan A blocks. Specialists (odds ratio [OR] 0.391, 95% confidence interval [CI] 0.179-0.855, P=0.016) and those in their roles for >10 yr (OR 0.551, 95% CI 0.327-0.927, P = 0.024) reported lower confidence levels. A purposive sample was selected for interviews, and data saturation was reached at 31 interviews. Peer-led learning emerged as the most effective learning modality for consultants and specialists. Barriers to regional anaesthesia education included apprehensions regarding complications, self-perceived incompetence, lack of continuing professional development time, insufficient support from the multidisciplinary team, and a lack of inclusivity within the regional anaesthesia community. Organisational culture had a substantial impact, with the presence of local regional anaesthesia champions emerging as a key facilitator. CONCLUSIONS This study highlights persistent perceived deficiencies in regional anaesthesia skills among consultants and specialists. We identified multiple barriers and facilitators, providing insights for targeted interventions aimed at improving regional anaesthesia education in this group.
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Affiliation(s)
- Xiaoxi Zhang
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK; Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK. https://twitter.com/xiaoxi_6
| | - Ross J Vanstone
- Department of Anaesthesia, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Simeon West
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eoin Harty
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
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Wolford GW, Wash EJ, Stowers MP, McMillon AR, LaCroix AN. The Acquisition of Static and Dynamic Intervention Skills by Graduate Speech-Language Pathology Students. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1524-1535. [PMID: 38477644 DOI: 10.1044/2024_ajslp-23-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
PURPOSE Speech-language pathology programs use simulated learning experiences (SLEs) to teach graduate student clinicians about fidelity to therapeutic interventions, including static skills (clinical actions that are delivered in a prespecified way regardless of the client's behavior) and dynamic skills (contingent responses formulated in response to a client's behavior). The purpose of this study was to explore student learning of static and dynamic skills throughout SLEs and live clinical practice. METHOD Thirty-three speech-language pathology graduate students participated in this study. Students were first trained to deliver an intervention before having their treatment fidelity measured at three time points: an initial SLE, actual clinical practice, and a final SLE. Treatment fidelity was first summarized using an overall accuracy score and then separated by static and dynamic skills. We hypothesized that (a) overall accuracy would increase from the initial simulation to treatment but remain steady from treatment to the final simulation and that (b) students would acquire dynamic skills more slowly than static skills. RESULTS In line with our hypotheses, students' overall accuracy improved over time. Although accuracy for static skills was mostly established after the first simulation, dynamic skills remained less accurate, with a slower acquisition timeline. CONCLUSIONS These results demonstrate that SLEs are efficacious in teaching students the clinical skills needed for actual clinical practice. Furthermore, we show that dynamic skills are more difficult for students to learn and implement than static skills, which suggests the need for greater attention to dynamic skill acquisition during clinical education.
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Affiliation(s)
- George W Wolford
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, Boone, NC
| | - Ethan J Wash
- College of Health Sciences, Midwestern University, Glendale, AZ
| | | | | | - Arianna N LaCroix
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN
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Laxton V, Maratos FA, Hewson DW, Baird A, Archer S, Stupple EJN. Effects of colour-coded compartmentalised syringe trays on anaesthetic drug error detection under cognitive load. Br J Anaesth 2024; 132:911-917. [PMID: 38336517 PMCID: PMC11103169 DOI: 10.1016/j.bja.2023.12.033] [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: 09/21/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Anaesthetic drug administration is complex, and typical clinical environments can entail significant cognitive load. Colour-coded anaesthetic drug trays have shown promising results for error identification and reducing cognitive load. METHODS We used experimental psychology methods to test the potential benefits of colour-coded compartmentalised trays compared with conventional trays in a simulated visual search task. Effects of cognitive load were also explored through an accompanying working memory-based task. We hypothesised that colour-coded compartmentalised trays would improve drug-detection error, reduce search time, and reduce cognitive load. This comprised a cognitive load memory task presented alongside a visual search task to detect drug errors. RESULTS All 53 participants completed 36 trials, which were counterbalanced across the two tray types and 18 different vignettes. There were 16 error-present and 20 error-absent trials, with 18 trials presented for each preloaded tray type. Syringe errors were detected more often in the colour-coded trays than in the conventional trays (91% vs 83%, respectively; P=0.006). In signal detection analysis, colour-coded trays resulted in more sensitivity to the error signal (2.28 vs 1.50, respectively; P<0.001). Confidence in response accuracy correlated more strongly with task performance for the colour-coded tray condition, indicating improved metacognitive sensitivity to task performance (r=0.696 vs r=0.447). CONCLUSIONS Colour coding and compartmentalisation enhanced visual search efficacy of drug trays. This is further evidence that introducing standardised colour-coded trays into operating theatres and procedural suites would add an additional layer of safety for anaesthetic procedures.
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Affiliation(s)
| | - Frances A Maratos
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - David W Hewson
- Department of Anaesthesia, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Baird
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Stephanie Archer
- Department of Psychology, University of Cambridge, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Edward J N Stupple
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK.
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Baig S, Al-Bedaery R, Togher C, De Oliveira JPW, Asim N. What guides student learning in the clinical years: A mixed methods study exploring study behaviours prior to the UK Medical Licensing Assessment (UKMLA). MEDICAL TEACHER 2024:1-8. [PMID: 38648499 DOI: 10.1080/0142159x.2024.2337246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Student study behaviours that prioritise the UKMLA content map over the local curriculum are a significant risk for UK medical education. To mitigate this, we describe a student-centred faculty process to improve local curriculum guidance based on an evaluation of student study behaviours, concerns and needs. Responses informed the build of an online curriculum map. METHODS A mixed methods approach was adopted, including an online anonymous survey exploring student study behaviours and preferences for curricular guidance. This was followed by student-led focus groups to explore emergent themes further. Qualitative data underwent reflexive thematic analysis. RESULTS 121 students responded to the survey, of which 12 consented to participate in two student-led focus groups. Five key themes emerged, including motivation for learning, student use of the intended curriculum, student experience of the enacted curriculum, the hidden curriculum, and expectations of an online curriculum map. CONCLUSIONS A participatory framework enabled shared aims and responsive outcomes for curricular development in the run up to the UKMLA. Student responses led to clarification of guidance, reorganisation of learning resources and optimal design of an online curriculum map which linked all content in a visible, UKMLA aligned framework, accessible to all students and teachers.
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Affiliation(s)
- Shehla Baig
- Institute of Medical and Biomedical Education, St George's University of London, UK
| | - Roaa Al-Bedaery
- Institute of Medical and Biomedical Education, St George's University of London, UK
| | - Connor Togher
- Medical School, St George's University of London, UK
| | | | - Naireen Asim
- Medical School, St George's University of London, UK
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Penner JC, Schuwirth L, Durning SJ. From Noise to Music: Reframing the Role of Context in Clinical Reasoning. J Gen Intern Med 2024; 39:851-857. [PMID: 38243110 PMCID: PMC11043232 DOI: 10.1007/s11606-024-08612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Affiliation(s)
- John C Penner
- Department of Medicine, University of California, San Francisco, CA, USA.
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Lambert Schuwirth
- Prideaux Discipline of Clinical Education, Flinders University, Adelaide, SA, Australia
| | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Skov RAC, Lawaetz J, Stroem M, Van Herzeele I, Resch TA, Eiberg JP. Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment. Eur J Vasc Endovasc Surg 2024; 67:672-680. [PMID: 37979611 DOI: 10.1016/j.ejvs.2023.11.016] [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: 06/22/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) is being used increasingly for the treatment of infrarenal abdominal aortic aneurysms. Improvement in educational strategies is required to teach future vascular surgeons EVAR skills, but a comprehensive, pre-defined e-learning and simulation curriculum remains to be developed and tested. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), an assessment tool for simulation based education (SBE) in EVAR, has previously been designed to assess EVAR skills, and a pass limit defining mastery level has been set. However, EVARATE was developed for anonymous video ratings in a research setting, and its feasibility for real time ratings in a standardised SBE programme in EVAR is unproven. This study aimed to test the effect of a newly developed simulation based modular course in EVAR. In addition, the applicability of EVARATE for real time performance assessments was investigated. METHODS The European Society of Vascular Surgery (ESVS) and Copenhagen Certification Programme in EVAR (ENHANCE-EVAR) was tested in a prospective cohort study. ENHANCE-EVAR is a modular SBE programme in EVAR consisting of e-learning and hands-on SBE. Participants were rated with the EVARATE tool by experienced EVAR surgeons. RESULTS Twenty-four physicians completed the study. The mean improvement in EVARATE score during the course was +11.8 (95% confidence interval 9.8 - 13.7) points (p < .001). Twenty-two participants (92%) passed with a mean number of 2.8 ± 0.7 test attempts to reach the pass limit. Cronbach's alpha coefficient was 0.91, corresponding to excellent reliability of the EVARATE scale. Differences between instructors' EVARATE ratings were insignificant (p = .16), with a maximum variation between instructors of ± 1.3 points. CONCLUSION ENHANCE-EVAR, a comprehensive certifying EVAR course, was proven to be effective. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE) is a trustworthy tool for assessing performance within an authentic educational setting, enabling real time feedback.
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Affiliation(s)
- Rebecca A C Skov
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Michael Stroem
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Timothy A Resch
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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Atiomo W, Ennab F, Stanley A, Ezimokhai M. Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory. Front Med (Lausanne) 2024; 11:1304417. [PMID: 38590321 PMCID: PMC10999601 DOI: 10.3389/fmed.2024.1304417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.
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Affiliation(s)
- William Atiomo
- College of Medicine, Dubai Healthcare City, Mohammed Bin Rashid University (MBRU) of Medicine and Health Sciences, Dubai, United Arab Emirates
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Hung CT, Wu SE, Chen YH, Soong CY, Chiang CP, Wang WM. The evaluation of synchronous and asynchronous online learning: student experience, learning outcomes, and cognitive load. BMC MEDICAL EDUCATION 2024; 24:326. [PMID: 38519950 PMCID: PMC10960437 DOI: 10.1186/s12909-024-05311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The abrupt onset of the COVID-19 pandemic compelled universities to swiftly establish online teaching and learning environments that were not only immediately deployable but also conducive to high-quality education. This study aimed to compare the effectiveness of the online synchronous and asynchronous teaching formats in the dermatology lecture for undergraduate medical students, including academic performance, self-efficacy, and cognitive load. METHODS A total of 170 fourth-year undergraduate medical students attending the dermatology lecture were included. The lecture was delivered using both the synchronous method (live online lecture via Webex meeting) and the asynchronous method (lecture videos shared on YouTube). The students had the freedom to choose their preferred method of attending the online lecture. The study assessed three main aspects: (1) learning outcomes measured through pretest, posttest, and retention test scores; (2) cognitive load experienced by students, including mental load and mental effort measured using eight items; and (3) satisfaction levels with each online teaching format. RESULTS In this study, 70 students opted for the synchronous online lecture, while 100 students chose the asynchronous online lecture. Both synchronous and asynchronous teaching methods exhibited significant improvements in post and retention test scores compared to the pretest. Satisfaction levels, rated on a scale of 0-5, were generally high for both teaching methods, with no significant differences observed (4.6 for synchronous, 4.53 for asynchronous; p =.350). Regarding cognitive load, the synchronous method showed a significantly lower level than the asynchronous method (p =.0001). Subgroup analysis revealed no difference in mental effort (p =.0662), but the level of mental load was lower in the synchronous method (p =.0005). CONCLUSIONS Both synchronous and asynchronous online teaching methods demonstrated improvements in learning outcomes and high levels of student satisfaction. However, the cognitive load experienced by students was lower in the synchronous setting compared to the asynchronous setting. These findings remind health professions educators that they would consider the students' cognitive load when designing online curricula.
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Affiliation(s)
- Chih-Tsung Hung
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Shou-En Wu
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan
| | - Yi-Hsien Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan
| | - Chen-Yeu Soong
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan
| | - Chien-Ping Chiang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., 114, Taipei, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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Wubshet H, Agegnehu AF, Workie MM, Addisu Y. Perception of the operation theater learning environment and related factors among anesthesia students in Ethiopian higher education teaching hospitals: a multicenter cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:303. [PMID: 38504241 PMCID: PMC10949678 DOI: 10.1186/s12909-024-05320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Operation theater learning involves three key elements: clinical work, learning, and the environment. There is little evidence regarding the operating theatre learning environment for anesthesia trainees. Identifying the overall perception of the operation theater learning environment helps to establish an efficient operation theater learning environment and produce competent anesthesia professionals. OBJECTIVE The aim of this study was to assess the perceptions of the operating theater learning environment and associated factors among undergraduate anesthesia students in Ethiopian higher education teaching hospitals from April to May 2023. METHODS A multicenter cross-sectional study was conducted on 313 undergraduate anesthesia students who began operation room clinical practice at 13 higher education teaching hospitals. The data were entered into EpiData version 4.6. A generalized ordered logistic regression model was used to analyze and identify factors associated with the operating theater learning environment using STATA software version MP17. RESULTS The findings of this study revealed that 45.05%,26.52%), 23% and 5.43% of the participants reported having desirable, moderately desirable, very desirable and undesirable perceptions of the operating theater learning environment, respectively, from highest to lowest. Preoperative discussion (AOR = 4.98 CI = 1.3-18.8), lack of teaching facilities (AOR = 0.16 CI = 0.03-0.75), noise from played music (AOR = 0.22 CI = 0.07-0.63), absence of tutors (AOR = 0.03 CI = 0.01-0.22), respect for students (AOR = 3.44 CI = 1.6-7.2), roll modeling for students (AOR = 3.23 CI = 1.5-6.8) and strict supervision of students (AOR = 0.24 CI = 0.07-0.88) were significantly associated with perceptions of the operation theater learning environment, with 95% CIs. CONCLUSION No study participant agreed that the operation theater learning environment in operation theatres was very undesirable. A lack of teaching facilities at the OR, a lack of tutors from the OR, noise from played music in the OR, a tutor respecting their student, a tutor role model for their student, a preoperative discussion with a tutor and strict supervision of the student are strongly associated with the operation theatre learning environment.
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Affiliation(s)
- Habtemariam Wubshet
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abatneh Feleke Agegnehu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Mengie Workie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yonas Addisu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Han Z, Barton KC, Ho LC, Yap KZ, Tan DSY, Lee SS, Neo CXR, Tan AHL, Boey BMY, Soon CJY, Gallagher PJ. Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:292. [PMID: 38491363 PMCID: PMC10943898 DOI: 10.1186/s12909-024-05254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students. METHODS Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy- Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach. RESULTS There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation. CONCLUSION This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.
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Affiliation(s)
- Zhe Han
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore.
| | - Keith C Barton
- Department of Curriculum and Instruction, School of Education, Indiana University, 201 N. Rose Avenue, 47405, Bloomington, IN, USA
| | - Li-Ching Ho
- Department of Curriculum and Instruction, School of Education, University of Wisconsin- Madison, 225 N. Mills Street, 53706, Madison, WI, USA
| | - Kai Zhen Yap
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Doreen Su-Yin Tan
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Shuh Shing Lee
- Center for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore, Singapore
| | - Constance Xue Rui Neo
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore, Singapore
| | - Amanda Han Lin Tan
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Brian Ming Yao Boey
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Charis Jia Yan Soon
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Paul J Gallagher
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
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Gammon J, Hunt J, Duffy L, Humphreys I, Hinkin J, Watkins A. Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy. J Infect Prev 2024; 25:3-10. [PMID: 38362116 PMCID: PMC10866124 DOI: 10.1177/17571774231224695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/08/2023] [Indexed: 02/17/2024] Open
Abstract
Background Hand hygiene and its significance for reducing the spread of infection is well evidenced and has been brought into sharp focus following the COVID-19 pandemic. Although a crucial clinical skill in ensuring safe healthcare, little is known regarding nursing students' effectiveness of hand hygiene practice. Aim The aim of this study was to evaluate the impact of an educational intervention on hand hygiene practice, designed by the research team for first year pre-registration nursing students. Particular emphasis was placed upon hand drying technique and time. Methodology 825 nursing students were observed and assessed for their hand hygiene practice in a clinical suite at a university setting. Nursing students were observed for compliance against set outcome measures involving hand hygiene preparation, hand and wrist washing technique, hand drying technique and time. Data were analysed quantitatively using SPSS. Results The educational intervention had a significant impact on the clinical skills learning of nursing students. 779 students passed the assessment at the first attempt (94.4%). Of the 46 students that failed to meet the necessary criteria, 45 satisfied the criteria at the second attempt; giving an overall optimal compliance of 99.9%. 99.6% of students complied with recommended hand drying standards. Conclusion This study offers an important contribution to the development and delivery of nursing education programmes. The educational intervention improved compliance with recommended hand hygiene technique and practice. Lack of attention to hand drying may negate effective hand hygiene in healthcare.
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Affiliation(s)
- John Gammon
- School of Health and Social Care, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Julian Hunt
- School of Health and Social Care, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Duffy
- Department of Nursing, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Ioan Humphreys
- Health and Wellbeing Academy, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Jon Hinkin
- Department of Nursing, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Alan Watkins
- Biomedical Sciences, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
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Spijkerman S, Manning DM, Green-Thompson LP. Undergraduate Anesthesia Skills for a Global Surgery Agenda: Students' Self-Reported Competence. Anesth Analg 2024; 138:616-625. [PMID: 36888537 DOI: 10.1213/ane.0000000000006375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Safe anesthesia is imperative for the Global Surgery agenda and Sustainable Development Goal 3. Due to a shortage of specialists in South Africa (SA), anesthetic services are often provided by nonspecialist doctors, often newly qualified and frequently without immediate supervision. The burden of disease in the developing world demands fit-for-purpose, day-one medical graduates. Although undergraduate anesthesia training is mandatory for medical students in SA, no outcomes are specified, and these are decided autonomously at each medical school. This study describes the current self-perceived anesthetic competence of medical students in SA as a needs assessment directed at achieving the goals of Global Surgery in SA and other developing countries. METHODS In this cross-sectional observational study, 1689 students (89% participation rate), representing all medical schools in SA, rated their self-perceived competence at graduation in 54 anesthetic-related Likert scale items in 5 themes: patient evaluation, patient preparation for anesthesia, practical skills performance, administration of anesthesia, and the management of intraoperative complications. Medical schools were divided into clusters A (≥25 days of anesthetic training) and B (<25 days). Descriptive statistics, Fisher exact test, and a mixed-effects regression model were used in the statistical analysis. RESULTS Students felt more prepared for history-taking and patient examination than for managing emergencies and complications. The self-perceived competence of students at cluster A schools was higher across all 54 items and all 5 themes. The same was observed for general medical skills and skills relating to maternal mortality in SA. CONCLUSIONS Time-on-task, capacity for repetition, and student maturity might have impacted self-efficacy and should be considered in curriculum development. Students felt less prepared for emergencies. Focused training and assessment aimed at emergency management should be considered. Students did not feel competent in general medical areas, in which anesthetists are experts, including resuscitation, fluid management, and analgesia. Anesthetists should take ownership of this training at the undergraduate level. Cesarean delivery is the most performed surgical procedure in sub-Saharan Africa. The Essential Steps in Managing Obstetric Emergencies (ESMOE) program was designed for internship training but can be introduced at undergraduate level. This study suggests that curriculum reform is required. The achievement of an agreed-upon set of standardized national undergraduate anesthetic competencies may ensure fit-for-purpose practitioners. Undergraduate and internship training should align to form part of a continuum of basic anesthetics training in SA. The findings of this study might benefit curriculum development in other regions with similar contexts.
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Kelkar A, Natarajan S, Kothari A, Bolisetty M. Comparison of cognitive workload and surgical outcomes between a three-dimensional and conventional microscope macular hole surgery. BMC Ophthalmol 2024; 24:95. [PMID: 38429711 PMCID: PMC10908162 DOI: 10.1186/s12886-024-03361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Performing a surgical task subjects the surgeon to multitudinal stressors, especially with the newer 3D technology. The quantum of cognitive workload using this modern surgical system in comparison to the Conventional microscope system remains unexplored. We evaluate the surgeon's cognitive workload and the surgical outcomes of macular hole(MH) surgery performed on a 3D versus a Conventional microscope operating system. METHODS 50 eyes of 50 patients with MH undergoing surgery using the 3D or Conventional microscope visualization system. Cognitive workload assessment was done by real-time tools(Surgeons' heart rate [HR] and oxygen saturation[SPO2]) and self-report tool(Surgery Task Load Index[SURG-TLX] questionnaire) of three Vitreoretinal surgeons. Based on the SURG-TLX questionnaire, an assessment of the workload was performed. RESULTS Of the 50 eyes, 30 eyes and 20 eyes underwent surgery with the Conventional microscope and the 3D system, respectively. No difference was noted in the MH basal-diameter(p = 0.128), total surgical-duration(p = 0.299), internal-limiting membrane(ILM) peel time(p = 0.682), and the final visual acuity (VA; p = 0.515) between the two groups. Both groups showed significant improvement in VA(p < 0.001) with a 90% closure rate at one-month post-surgery. Cognitive workload comparison, the intraoperative HR(p = 0.024), total workload score(P = 0.005), and temporal-demand dimension(p = 0.004) were significantly more in Conventional microscope group as compared to 3D group. In both the groups, the HR increased significantly from the baseline while performing ILM peeling and at the end. CONCLUSION The surgeon's cognitive workload is markedly reduced while performing macular hole surgery with a 3D viewing system. Moreover, duration of surgery including ILM peel time, MH closure rates, and visual outcomes remains unaffected irrespective of the operating microscope system.
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Affiliation(s)
- Aditya Kelkar
- National Institute Of Ophthalmology, 1187/30, off Ghole road, near Phule Museum, 411005, Pune, Maharashtra, India.
| | | | - Akshay Kothari
- National Institute Of Ophthalmology, 1187/30, off Ghole road, near Phule Museum, 411005, Pune, Maharashtra, India
| | - Mounika Bolisetty
- National Institute Of Ophthalmology, 1187/30, off Ghole road, near Phule Museum, 411005, Pune, Maharashtra, India
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MacNeill H, Masters K, Nemethy K, Correia R. Online learning in Health Professions Education. Part 1: Teaching and learning in online environments: AMEE Guide No. 161. MEDICAL TEACHER 2024; 46:4-17. [PMID: 37094079 DOI: 10.1080/0142159x.2023.2197135] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Online learning in Health Professions Education (HPE) has been evolving over decades, but COVID-19 changed its use abruptly. Technology allowed necessary HPE during COVID-19, but also demonstrated that many HP educators and learners had little knowledge and experience of these complex sociotechnical environments. Due to the educational benefits and flexibility that technology can afford, many higher education experts agree that online learning will continue and evolve long after COVID-19. As HP educators stand at the crossroads of technology integration, it is important that we examine the evidence, theories, advantages/disadvantages, and pedagogically informed design of online learning. This Guide will provide foundational concepts and practical strategies to support HPE educators and institutions toward advancing pedagogically informed use of online HPE. This Guide consists of two parts. The first part will provide an overview of evidence, theories, formats, and educational design in online learning, including contemporary issues and considerations such as learner engagement, faculty development, inclusivity, accessibility, copyright, and privacy. The second part (to be published as a separate Guide) focuses on specific technology tool types with practical examples for implementation and integration of the concepts discussed in Guide 1, and will include digital scholarship, learning analytics, and emerging technologies. In sum, both guides should be read together, as Guide 1 provides the foundation required for the practical application of technology showcased in Guide 2.Please refer to the video abstract for Part 1 of this Guide at https://bit.ly/AMEEGuideOnlineLearning.
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Affiliation(s)
- Heather MacNeill
- Department of Medicine, Continusing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ken Masters
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Kataryna Nemethy
- Baycrest Academy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Raquel Correia
- Faculté de Médecine, Université Paris Cité, Paris, France
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Eroğlu FS, Erkan B, Koyuncu SB, Komşal ZR, Çiçek FE, Ülker M, Toklu ME, Atlan M, Kıyak YS, Kula S, Coşkun Ö, Budakoğlu Iİ. Effectiveness of using 2D atlas and 3D PDF as a teaching tool in anatomy lectures in initial learners: a randomized controlled trial in a medical school. BMC MEDICAL EDUCATION 2023; 23:962. [PMID: 38102632 PMCID: PMC10722710 DOI: 10.1186/s12909-023-04960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Anatomy is a crucial part of medical education, and there have been attempts to improve this field by utilizing various methods. With the advancement of technology, three-dimensional (3D) materials have gained popularity and become a matter of debate about their effectiveness compared to two-dimensional (2D) sources. This research aims to analyze the effectiveness of 3D PDFs compared to 2D atlases. METHODS This study is a randomized controlled trial involving 87 Year-1 and Year-2 medical students at Gazi University Faculty of Medicine, Turkey. The study was conducted in two steps. In Step-1, students were randomized to watch lecture videos on liver anatomy and male genitalia anatomy supplemented with either a 3D PDF (intervention group) or 2D atlas (control group) images. Following the video lectures, a test (immediate test) was administered. In Step-2, the same test (delayed test) was administered 10 days after the immediate test. The test scores were compared between the intervention and control groups. In addition to the descriptive analyses, Chi-square and Mann-Whitney U tests were performed. RESULTS In the immediate test, while there was no significant difference between the groups for the liver test (p > 0.05), 3D PDF group's scores (Median = 24.50) was significantly higher than the 2D atlas group's in the genitalia test (Median = 21.00), (p = 0.017). The effect size (Cohen's d) was 0.57. In the delayed test, there was no significant difference between the groups in the liver and genitalia tests (p > 0.05). However, the effect size in the immediate genitalia test was 0.40. Year-1 students' immediate test of genitalia performances were significantly higher in the 3D PDF group (Median = 24.00) than the 2D atlas group (Median = 19.00), (p = 0.016). The effect size was 0.76. Also, Year-1 students' 3D PDF group (Median = 20.50) presented with significantly higher performance than the 2D atlas group (Median = 12.00), (p = 0.044) in the delayed test of genitalia, with the 0.63 effect size. CONCLUSION 3D PDF is more effective than 2D atlases in teaching anatomy, especially to initial learners. It is particularly useful for teaching complex anatomical structures, such as male genitalia, compared to the liver. Hence, it may be a valuable tool for medical teachers to utilize during lectures.
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Affiliation(s)
| | - Beyza Erkan
- Gazi University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | - Melike Atlan
- Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yavuz Selim Kıyak
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, Beşevler, Ankara, 06500, Turkey.
| | - Serdar Kula
- Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özlem Coşkun
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, Beşevler, Ankara, 06500, Turkey
| | - Işıl İrem Budakoğlu
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, Beşevler, Ankara, 06500, Turkey
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Lumowa K, Lui KL, Daher N, Baek C, Tan LD, Alismail A. Evaluation of tracheostomy suctioning procedure among nursing and respiratory therapy students: wearable manikin vs. standard manikin. Front Med (Lausanne) 2023; 10:1220632. [PMID: 38131045 PMCID: PMC10734638 DOI: 10.3389/fmed.2023.1220632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction This study aims to evaluate cognitive load (CL), emotional levels (EL), and stress levels (SL) of students when using a wearable manikin vs. a standard manikin for tracheostomy suctioning (TS). Methods This study was approved by the Institutional Review Board. Subjects were recruited by email. Subjects completed a baseline demographics questionnaire, then they were randomized into two groups: wearable manikin group (WMG) or standard manikin group (SMG). For the WMG, an actor simulated a patient by wearing the device. In phase I, both groups were educated on how to perform TS by video and offered hands-on practice. Then I put through a tracheostomy suctioning clinical simulation and completed a post sim-survey. In phase II, the same survey was repeated after encountering a real patient as part of their clinical rotation. Results A total of 30 subjects with a mean age 26.0 ± 5.5 years participated. 20 (66.7%) were respiratory care students and 10 (33.3%) were nursing students. In the WMG, the median stress level dropped significantly post phase II compared to post phase I [2(1,4) vs.3(1,5), p = 0.04]. There were no significant changes in median CL, confidence, and satisfaction levels between post phase II and post phase I (p > 0.05). In the SMG, the satisfaction level increased significantly post phase II compared to post phase I [5(4,5) vs.4(2,5), p = 0.004], but there were no significant changes in CL, SL, and confidence levels between post phase I and phase II. There was no significant difference in mean EL scores over time and these changes did not differ by group. Subjects in the WMG showed a higher mean competency score than those in the SMG (85.5 ± 13.6 vs. 78.5 ± 20.8, p = 0.14, Cohen's d = 0.4), yet not significant. Conclusion Our results showed that the WMG is beneficial in helping bridge the gap of learning TS from the sim setting to the real-world clinical setting. More studies with higher sample size and use of other CL scales that assesses the different types of CL are needed to validate our findings.
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Affiliation(s)
- Kevin Lumowa
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, United States
| | - Kin Long Lui
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, United States
- Adventist Health White Memorial, Los Angeles, CA, United States
| | - Noha Daher
- Allied Health Studies, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, United States
| | - Caroline Baek
- School of Nursing, Loma Linda University Health, Loma Linda, CA, United States
| | - Laren D. Tan
- Department of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Health, Loma Linda, CA, United States
- Department of Medicine, School of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, United States
- Department of Medicine, School of Medicine, Loma Linda University Health, Loma Linda, CA, United States
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Wolfe RM, Hant FN, Ishizawar RC, Criscione-Schreiber LG, Jonas BL, O'Rourke KS, Bolster MB. Virtual Learning and Assessment in Rheumatology Fellowship Training: Objective Structured Clinical Examination Revisited. Arthritis Care Res (Hoboken) 2023; 75:2435-2441. [PMID: 37291752 DOI: 10.1002/acr.25170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE With the onset of the COVID-19 pandemic, an annual multi-institutional face-to-face rheumatology objective structured clinical examination (ROSCE) was transformed into a virtual format. The educational goals of the virtual ROSCE (vROSCE) were to reproduce the educational value of the previous in-person ROSCE, providing a valuable formative assessment of rheumatology training activities encompassing the 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies for fellows-in-training (FITs). This article describes the novel design, feasibility, and stakeholder value of a vROSCE. METHODS Through an established collaboration of 5 rheumatology fellowship training programs, in February 2021, a vROSCE was created and conducted using a Zoom platform. Station development included learning objectives, FIT instructions, faculty proctor instructions, and a checklist by which to provide structured formative feedback. An anonymous, optional web-based survey was sent to FIT participants to evaluate the experience. RESULTS Twenty-three rheumatology FITs from 5 institutions successfully rotated through 6 stations in the vROSCE. Immediate feedback was given to each FIT using standardized rubrics structured around ACGME core competencies. A total of 65% of FITs (15 of 23) responded to the survey, and 93% of survey respondents agreed or strongly agreed that the vROSCE was a helpful educational activity and identified individualized opportunities for improvement. CONCLUSION A vROSCE is an innovative, feasible, valuable, and well-received educational technology tool. The vROSCE enriched rheumatology FITs' education and offered collaborative learning experiences across institutions.
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Affiliation(s)
- Rachel M Wolfe
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Faye N Hant
- Medical University of South Carolina, Charleston
| | | | | | - Beth L Jonas
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Marcy B Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston
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