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Kim G, Issenberg SB, Roh YS. Factors Affecting Nursing Students' Reflective Thinking During Simulation Debriefing. Nurse Educ 2024; 49:E120-E125. [PMID: 37944146 DOI: 10.1097/nne.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear. PURPOSE This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students. METHODS This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking. RESULTS Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students. CONCLUSIONS Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing.
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Affiliation(s)
- Giyon Kim
- Author Affiliations: Professor (Dr Kim), Yonsei University, Wonju College of Nursing, Ilsan-ro, Wonjuju-si, Gangwon-do, Republic of Korea; Professor (Dr Issenberg), University of Miami Miller School of Medicine, Miami, Florida; and Professor (Dr Roh), Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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Lorello GR, Hodwitz K, Issenberg SB, Brydges R. Relinquishing control? Supervisor co-regulation may disrupt students' self-regulated learning during simulation-based training. Adv Health Sci Educ Theory Pract 2024; 29:9-25. [PMID: 37245197 DOI: 10.1007/s10459-023-10244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Kathryn Hodwitz
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Room 5-086, 209 Victoria St., Toronto, ON, M5B 1T8, Canada
| | - S Barry Issenberg
- Michael S Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Brydges
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Room 5-086, 209 Victoria St., Toronto, ON, M5B 1T8, Canada.
- Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Issenberg SB, Chandran L. Proceedings from the International Conference on the Future of Health Professions Education 2022. Med Teach 2024:1-5. [PMID: 38206903 DOI: 10.1080/0142159x.2023.2298757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Affiliation(s)
- S Barry Issenberg
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Latha Chandran
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
INTRODUCTION Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. METHODS This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. RESULTS PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. CONCLUSIONS The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.
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Affiliation(s)
- William C McGaghie
- Departments of Medical Education and Preventive Medicine and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Barry Issenberg
- Departments of Medicine and Medical Education and the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Song E, Issenberg SB, Roh YS. Effects of Prebriefing Using Online Team-Based Learning in Advanced Life Support Education for Nurses. Comput Inform Nurs 2023; 41:909-914. [PMID: 37580050 DOI: 10.1097/cin.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
An effective prebriefing strategy is needed that can improve the learning outcomes of nurses in advanced life support education. This study aimed to identify the effects of prebriefing with online team-based learning on hospital nurses' knowledge, performance, and self-efficacy in advanced life support education. A nonequivalent control group pretest-posttest design was adopted. Nurses in the experimental group (n = 26) participated in prebriefing using online team-based learning followed by self-directed learning, whereas nurses in the control group (n = 27) experienced only self-directed learning before advanced life support education. Wilcoxon signed-ranks tests were used to identify the posttest-pretest differences of the study variables in each group. Both groups showed improved knowledge, individual performance, and self-efficacy after the education. Nurses in the experimental group reported higher self-efficacy scores compared with those in the control group. There were no differences between the experimental and control groups in knowledge, individual performances, or team performance. Online team-based learning as a prebriefing modality resulted in greater improvements in self-efficacy in advanced life support education.
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Affiliation(s)
- Eunkyoung Song
- Author Affiliations: Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea (Ms Song); University of Miami Miller School of Medicine, FL (Dr Issenberg); Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea (Dr Roh)
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Chen YC, Issenberg SB, Chiu YJ, Chen HW, Issenberg Z, Kang YN, Lin CW, Wu JC. Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events. Med Teach 2023; 45:368-374. [PMID: 36288746 DOI: 10.1080/0142159x.2022.2137394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues. METHODS A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey. RESULTS During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event. CONCLUSIONS Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].
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Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Wen Chen
- NP, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | | | - Yi-No Kang
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Lin
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
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Roh YS, Jang KI, Issenberg SB. Gender Differences in Psychological Safety, Academic Safety, Cognitive Load, and Debriefing Satisfaction in Simulation-Based Learning. Nurse Educ 2022; 47:E109-E113. [PMID: 35324496 DOI: 10.1097/nne.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As there is an increasing trend in the number of male-identifying learners in undergraduate nursing education, a need exists to identify the gender differences in learners' perceptions regarding simulation-based learning. PURPOSE This study aimed to identify the gender differences in psychological safety, academic safety, cognitive load, and debriefing satisfaction in simulation-based nursing education. METHODS A cross-sectional descriptive survey was implemented with 97 female and 95 male nursing students. Data were analyzed using Mann-Whitney U tests or independent-samples t tests. RESULTS Female nursing students reported a lower academic safety and higher intrinsic load than male nursing students. Male nursing students perceived a higher germane load than female nursing students. CONCLUSIONS The significance of the present study was the identification of gender differences in participant perception of the simulation learning experience for effective simulation design.
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Affiliation(s)
- Young Sook Roh
- Professor (Roh), Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea; Professor (Jang), College of Nursing, The Kyungbok University, Namyangju-si, Gyeonggi-do, Republic of Korea; and Professor (Issenberg), University of Miami Miller School of Medicine, Miami, Florida
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Roh YS, Issenberg SB. Effects of a tiered competence-based simulation educator development program. Nurse Educ Pract 2022; 59:103300. [DOI: 10.1016/j.nepr.2022.103300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
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Chen YC, Issenberg SB, Issenberg Z, Chen HW, Kang YN, Wu JC. Factors associated with medical students speaking-up about medical errors: A cross-sectional study. Med Teach 2022; 44:38-44. [PMID: 34477475 DOI: 10.1080/0142159x.2021.1959904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Training medical students to speak up when they witness a potential error is an important competency for patient safety, but details regarding the barriers that prevent medical students from effectively communicating are lacking. Therefore, this study aimed at exploring the factors affecting medical students' willingness to speak up for patient safety when a medical error was observed. METHODS This is a cross-sectional study at a medical university in Taiwan, and 151 medical students in clinical clerkship completed a survey including demographic characteristics, conflict of interests/social relationship, personal capability, and personality and characteristics of senior staff domains. Data were analyzed using t-test. RESULTS Three of five items in the conflict of interests/social relationship domain showed statistically significant importance, including 'I am afraid of being punished' (Mean difference, MD = 0.37; p < 0.01), 'I do not want to break unspoken rules' (MD = 0.55; p < 0.01), and 'I do not want to have bad team relationship' (MD = 0.58; p < 0.01). Two items (perception of knowledge/understanding and communication skills) in the personal capability domain were significantly important to speaking up. Six of 10 items in personality and characteristics of senior staff domain were rated significantly important in deciding to speak up. The top three factors of them were senior personnel with 'Grumpy' personality (MD = 1.20; p < 0.01), 'hierarchy gap' (MD = 1.12; p < 0.01), and senior personnel with 'Stubborn' personality (MD = 1.06; p < 0.01). CONCLUSION Our findings demonstrated medical students' perspectives on barriers to speaking up in the event of medical error. Some factors related to characteristics of senior staff could compromise medical students' ability to speak up in the event of medical error. These results might be important for medical educators in designing personalized educational activities related to medical students' ability to speak up for patient safety.
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Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Medicine and Michael S. Gordon Chair of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Nursing and Health in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Continuing Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hui-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yi-No Kang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
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Ko Y, Issenberg SB, Roh YS. Effects of peer learning on nursing students' learning outcomes in electrocardiogram education. Nurse Educ Today 2022; 108:105182. [PMID: 34741917 DOI: 10.1016/j.nedt.2021.105182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nurses should have the ability to interpret electrocardiograms (ECGs) quickly and accurately, but their ECG interpretation skills may be suboptimal. The best evidence for effective teaching methods is lacking. OBJECTIVES This study aimed to compare the effects of peer and self-directed individual learning methods on nursing students' learning flow, interpretation skills, and self-confidence in web-based ECG education. DESIGN This study employed a nonequivalent control group with a pretest-posttest design. SETTINGS This study was conducted at two colleges of nursing in the Republic of Korea. PARTICIPANTS Nursing students were conveniently assigned to either a peer learning group (n = 45) or a self-directed individual learning group (n = 51). METHODS A self-administered questionnaire was used to measure the nursing students' learning flow and self-confidence in ECG rhythm interpretation. ECG interpretation skills were measured using a web-based interpretation skills test. Data were analyzed using a paired t-test and a two-sample t-test. RESULTS Nursing students in both groups showed improved learning flow, interpretation skills, and self-confidence after ECG education compared with before learning. However, there were no significant pretest-posttest differences in learning flow, interpretation skills, or self-confidence between the two groups. CONCLUSIONS Peer learning was as effective as self-directed individual learning in improving nursing students' learning flow, interpretations skills, and self-confidence in web-based education. Nurse educators should educate nursing students to have optimal ECG interpretation abilities, and web-based peer or individual learning are effective education methods.
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Affiliation(s)
- Youngmin Ko
- Graduate School of Nursing and Health Professions, Chung-Ang University, Seoul, Republic of Korea
| | | | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
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Ajmi SC, Kurz MW, Ersdal H, Lindner T, Goyal M, Issenberg SB, Vossius C. Cost-effectiveness of a quality improvement project, including simulation-based training, on reducing door-to-needle times in stroke thrombolysis. BMJ Qual Saf 2021; 31:569-578. [PMID: 34599087 DOI: 10.1136/bmjqs-2021-013398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rapid revascularisation in acute ischaemic stroke is crucial to reduce its total burden including societal costs. A quality improvement (QI) project that included streamlining the stroke care pathway and simulation-based training was followed by a significant reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes after stroke thrombolysis at our centre. Here, we present a retrospective cost-effectiveness analysis of the QI project. METHODS Costs for implementing and sustaining QI were assessed using recognised frameworks for economic evaluations. Effectiveness was calculated from previously published outcome measures. Cost-effectiveness was presented as incremental cost-effectiveness ratios including costs per minute door-to-needle time reduction per patient, and costs per averted death in the 13-month post-intervention period. We also estimated incremental cost-effectiveness ratios for a projected 5-year post-intervention period and for varying numbers of patients treated with thrombolysis. Furthermore, we performed a sensitivity analysis including and excluding costs of unpaid time. RESULTS All costs including fixed costs for implementing the QI project totalled US$44 802, while monthly costs were US$2141. We calculated a mean reduction in door-to-needle time of 13.1 min per patient and 6.36 annual averted deaths. Across different scenarios, the estimated costs per minute reduction in door-to-needle time per patient ranged from US$13 to US$29, and the estimated costs per averted death ranged from US$4679 to US$10 543. CONCLUSIONS We have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions.
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Affiliation(s)
- Soffien Chadli Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway .,Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Lindner
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - S Barry Issenberg
- The Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Corinna Vossius
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Hong HS, Issenberg SB, Roh YS. Effects of Standardized Patient-Based Training on Surgical Nurses' Competencies for Managing Hand Injuries. J Contin Educ Nurs 2021; 51:189-196. [PMID: 32232495 DOI: 10.3928/00220124-20200317-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The competence of nurses who care for patients with finger replantation is critical for positive patient outcomes. This study sought to identify the effects of standardized patient (SP)-based training on surgical ward nurses' knowledge, clinical performance, and self-efficacy regarding finger replantation. METHOD A wait-list control group with a crossover design was used for this study. Nurses were randomly assigned to group A (n = 10) or to the wait-list control group B (n = 10). Training consisted of a lecture, task training, and SP-based training. Knowledge, clinical performance, and self-efficacy data were collected at baseline, after the first intervention, and after 1 month at group crossover and second intervention. Data were analyzed using repeated measures ANOVA. RESULTS Nurses demonstrated greater knowledge, better clinical performance, and higher self-efficacy scores after the SP-based training. Following crossover, knowledge, clinical performance, and self-efficacy scores were retained 1 month after the training in group A. CONCLUSION SP-based training produced improvement and retention in knowledge, clinical performance, and self-efficacy. [J Contin Educ Nurs. 2020;51(4):189-196.].
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Griswold S, Uchida T, Issenberg SB, Motola I, McGaghie WC, Gisondi MA, Lorenz A, Barsuk JH. Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice. BMJ Simul Technol Enhanc Learn 2021; 7:457-458. [PMID: 35515745 PMCID: PMC8936733 DOI: 10.1136/bmjstel-2021-000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Abstract
Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team's voice and safety are important. Calls for personal, physical or patient safety should never be disregarded or met with retaliation.
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Affiliation(s)
- Sharon Griswold
- Department of Emergency Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Toshiko Uchida
- Departments of Medical Education and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - S Barry Issenberg
- Departments of Medical Education and Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ivette Motola
- Departments of Medical Education and Emergency Medicine of Miami Miller School of Medicine, Miami, Florida, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Miami, Florida, USA
| | - Michael A Gisondi
- Department of Emergency Medicine and The Precision Education and Assessment Research Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Amelia Lorenz
- Northwestern University Clinical Education Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Departments of Medical Education and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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van Zuilen MH, England JS, Sussman DA, Deshpande AR, Mechaber AJ, Issenberg SB, Lichtenheld MG. The Fallacy of Teaching and the Illusion of Learning: Improving Articulation of Basic Science in the Medical School Curriculum. Med Sci Educ 2020; 30:1735-1736. [PMID: 34457838 PMCID: PMC8368444 DOI: 10.1007/s40670-020-01075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 06/13/2023]
Abstract
Despite calls from educators to re-engineer how faculty deliver medical student curricula with integrated basic science concepts, this content is still frequently disarticulated from other curricular components. We renewed our curriculum using evidence-based pedagogical and cognitive learning strategies to interleave basic science across the 4-year curriculum.
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Mechaber AJ, Deshpande AR, Agarwal GG, Imm M, van Zuilen RM, Lichtstein DM, Issenberg SB, Gardner LB. University of Miami Leonard M. Miller School of Medicine. Acad Med 2020; 95:S123-S127. [PMID: 33626662 DOI: 10.1097/acm.0000000000003459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Caban-Martinez AJ, Schaefer-Solle N, Santiago K, Louzado-Feliciano P, Brotons A, Gonzalez M, Issenberg SB, Kobetz E. Epidemiology of SARS-CoV-2 antibodies among firefighters/paramedics of a US fire department: a cross-sectional study. Occup Environ Med 2020; 77:857-861. [PMID: 32764107 DOI: 10.1136/oemed-2020-106676] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We estimate the point seroprevalence of SARS-CoV-2 antibodies in the frontline firefighter/paramedic workforce of a South Florida fire department located in the epicentre of a State outbreak. METHODS A cross-sectional study design was used to estimate the point seroprevalence of SARS-CoV-2 antibodies using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay among frontline firefighters/paramedics collected over a 2-day period, 16-17 April 2020. Fire department personnel were emailed a survey link assessing COVID-19 symptoms and work exposures the day prior to the scheduled drive-through antibody testing at a designated fire station. Off-duty and on-duty firefighter/paramedic personnel drove through the fire station/training facility in their personal vehicles or on-duty engine/rescue trucks for SARS-CoV-2 antibody testing. RESULTS Among the 203 firefighters/paramedics that make up the fire department workforce, 18 firefighters/paramedics (8.9%) tested positive for SARS-CoV-2 antibodies, of which 8 firefighters/paramedics (3.9%) were IgG positive only, 8 (3.9%) were IgM positive only and 2 (0.1%) were IgG/IgM positive. The positive predictive value (PPV) of the serological test is estimated to be 33.2% and the negative predictive value is 99.3%. The average number of COVID-19 case contacts (ie, within 6 feet of an infected person (laboratory-confirmed or probable COVID-19 patient) for ≥15 min) experienced by firefighters/paramedics was higher for those with positive serology compared with those with negative (13.3 cases vs 7.31 cases; p=0.022). None of the antibody positive firefighters/paramedics reported receipt of the annual influenza vaccine compared with firefighters/paramedics who tested negative for SARS-CoV-2 antibodies (0.0% vs 21.0%; p=0.027). CONCLUSION Rapid SARS-CoV-2 IgM-IgG antibody testing documented early-stage and late-stage infection in a firefighter workforce providing insight to a broader medical surveillance project on return to work for firefighters/paramedics. Given the relatively low PPV of the serological test used in this study back in April 2020, caution should be used in interpreting test results.
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Affiliation(s)
- Alberto J Caban-Martinez
- Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA .,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Natasha Schaefer-Solle
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA.,Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Katerina Santiago
- Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Angel Brotons
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marco Gonzalez
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - S Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Erin Kobetz
- Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA.,Medicine, University of Miami School of Medicine, Miami, Florida, USA
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Dieckmann P, Birkvad Rasmussen M, Issenberg SB, Søreide E, Østergaard D, Ringsted C. Long-term experiences of being a simulation-educator: A multinational interview study. Med Teach 2018; 40:713-720. [PMID: 29793384 DOI: 10.1080/0142159x.2018.1471204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The long-term reactions, experiences and reflections of simulation educators have not been explored. In a semistructured, exploratory interview study, the experiences of simulation educators in either Advanced Life Support (ALS) or Crisis Resource Management (CRM) courses in Denmark, Norway and the USA were analyzed. Three overarching themes were identified: (1) general reflections on simulation-based teaching, (2) transfer of knowledge and skills from the simulation setting to clinical settings and (3) more overarching transformations in simulation educators, simulation participants, and the healthcare system. Where ALS was deemed as high on the efficiency dimension of learning, CRM courses were described as high on the innovation dimension. General reflections, transfer and transformations described were related to differences in course principles. The results are relevant for career planning, faculty development and understanding simulation as social practice.
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Affiliation(s)
- P Dieckmann
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - M Birkvad Rasmussen
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
| | - S B Issenberg
- c University of Miami Gordon Center for Simulation and Innovation in Medical Education , Miami , USA
| | - E Søreide
- d Stavanger University Hospital, Critical Care and Anesthesiology Research Group , Stavanger , Norway
- e Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - D Østergaard
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - C Ringsted
- f Center for Health Science Education , University of Aarhus , Aarhus , Denmark
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Motola I, Brotons AA, Rodriguez RD, Marulanda-Londoño ET, Li H, Hernandez S, Rivera HF, Schwemmer SL, Issenberg SB. Abstract WP232: Prospective Validation of the Miami Emergency Neurologic Deficit (MEND) Exam for Detection of Stroke. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Early detection and rapid transport to a stroke center are essential in the care of stroke patients. The Miami Emergency Neurologic Deficit (MEND) exam, developed in 1998, incorporates the posterior circulation elements missed by the Cincinnati Prehospital Stroke Scale (CPSS). It has a max score of 22, and includes all three components of the CPSS and six additional components from the National Institutes of Health Stroke Scale (NIHSS) (level of consciousness, orientation, commands, visual fields, gaze, leg motor, limb ataxia, and sensation). The MEND exam takes under two minutes to perform, and requires no tools, making it ideal as a screening tool, or for repeated examinations.
Purpose:
Determine the predictive value of the MEND exam completed by prehospital providers in the field for final diagnosis of stroke.
Methods:
We analyzed MEND exam findings conducted by paramedics on consecutive patients suspected of stroke, transferred directly from Monroe County, FL to our large urban academic hospital. We sought to determine the MEND’s ability, when administered by paramedics, to predict stroke or transient ischemic attack (TIA), based on the patient’s final diagnosis on hospital discharge. Statistical analysis was conducted using SAS, v.9.3. Receiver operating characteristic curves, sensitivity, specificity, positive predictive value and negative predictive value were determined.
Results:
From September 2008 to June 2017, 143 patients presenting to EMS had MEND exams completed. Eighty-one percent (n=57) were males. Mean age was 68 (21-98). The average MEND score was 5 (range 0-14). Of 101 strokes, 89 were ischemic (88%) and 12 hemorrhagic (12%). Area under the curve for MEND exam predictability for final diagnosis of stroke or TIA was 0.82 (95% CI 0.73-0.91). The sensitivity, specificity, PPV and NPV for different cut-offs of the MEND exam are: MEND ≥2: 94%, 59%, 0.84, 0.81; MEND ≥3: 84%, 69%, 0.87, 0.64; MEND ≥4: 64%, 78%, 0.87, 0.47.
Conclusion:
The MEND exam, completed in the prehospital setting by paramedics, is an effective screening tool for detecting stroke. Since the MEND includes components excluded in other commonly used screening exams, and can be completed quickly, it is a valuable tool for assessing stroke patients.
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Affiliation(s)
| | | | | | | | - Hua Li
- Biostatistics, Univ of Miami Sch of Med, Miami, FL
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Motola I, Brotons AA, Rodriguez RD, Marulanda-Londoño E, Carter S, Li H, Issenberg SB. Abstract WP222: Predictive Value of the Miami Emergency Neurologic Deficit (MEND) Exam for Detecting Large Vessel Occlusion Strokes. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The Miami Emergency Neurologic Deficit (MEND) exam is a screening tool for identifying stroke patients in the field. It is rapid, and can detect both anterior and posterior circulation strokes. Recent developments in the care of ischemic stroke patients with large vessel occlusion (LVO) have highlighted the need to transport these patients to comprehensive stroke centers (CSC) with neurointerventional capabilities. This field triage requires a screening tool that can rapidly and accurately identify LVO patients.
Purpose:
Determine the predictive value of the MEND exam for detecting LVO stroke, when completed by prehospital providers in the field.
Methods:
We analyzed MEND exam findings conducted by paramedics on patients suspected of stroke, who were airlifted to our CSC. We sought to determine the MEND’s ability, when administered by paramedics, to identify LVO, based on imaging (CT/CTA or MRA) or findings on intervention. Large vessel occlusion was defined as a total occlusion of the ICA, MCA-M1, MCA-M2, ACA-A1, ACA-A2, BA, VA, PCA-P1, or PCA-P2. Statistical analysis was conducted using SAS, v.9.3. Receiver operating characteristic curves, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
Results:
From September 2008 to June 2017, 143 patients had MEND exams completed. Of these, 121 were airlifted to a CSC, where they had the NIHSS performed. The mean MEND score was 5 (0-14), and the mean NIHSS on arrival to the hospital was 10 (0-34). Of 101 strokes, 89 were ischemic (88%) and 12 hemorrhagic (12%). LVO was diagnosed in 43 stroke patients (42%). Area under the curve for MEND exam predictability for LVO was 0.65 (95% CI 0.49-0.75). The sensitivity, specificity, PPV and NPV for different cut-offs of the MEND exam are: MEND ≥3: 98%, 29%, 0.43, 0.96; MEND ≥4: 81%, 51%, 0.48, 0.83; MEND ≥5: 60%, 65%, 0.49, 0.74.
Conclusion:
The MEND is a simple and rapid evaluation that can be performed in the field by EMS personnel to screen for LVO strokes. In our study, a MEND score ≥3 identified 98% of LVOs, and a score ≥4 identified 81% of LVOs, with improved specificity. The MEND exam is an effective tool to identify patients with LVO for transport to a CSC.
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Affiliation(s)
| | | | | | | | | | - Hua Li
- Biostatistics, Univ of Miami Sch of Med, Miami, FL
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Anzardo EV, Motola I, Brotons AA, Carter SP, Rodriguez RD, Issenberg SB. Abstract TP356: Advanced Stroke Life Support® Course Significantly Improves Knowledge of Stroke Diagnosis and Management for Prehospital and Hospital-Based Providers. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Comprehensive stroke education is necessary for rapid and effective diagnosis and treatment of stroke victims, especially in the prehospital and emergency department settings. Early acute stroke recognition and appropriate treatment lead to improved patient outcomes. Prehospital and hospital-based health care providers can make the difference between the opportunity for recovery, or a life of long-term disability, and even death. Advanced Stroke Life Support (ASLS®) is a one-day, evidence-based stroke course consisting of didactic lectures and interactive instruction. The sessions include video-based cases where the learners diagnose and develop a management plan for patients with strokes or stroke mimics; skills sessions where learners examine standardized patients who simulate major stroke syndromes; and an interactive game as a course summary. The purpose of this study is to evaluate the ASLS® course’s impact on knowledge of stroke diagnosis and management among prehospital and hospital-based providers.
Methods:
The ASLS® course was delivered to prehospital and hospital-based providers throughout the United States. All instructors were trained in a train-the-trainer program administered by the ASLS® home site faculty. A total of 9,678 prehospital and hospital-based personnel participated in the course between November 19, 2014 and May 31, 2017. Outcomes were measured using previously validated 25-item written pre-course and post-course assessments.
Results:
A total of 9,678 participants were included in statistical analyses. Using IBM SPSS Statistics, v.24, paired sample t-tests were performed on the data. Learners demonstrated a statistically significant increase in knowledge from pre- to post-course assessment, from a pre-course mean of 64.4% to a mean of 89.1% at post-course assessment (p < .001). Statistically significant increases in knowledge also occurred within both learner groups, with performance for prehospital learners rising from 63.8% to 90% (p < .001). Hospital-based learners improved from 64.8% to 88.6% (p < .001).
Conclusions:
Prehospital and hospital-based providers who participated in the ASLS® one-day course significantly improved their knowledge of stroke diagnosis and management.
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Shin JY, Issenberg SB, Roh YS. The effects of neurologic assessment E-learning in nurses. Nurse Educ Today 2017; 57:60-64. [PMID: 28734188 DOI: 10.1016/j.nedt.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/06/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes. OBJECTIVES The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses. DESIGN This study used a non-equivalent control group pretest-posttest design. SETTINGS Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26). METHODS The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest. RESULTS There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028). CONCLUSIONS Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.
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Affiliation(s)
- Ji Yeon Shin
- Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - S Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, USA.
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, 06974, Republic of Korea.
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McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. Revisiting 'A critical review of simulation-based medical education research: 2003-2009'. Med Educ 2016; 50:986-91. [PMID: 27628715 DOI: 10.1111/medu.12795] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Roha YS, Lima EJ, Issenberg SB. Effects of an integrated simulation-based resuscitation skills training with clinical practicum on mastery learning and self-efficacy in nursing students. Collegian 2016; 23:53-9. [PMID: 27188040 DOI: 10.1016/j.colegn.2014.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study evaluates the effectiveness of integrated simulation-based resuscitation skills training combined with a clinical practicum by assessing nursing students' knowledge, psychomotor skills, and self-efficacy. METHODS In a pretest-posttest design, 255 second-year nursing students participated in an emergency nursing clinical course consisting of a two-hour simulation-based resuscitation skills training component along with an 80-hour clinical placement in an emergency department. Knowledge, self-efficacy, and psychomotor skill errors were measured. Analyses of pre- and post-test data were performed on three subgroups: the simulation-only group, the simulation with clinical observation group, and the simulation with clinical performance group. Stu- dents were divided into these groups based on resuscitation experiences during their clinical practicum in the emergency department. RESULTS Mean scores of knowledge (z = -13.879, p < .001) and self-efficacy (z = -10.969, p < .001) significantly improved after the clinical practicum compared to baseline. Knowl- edge (F = .502, p = .606), psychomotor skill error (F = 1.587, p = .207), and self-efficacy (F = .481, p = .619) did not significantly differ among the three subgroups after controlling for two covari- ates (age, Basic Life Support certification) in the analysis of covariance models. CONCLUSION Integrated simulation-based resuscitation skills training combined with a clinical practicum might be beneficial for enhancing mastery learning and self-efficacy in nursing students through learner engagement and feedback.
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Multak N, Newell K, Spear S, Scalese RJ, Issenberg SB. A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students. J Physician Assist Educ 2015; 26:70-76. [PMID: 25933013 DOI: 10.1097/jpa.0000000000000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. METHODS This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. RESULTS Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. CONCLUSIONS This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.
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Affiliation(s)
- Nina Multak
- Nina Multak, MPAS, PA-C, is an associate clinical professor at the Drexel University Physician Assistant Program, Philadelphia, Pennsylvania. Karen Newell, MMSc, PA-C, is an assistant professor at the Emory University Physician Assistant Program, Atlanta, Georgia. Sherrie Spear, MHS, PA-C, is an assistant professor at the Duke University Physician Assistant Program, Durham, North Carolina. Ross J. Scalese, MD, is an associate professor of Medicine and director of Educational Technology Development at the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida. S. Barry Issenberg, MD, is the associate dean for Research in Medical Education, professor of Medicine, and director of the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida
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Rasmussen MB, Tolsgaard MG, Dieckmann P, Issenberg SB, Ostergaard D, Søreide E, Rosenberg J, Ringsted CV. Factors relating to the perceived management of emergency situations: a survey of former Advanced Life Support course participants' clinical experiences. Resuscitation 2014; 85:1726-31. [PMID: 25151548 DOI: 10.1016/j.resuscitation.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/06/2014] [Accepted: 08/05/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants. METHODS This study was a survey of former ALS course participants' long-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway. RESULTS A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as "managed well". In general, the responders' confidence in being ALS providers was high, mean 4.3 (SD 0.8), scale 1-5. Significant differences between the perceived "well" and "not well" managed situations were found for all questions, p<0.001. The largest differences related to perception of co-workers' ability to apply ALS principles, the team atmosphere and communication. Responders' ratings of quality of management of emergency situations increased with intensity of setting. However, the 'clinical setting' was rated significantly lower as attributor to ability to apply ALS principles compared to 'co-workers familiarity with ALS principles', 'own confidence as ALS-provider' and 'own social/inter-personal skills'. CONCLUSION The results of this survey emphasise that ALS providers' perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers' skills. Team related factors associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management of emergency situations to the same extent as individual and team factors.
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Affiliation(s)
- Maria B Rasmussen
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Martin G Tolsgaard
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Juliane Marie Centre, Rigshospitalet, Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Peter Dieckmann
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - S Barry Issenberg
- Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Miami, FL 33136, USA
| | - Doris Ostergaard
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Eldar Søreide
- Stavanger Acute Medicine Foundation for Education and Research (Safer), Stavanger University Hospital, 4068 Stavanger, Norway
| | - Jens Rosenberg
- Department of Internal Medicine, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Charlotte V Ringsted
- Department of Anesthesia and The Wilson Centre, University of Toronto and University Health Network, Toronto, ON, Canada
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Lenchus JD, Carvalho CM, Ferreri K, Sanko JS, Arheart KL, Fitzpatrick M, Issenberg SB. Filling the void: defining invasive bedside procedural competency for internal medicine residents. J Grad Med Educ 2013; 5:605-12. [PMID: 24455009 PMCID: PMC3886459 DOI: 10.4300/jgme-d-13-00030.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/26/2013] [Accepted: 06/17/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents perform invasive bedside procedures in most training programs. To date, there is no universal approach for determining competency and ensuring quality and safety of care. OBJECTIVE We developed and implemented an assessment of central venous catheter insertion competency for internal medicine and internal medicine-pediatrics residents, using measurements for knowledge, skill, and attitude and linking them to procedural outcomes. METHODS We conducted a cohort study of a 4-week, resident-run procedure service from July 2007 through June 2011 at a large academic medical center. Knowledge was assessed by using a written test, technical skill by using a checklist, and attitude by self- and supervisor assessments of residents' confidence and capability. Competence was defined as (1) a minimum written test score (70%); (2) a perfect checklist score; (3) a resident's self-assessed confidence and capability scores of 4 or 5 of 5; and (4) faculty rating of the resident's confidence and capability as 5 of 5. A composite success rate was based on procedural outcomes (eg, completed procedures, less than 3 forward needle passes, and complication rate) and was compared to the checklist scores. RESULTS A total of 148 internal medicine and medicine-pediatrics residents inserted 639 catheters, and 53 (36%) achieved competence by the end of 4 weeks. Residents judged to be competent by checklist scores had a higher composite success rate than those deemed not competent. CONCLUSIONS Our multi-factorial criteria used to define central venous catheter insertion competency effectively discriminated between residents judged to be competent and those judged not competent, using data from procedural outcomes.
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Abstract
PURPOSE The purpose of this study was to develop and evaluate psychometric properties of the instrument, Resuscitation Self-Efficacy Scale for nurses. METHODS This was a methodological study for instrument development and psychometric testing. The initial item pool derived from literature review and experts resulted in 30 items linked to resuscitation self-efficacy. A convenience sample of 509 Korean nurses from eleven academic teaching hospitals participated in a survey to examine psychometric properties of the scale. To examine construct validity, exploratory factor analysis and known-group comparison were used. Cronbach's coefficient alpha was used to determine the scale's internal consistency reliability. RESULTS The final scale included 17 items with four-component structure termed 'Recognition', 'Debriefing and recording', 'Responding and rescuing', and 'Reporting'. These four factors accounted for 57.5% of the variance. Each subscale and the total scale demonstrated satisfactory internal consistency: .82; .88; .87; .83; and .91 respectively. Experienced nurses reported significantly higher self-efficacy mean scores in both total and subscales compared to new graduate nurses. CONCLUSION The Resuscitation Self-Efficacy Scale for nurses yields reliable and valid results in appraising the level of resuscitation self-efficacy for Korean nurses. Further study is needed to test and refine the scale.
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Affiliation(s)
- Young Sook Roh
- Red Cross College of Nursing, CAU Healthcare System, Chung-Ang University, Seoul, Korea
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Roh YS, Issenberg SB. Association of cardiopulmonary resuscitation psychomotor skills with knowledge and self‐efficacy in nursing students. Int J Nurs Pract 2013; 20:674-9. [DOI: 10.1111/ijn.12212] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Young Sook Roh
- Red Cross College of NursingChung‐Ang UniversityChung‐Ang University Healthcare System Seoul Korea
| | - S Barry Issenberg
- Gordon Center for Research in Medical EducationUniversity of Miami Miller School of Medicine Miami Florida USA
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Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach 2013; 35:e1511-30. [PMID: 23941678 DOI: 10.3109/0142159x.2013.818632] [Citation(s) in RCA: 493] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in simulation for training, such as aviation, the military and space exploration. Increased demands on training hours, limited patient encounters, and a focus on patient safety have led to a new paradigm of education in healthcare that increasingly involves technology and innovative ways to provide a standardized curriculum. A robust body of literature is growing, seeking to answer the question of how best to use simulation in healthcare education. Building on the groundwork of the Best Evidence in Medical Education (BEME) Guide on the features of simulators that lead to effective learning, this current Guide provides practical guidance to aid educators in effectively using simulation for training. It is a selective review to describe best practices and illustrative case studies. This Guide is the second part of a two-part AMEE Guide on simulation in healthcare education. The first Guide focuses on building a simulation program, and discusses more operational topics such as types of simulators, simulation center structure and set-up, fidelity management, and scenario engineering, as well as faculty preparation. This Guide will focus on the educational principles that lead to effective learning, and include topics such as feedback and debriefing, deliberate practice, and curriculum integration - all central to simulation efficacy. The important subjects of mastery learning, range of difficulty, capturing clinical variation, and individualized learning are also examined. Finally, we discuss approaches to team training and suggest future directions. Each section follows a framework of background and definition, its importance to effective use of simulation, practical points with examples, and challenges generally encountered. Simulation-based healthcare education has great potential for use throughout the healthcare education continuum, from undergraduate to continuing education. It can also be used to train a variety of healthcare providers in different disciplines from novices to experts. This Guide aims to equip healthcare educators with the tools to use this learning modality to its full capability.
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Golden AG, Gammonley D, Hunt D, Olsen E, Issenberg SB. The attitudes of graduate healthcare students toward older adults, personal aging, health care reform, and interprofessional collaboration. J Interprof Care 2013; 28:40-4. [DOI: 10.3109/13561820.2013.830595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Roh YS, Issenberg SB, Chung HS, Kim SS, Lim TH. A survey of nurses' perceived competence and educational needs in performing resuscitation. J Contin Educ Nurs 2013; 44:230-6. [PMID: 23458080 DOI: 10.3928/00220124-20130301-83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. METHODS A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. RESULTS On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. CONCLUSION Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses.
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McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Translational educational research: a necessity for effective health-care improvement. Chest 2013; 142:1097-1103. [PMID: 23138127 DOI: 10.1378/chest.12-0148] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research.
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Affiliation(s)
- William C McGaghie
- Center for Education in Medicine and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - S Barry Issenberg
- Michael S. Gordon Center for Research in Medical Education and Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Brydges R, Peets A, Issenberg SB, Regehr G. Divergence in student and educator conceptual structures during auscultation training. Med Educ 2013; 47:198-209. [PMID: 23323659 DOI: 10.1111/medu.12088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Simulation-based medical education allows trainees to engage in self-regulated learning (SRL), yet research aimed at elucidating the mechanisms of SRL in this context is relatively absent. We compared 'unguided' SRL with 'directed' SRL (DSRL), wherein learners followed an expert-designed booklet. METHODS Year 1 medical students (n = 37) were randomly assigned to practise identifying seven cardiac murmurs using a simulator and video only (SRL group) or a simulator and video plus the booklet (DSRL group). All participants completed a 22-item test 3 weeks later. To compare interventions, we analysed students' diagnostic accuracy. As a novel source of evidence, we documented how participants autonomously sequenced the seven murmurs during initial and delayed practice sessions. In addition, we surveyed clinical educators (n = 17) to find out how they would sequence their teaching of these murmurs. RESULTS The DSRL group used 50% more training time than the SRL group (p < 0.001). The groups' diagnostic accuracy, however, did not differ significantly on the post-test, retention test or transfer test items (p > 0.12). Despite practising with the expert-defined 'timing-based' approach to murmur diagnosis (i.e. systolic versus diastolic), 84% of DSRL participants implemented a location-based approach (i.e. practising aortic murmurs separately from mitral murmurs) during a second, unguided practice session. Notably, most SRL participants used that same approach spontaneously. By contrast, clinical educators were split in their use of the timing-based (n = 10) and the location-based (n = 6) approaches. Chi-squared analyses suggested educators' conceptions for organising murmurs differed significantly from students' conceptions. CONCLUSIONS Contrary to our predictions, directing students' SRL produced no additional benefit and increased their practice time. Our findings suggest one potential source of these results was a divergence between student and educator conceptions for structuring the practice of cardiac auscultation skills. This phenomenon has not been well articulated in the medical education literature, and may have important implications in many (especially technology-mediated) educational contexts.
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Affiliation(s)
- Ryan Brydges
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Chung HS, Issenberg SB, Phrampus P, Miller G, Je SM, Lim TH, Kim YM. International collaborative faculty development program on simulation-based healthcare education: a report on its successes and challenges. Korean J Med Educ 2012; 24:319-27. [PMID: 25813328 PMCID: PMC8813360 DOI: 10.3946/kjme.2012.24.4.319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/15/2012] [Accepted: 08/18/2012] [Indexed: 05/21/2023]
Abstract
PURPOSE Countries that are less experienced with simulation-based healthcare education (SBHE) often import Western programs to initiate their efforts to deliver effective simulation training. Acknowledging cultural differences, we sought to determine whether faculty development program on SBHE in the United States could be transported successfully to train faculty members in Korea. METHODS An international, collaborative, multi-professional program from a pre-existing Western model was adapted. The process focused on prioritization of curricular elements based on local needs, translation of course materials, and delivery of the program in small group facilitation exercises. Three types of evaluation data were collected: participants' simulation experience; participants' ratings of the course; and participant's self-assessment of the impact of the course on their knowledge, skills, and attitudes (KSA) toward simulation teaching. RESULTS Thirty faculty teachers participated in the course. Eighty percent of the participants answered that they spent less than 25% of their time as simulation instructors. Time spent on planning, scenario development, delivering training, research, and administrative work ranged from 10% to 30%. Twenty-eight of 30 participants agreed or strongly agreed that the course was excellent and relevant to their needs. The participants' assessment of the impact of the course on their KSA toward simulation teaching improved significantly. CONCLUSION Although there were many challenges to overcome, a systematic approach in the adaptation of a Western simulation faculty development course model was successfully implemented in Korea, and the program improves self-confidence and learning in participants.
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Affiliation(s)
- Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Corresponding Author: Hyun Soo Chung Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonjuro, Gangnamgu, Seoul, Korea 135-720 Tel: +82.2-2019-3030 Fax: +82.2-2019-4820
| | - S. Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, USA
| | - Paul Phrampus
- Peter M. Winter Institute for Simulation Education and Research, University of Pittsburgh, Pittsburgh, USA
| | - Geoff Miller
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, USA
| | - Sang Mo Je
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Min Kim
- Department of Emergency Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
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Abstract
Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses.
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Affiliation(s)
- Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University (CAU), CAU Healthcare system, Seoul, Korea
| | | | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Brotons AA, Motola I, Rivera HF, Soto RE, Schwemmer S, Issenberg SB. Abstract 3468: Correlation of the Miami Emergency Neurologic Deficit (MEND) Exam Performed in the Field by Paramedics with an Abnormal NIHSS and Final Diagnosis of Stroke for Patients Airlifted from the Scene. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a3468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction
Early recognition and rapid transport to a stroke center by prehospital providers is essential in the care of stroke patients. In this study, prehospital providers were trained to perform the Miami Emergency Neurologic Deficit (MEND) exam as part of an 8-hour comprehensive course, Advanced Stroke Life Support (ASLS
®
). The MEND exam was devised to facilitate communication between healthcare providers throughout the continuum of care for stroke patients. It can provide a baseline exam in the prehospital setting, and then be used by nurses for initial evaluation and subsequent exams in the ED, ICU or hospital floor. The MEND exam incorporates all three components of the Cincinnati Prehospital Stroke Scale (CPSS) and six additional components from the NIHSS (level of consciousness, orientation, commands, visual fields, gaze, leg motor, limb ataxia, sensation). The exam takes less than 2 minutes and requires no tools, making it ideal for the Prehospital environment.
Purpose
Determine the correlation of the MEND exam completed by a prehospital provider on scene to the initial NIHSS performed by the neurologist at the receiving facility, and the final diagnosis.
Methods
All prehospital providers from three Fire Rescue agencies participated in the training (96 EMT-P, 68 EMT, 5 RN). The Prehospital providers conducted the CPSS, and if abnormal, placed the helicopter team on standby. They then completed the MEND exam and communicated their findings to a receiving hospital stroke neurologist. We retrospectively reviewed the MEND exam performed by the prehospital providers to determine the correlation with the same components of the initial NIHSS at the hospital. While the NIHSS assigned a numerical value to those specific components, the MEND exam did not. Additionally, we examined the final discharge diagnosis to determine how many patients had a stroke or transient ischemic attack (TIA).
Results
From Sept. 2008 to June 2011, 51 patients met the criteria of having both a MEND exam and NIHSS completed. There were 32 males (63%) and 19 females (37%) with a median age of 67 years (44-98 years). The average NIHSS score was 9 (range 0-30). 90.2% (46 of 51) of patients had an NIHSS that correlated to the findings on the MEND (95% C.I. 90.1-90.3). Of the 5 remaining patients, 1 completely recovered on the flight (diagnosed with a TIA), and 3 had a NIHSS score of 0 and were diagnosed with other conditions. Stroke or TIA was diagnosed in 40 patients (78.4%). Of 37 strokes, 32 were ischemic (86.5%) and 5 hemorrhagic (13.5%). The 11 patients not diagnosed with a stroke had several other pathologies (e.g. seizure, hypertensive crisis, viral encephalitis, complex migraine).
Conclusion
The MEND exam completed in the Prehospital setting correlated well with the initial NIHSS performed at the receiving facility. The MEND exam is a valuable tool when assessing stroke patients and determining need for air transport.
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Chung HS, Issenberg SB, Phrampus P, Miller G, Je SM, Lim TH, Kim YM. The impact of an international faculty development program on simulation-based healthcare education. Med Teach 2012; 34:510. [PMID: 22578046 DOI: 10.3109/0142159x.2012.675458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Issenberg SB, Chung HS, Devine LA. Patient Safety Training Simulations Based on Competency Criteria of the Accreditation Council for Graduate Medical Education. ACTA ACUST UNITED AC 2011; 78:842-53. [DOI: 10.1002/msj.20301] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Acad Med 2011; 86:e8-e9. [PMID: 22030671 DOI: 10.1097/acm.0b013e3182308d37] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- William C McGaghie
- NUCATS Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011; 86:706-11. [PMID: 21512370 PMCID: PMC3102783 DOI: 10.1097/acm.0b013e318217e119] [Citation(s) in RCA: 947] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). METHOD This is a quantitative meta-analysis that spans 20 years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes. RESULTS Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared with traditional clinical medical education was 0.71 (95% confidence interval, 0.65-0.76; P < .001). CONCLUSIONS Although the number of reports analyzed in this meta-analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.
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Affiliation(s)
- William C McGaghie
- Northwestern University Clinical and Translational Sciences Institute, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
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Issenberg SB. Ottawa 2010 Conference--consensus statements and recommendations. Med Teach 2011; 33:181-182. [PMID: 21345057 DOI: 10.3109/0142159x.2011.551562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- S Barry Issenberg
- Michael S Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, PO Box 016960 (D41), Miami, FL 33101, USA.
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Lenchus J, Issenberg SB, Murphy D, Everett-Thomas R, Erben L, Arheart K, Birnbach DJ. A blended approach to invasive bedside procedural instruction. Med Teach 2011; 33:116-23. [PMID: 20874027 DOI: 10.3109/0142159x.2010.509412] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study assessed the impact of a blended, standardized curriculum for invasive bedside procedural training on medical knowledge and technical skills for Internal Medicine residents. METHODS The investigators developed a curriculum in procedural instruction and performance for Internal Medicine house staff, and implemented the program at a tertiary care academic medical center with a primary affiliation with a US medical school. The investigators chose procedures recommended for technical competence by the American Board of Internal Medicine: lumbar puncture, thoracentesis, paracentesis, central venous catheter insertion, and knee arthrocentesis. The program included: (1) assessment of baseline medical knowledge and technical proficiency on mannequins, (2) video instruction of procedure, (3) faculty-led discussion of critical concepts, (4) faculty demonstration of the procedure on mannequin, (5) individual practice on simulators, (6) post-intervention knowledge evaluation, and (7) post-intervention skills evaluation. The performance achieved during the initial skills evaluation on a mannequin was compared to the performance achieved on the first patient subsequent to the instructional portion. RESULTS All participants with complete data demonstrated a statistically significant pre-intervention to post-intervention improvement (p < 0.05) in comprehensive medical knowledge and procedural skills. CONCLUSION A blended, standardized curriculum in invasive bedside procedural instruction can significantly improve performance in participants' medical knowledge and technical skills.
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Affiliation(s)
- Joshua Lenchus
- University of Miami – Jackson Hospital Center for Patient Safety, 1611 NW 12 Avenue, Institute building, 4th floor, Miami, FL 33136, USA.
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Harden RM, Gessner IH, Gunn M, Issenberg SB, Pringle SD, Stewart A. Creating an e-learning module from learning objects using a commentary or 'personal learning assistant'. Med Teach 2011; 33:286-90. [PMID: 21456985 DOI: 10.3109/0142159x.2011.557104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The use of learning objects (LOs), small chunks of learning stored digitally and reused or referenced to support learning, was described as a promising approach to the creation of e-learning modules or programmes. In practice, however, the early enthusiasm has waned and the approach has not been widely adopted. It is argued that this was due, at least in part, to a neglect of the pedagogy and an emphasis on the technical aspects of interoperability and reusability. This article describes a practical approach to constructing a learning module using LOs where a commentary links LOs selected for inclusion in the programme. The commentary tells the story of the e-learning module and provides the learner with a context for an LO. It can be viewed as a 'personal learning assistant' that advises students about the management of their learning and relates the e-learning module to the overall learning outcomes for the curriculum. The commentary also allows the lecturer to comment on LOs selected for inclusion in the programme which otherwise might have to be adapted or excluded when the programme was constructed. The use of a commentary to link and introduce LOs has been successfully adopted in the development of e-learning programmes. Teachers are encouraged to consider the approach and to look again at the use of LOs to create e-learning resources.
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Miller GT, Motola I, Brotons AA, Issenberg SB. Preparing for the worst. A review of the ADDIE simulation model for disaster-response training. JEMS 2010; 35:11-13. [PMID: 21510435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Geoffrey T Miller
- University of Miami Gordon Center for Research in Medical Education, USA.
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Golden AG, van Zuilen MH, Mintzer MJ, Issenberg SB, Silverman MA, Roos BA. A fourth-year medical school clerkship that addressed negative attitudes toward geriatric medicine. J Am Geriatr Soc 2010; 58:746-50. [PMID: 20398156 DOI: 10.1111/j.1532-5415.2010.02774.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth-year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship "the most outstanding clinical course" at the medical school.
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Affiliation(s)
- Adam G Golden
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida 33125, USA.
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Abstract
OBJECTIVES This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. METHODS This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969-2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003-2009. RESULTS The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. CONCLUSIONS Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.
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Affiliation(s)
- William C McGaghie
- Augusta Webster, MD, Office of Medical Education and Faculty Development, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-3008, USA.
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Hatala R, Issenberg SB, Kassen B, Cole G, Bacchus CM, Scalese RJ. Assessing cardiac physical examination skills using simulation technology and real patients: a comparison study. Med Educ 2008; 42:628-636. [PMID: 18221269 DOI: 10.1111/j.1365-2923.2007.02953.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE High-stakes assessments of doctors' physical examination skills often employ standardised patients (SPs) who lack physical abnormalities. Simulation technology provides additional opportunities to assess these skills by mimicking physical abnormalities. The current study examined the relationship between internists' cardiac physical examination competence as assessed with simulation technology compared with that assessed with real patients (RPs). METHODS The cardiac physical examination skills and bedside diagnostic accuracy of 28 internists were assessed during an objective structured clinical examination (OSCE). The OSCE included 3 modalities of cardiac patients: RPs with cardiac abnormalities; SPs combined with computer-based, audio-video simulations of auscultatory abnormalities, and a cardiac patient simulator (CPS) manikin. Four cardiac diagnoses and their associated cardiac findings were matched across modalities. At each station, 2 examiners independently rated a participant's physical examination technique and global clinical competence. Two investigators separately scored diagnostic accuracy. RESULTS Inter-rater reliability between examiners for global ratings (GRs) ranged from 0.75-0.78 for the different modalities. Although there was no significant difference between participants' mean GRs for each modality, the correlations between participants' performances on each modality were low to modest: RP versus SP, r = 0.19; RP versus CPS, r = 0.22; SP versus CPS, r = 0.57 (P < 0.01). CONCLUSIONS Methodological limitations included variability between modalities in the components contributing to examiners' GRs, a paucity of objective outcome measures and restricted case sampling. No modality provided a clear 'gold standard' for the assessment of cardiac physical examination competence. These limitations need to be addressed before determining the optimal patient modality for high-stakes assessment purposes.
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Affiliation(s)
- Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and academic environments that limit patient availability as educational opportunities; worldwide attention focused on the problem of medical errors and the need to improve patient safety; and the paradigm shift to outcomes-based education with its requirements for assessment and demonstration of competence. The use of simulators addresses many of these issues: they can be readily available at any time and can reproduce a wide variety of clinical conditions on demand. In lieu of the customary (and arguably unethical) system, whereby novices carry out the practice required to master various techniques--including invasive procedures--on real patients, simulation-based education allows trainees to hone their skills in a risk-free environment. Evaluators can also use simulators for reliable assessments of competence in multiple domains. For those readers less familiar with medical simulators, this article aims to provide a brief overview of these educational innovations and their uses; for decision makers in medical education, we hope to broaden awareness of the significant potential of these new technologies for improving physician training and assessment, with a resultant positive impact on patient safety and health care outcomes.
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Affiliation(s)
- Ross J Scalese
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, P.O. Box 016960 (D-41), Miami, FL 33101, USA.
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