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Dahlke S, Rayner JA, Fetherstonhaugh D, Butler JI, Kennedy M. Gerontological educational interventions for student nurses: a systematic review of qualitative findings. Int J Nurs Educ Scholarsh 2025; 22:ijnes-2023-0042. [PMID: 38459787 DOI: 10.1515/ijnes-2023-0042] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/28/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. METHODS Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. CONCLUSIONS Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jo-Anne Rayner
- ACEBAC, 2080 La Trobe University , Bundoora, VIC, Australia
| | | | | | - Megan Kennedy
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Miller-Kuhlmann R, Sasnal M, Gold CA, Nassar AK, Korndorffer JR, Van Schaik S, Marmor A, Williams S, Blankenburg R, Rassbach CE. Tips for developing a coaching program in medical education. Med Educ Online 2024; 29:2289262. [PMID: 38051864 PMCID: PMC10783821 DOI: 10.1080/10872981.2023.2289262] [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: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.
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Affiliation(s)
| | - Marzena Sasnal
- Center for Research on Education Outcomes, Stanford University, Palo Alto, USA
| | - Carl A. Gold
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, USA
| | | | | | - Sandrijn Van Schaik
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Andrea Marmor
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Sarah Williams
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Ovitsh RK, Gupta S, Kusnoor A, Jackson JM, Roussel D, Mooney CJ, Pinto-Powell R, Appel JL, Mhaskar R, Gold J. Minding the gap: towards a shared clinical reasoning lexicon across the pre-clerkship/clerkship transition. Med Educ Online 2024; 29:2307715. [PMID: 38320116 PMCID: PMC10848998 DOI: 10.1080/10872981.2024.2307715] [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: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
Teaching and learning of clinical reasoning are core principles of medical education. However, little guidance exists for faculty leaders to navigate curricular transitions between pre-clerkship and clerkship curricular phases. This study compares how educational leaders in these two phases understand clinical reasoning instruction. Previously reported cross-sectional surveys of pre-clerkship clinical skills course directors, and clerkship leaders were compared. Comparisons focused on perceived importance of a number of core clinical reasoning concepts, barriers to clinical reasoning instruction, level of familiarity across the undergraduate medical curriculum, and inclusion of clinical reasoning instruction in each area of the curriculum. Analyses were performed using the Mann Whitney U test. Both sets of leaders rated lack of curricular time as the largest barrier to teaching clinical reasoning. Clerkship leaders also noted a lack of faculty with skills to teach clinical reasoning concepts as a significant barrier (p < 0.02), while pre-clerkship leaders were more likely to perceive that these concepts were too advanced for their students (p < 0.001). Pre-clerkship leaders reported a higher level of familiarity with the clerkship curriculum than clerkship leaders reported of the pre-clerkship curriculum (p < 0.001). As faculty transition students from the pre-clerkship to the clerkship phase, a shared understanding of what is taught and when, accompanied by successful faculty development, may aid the development of longitudinal, milestone-based clinical reasoning instruction.
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Affiliation(s)
- Robin K. Ovitsh
- Department of Pediatrics, Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Shanu Gupta
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Anita Kusnoor
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer M. Jackson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danielle Roussel
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher J. Mooney
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Roshini Pinto-Powell
- Department of Medicine and Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joel L. Appel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - Jonathan Gold
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA
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Koelewijn G, Hennus MP, Kort HSM, Frenkel J, van Houwelingen T. Games to support teaching clinical reasoning in health professions education: a scoping review. Med Educ Online 2024; 29:2316971. [PMID: 38394053 PMCID: PMC10896137 DOI: 10.1080/10872981.2024.2316971] [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: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. METHODS A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. RESULTS Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. CONCLUSION All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.
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Affiliation(s)
- Gilbert Koelewijn
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P Hennus
- Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helianthe S M Kort
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Building Healthy Environments for Future Users Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Joost Frenkel
- Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Çetinkaya L, Keser İ, Yildirim S, Keser H. The effect of case-based mobile virtual patient application on students' academic achievement in clinical reasoning skills. Med Educ Online 2024; 29:2322223. [PMID: 38445566 PMCID: PMC10919315 DOI: 10.1080/10872981.2024.2322223] [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: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
This mixed-method study aims to determine the effect of the use of mobile virtual patient application with narrated case-based virtual patients as an assistive technology on students' clinical reasoning skills. It makes a notable contribution by exploring the impact of mobile virtual patient applications on healthcare students' clinical skills and their preparation for real-world patient care. In addition, the accuracy of the analysis results regarding the effect on student achievement was analyzed with a second dataset tool, and thus, aiming to increase reliability by verifying the same research question with a different quantitative analysis technique. In the qualitative part of the study, students' views on the implementation were collected through an open-ended questionnaire and the data were subjected to content analysis. An achievement test was also developed to determine the development of students' clinical reasoning skills, which revealed that each of the learning environments had different outcomes regarding students' achievement and that supporting the traditional environment with the mobile virtual patient application yielded better results for increasing students' achievement. Students' opinions about the mobile virtual patient application and the process also support the increase in academic achievement aimed at measuring clinical reasoning skills. The content analysis showed that the students, who generally reported multiple positive factors related to the application, thought that the stories and cases presented created a perception of reality, and they especially highlighted the contribution of the application to learning the story organization. Based on all these results, it can be said that the application supports clinical reasoning, provides practical experience, improves academic achievement, and contributes positively to motivation.
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Affiliation(s)
- Levent Çetinkaya
- Department of Computer Education and Instructional Technology, Canakkale Onsekiz Universty, Canakkale, Türkiye
| | - İ̇lke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Serkan Yildirim
- Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
| | - Hafize Keser
- Faculty of Educational Sciences, Department of Computer Education and Instructional Technology, Ankara University, Ankara, Türkiye
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Cahill A, Martin M, Beachy B, Bauman D, Howard-Young J. The contextual interview: a cross-cutting patient-interviewing approach for social context. Med Educ Online 2024; 29:2295049. [PMID: 38320114 PMCID: PMC10848999 DOI: 10.1080/10872981.2023.2295049] [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: 07/05/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Patient interviewing pedagogy in medical education has not evolved to comprehensively capture the biopsychosocial model of healthcare delivery. While gathering a patient's social history targets important aspects of social context it does not adequately capture and account for the real-time reassessment required to understand evolving factors that influence exposure to drivers of health inequities, social determinants of health, and access to supports that promote health. The authors offer a patient interviewing approach called the Contextual Interview (CI) that specifically targets dynamic and ever-changing social context information. To substantiate the use of the CI in medical education, the authors conducted a qualitative review of the Accreditation Council for Graduate Medical Education Milestones for primary care specialties (Family Medicine, Internal Medicine, and Pediatrics). Milestones were coded to the extent to which they reflected the learner's need to acknowledge, assess, synthesize and/or apply patient contextual data in real-time patient encounters. Approximately 1 in 5 milestones met the context-related and patient-facing criteria. This milestone review further highlights the need for more intentional training in eliciting meaningful social context data during patient interviewing. The CI as a cross-cutting, practical, time-conscious, and semi-structured patient interviewing approach that deliberately elicits information to improve the clinician's sense and understanding of a patient's social context. The authors reviewed future directions in researching adapted versions of the CI for undergraduate and graduate medical education.
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Affiliation(s)
- Amber Cahill
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew Martin
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Bridget Beachy
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - David Bauman
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - Jordan Howard-Young
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Wang X, Song Z, Chen X, Zhou Y, Lou Y, Liu T, Zhang D. Rapid cycle deliberate practice: application in forceps simulation training for gynecology and obstetrics residents. Ann Med 2024; 56:2301596. [PMID: 38478750 PMCID: PMC10939101 DOI: 10.1080/07853890.2023.2301596] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/17/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Rapid Cycle Deliberate Practice (RCDP) has gained prominence in recent years as an innovative teaching method in simulation-based training for adult and pediatric emergency medical skills. However, its application in the training of forceps delivery skills among obstetrics and gynecology residents remains unexplored. This study aimed to assess the impact of RCDP in this domain. METHODS Conducted in March 2021, this randomized controlled study involved 60 second-year obstetrics and gynecology residents undergoing standardized training. Participants were randomly assigned to the RCDP group or the traditional teaching method (TTM) group, each comprising 30 residents. The RCDP group followed the RCDP practice mode, while the TTM group adhered to conventional simulation teaching. Post-training assessment of operational proficiency was conducted immediately and after one year. Independent operational confidence and training satisfaction were evaluated through questionnaire surveys and the Satisfaction with Simulation Experience (SSE) scale. Data analysis utilized SPSS 23.0. RESULTS The RCDP group displayed significantly higher immediate post-training forceps operation scores compared to the TTM group (92.00 [range: 90.00-94.00] vs. 88.00 [range: 86.75-92.00]; z = 3.79; p < .001). However, no significant difference emerged in forceps operation scores after one year (86.00 [range: 85.00-88.00] vs. 85.50 [range: 84.00-88.25]; z = 0.54; p = .59). The RCDP group exhibited notable performance improvement over the TTM group (z = 3.49; p < .001). Independent operation confidence showed no significant discrepancy (p > .05). Importantly, the RCDP group reported higher satisfaction scores, particularly in the Debriefing and Reflection subscale (44.00 [range: 43.00-45.00] vs. 41.00 [range: 41.50-43.00]; z = 5.24; p < .001), contributing to an overall superior SSE score (z = 4.74; p < .001). CONCLUSIONS RCDP exhibits immediate efficacy in elevating forceps delivery skills among residents. However, sustained skill enhancement necessitates innovative approaches, while RCDP's value lies in tailored feedback and reflection for enriched medical education.
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Affiliation(s)
- Xiaoxue Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueting Chen
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangzi Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yingze Lou
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tong Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Erbay Dallı Ö, Kelebek Girgin N. Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence. Intensive Crit Care Nurs 2024; 82:103622. [PMID: 38215558 DOI: 10.1016/j.iccn.2024.103622] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs. RESEARCH METHODOLOGY/DESIGN A pre-post test intervention study without a control group. SETTING The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients). MAIN OUTCOME MEASURES The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E). RESULTS The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001). CONCLUSION The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings. IMPLICATIONS FOR CLINICAL PRACTICE Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.
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Affiliation(s)
- Öznur Erbay Dallı
- Bursa Uludag University Faculty of Health Sciences, Department of Internal Medicine Nursing, Nilüfer, BURSA 16059, Turkey.
| | - Nermin Kelebek Girgin
- Bursa City Hospital, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, BURSA 16110, Turkey
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Abraham P, Dubois N, Rimmelé T, Lilot M, Balança B. Enhancing perioperative care through decontextualized simulation: A game-changer for non-technical skills training. J Clin Anesth 2024; 94:111428. [PMID: 38422954 DOI: 10.1016/j.jclinane.2024.111428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Paul Abraham
- Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France.
| | - Nadège Dubois
- Medical Simulation Center, Public Health Department, Liège University, Liège, Belgium
| | - Thomas Rimmelé
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Unit of Pediatric and Congenital Cardio-thoracic Anesthesia and Intensive Care, Medical-Surgical Department of Congenital Cardiology of the Fœtus, Child and Adult. Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Baptiste Balança
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Neurologic Intensive care and Anesthesiology, Hospices Civils de Lyon, Pierre Wertheimer Hospital and Claude Bernard University Lyon 1 - Neuroscience Research Center, Lyon, France
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Rubin JE, Pandian B, Jotwani R, Pryor KO, Rubin LA, Mack PF. Leveraging spatial computing to improve crisis management training in anesthesiology. J Clin Anesth 2024; 93:111358. [PMID: 38104400 DOI: 10.1016/j.jclinane.2023.111358] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Affiliation(s)
- John E Rubin
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Balaji Pandian
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Rohan Jotwani
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Lori A Rubin
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Patricia F Mack
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
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Lim SH, Ang SY, Aloweni F, Siow KCE, Koh SBL, Ayre TC. Factors associated with practice readiness among newly qualified nurses in their first two years of practice. Nurse Educ Today 2024; 136:106143. [PMID: 38422796 DOI: 10.1016/j.nedt.2024.106143] [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: 08/23/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession. OBJECTIVES To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession. DESIGN A cross-sectional study. SETTINGS AND PARTICIPANTS A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore. METHODS Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice. RESULTS More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03). CONCLUSIONS It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.
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Affiliation(s)
- Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore.
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore.
| | - Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore.
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12
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Saragih ID, Tarihoran DETAU, Lin WT, Lee BO. Outcomes of scenario-based simulation courses in nursing education: A systematic review and meta-analysis. Nurse Educ Today 2024; 136:106145. [PMID: 38422795 DOI: 10.1016/j.nedt.2024.106145] [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: 07/28/2023] [Revised: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This study aimed to investigate the effects of scenario-based simulation courses on nursing students' professional knowledge, clinical practice skills, and self-confidence in learning. DESIGN A systematic review and meta-analysis. DATA SOURCES A literature search of six databases including CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science was performed on 28 February 2023. REVIEW METHODS The methodological quality of the studies included was assessed using RoB 2. A random-effects model was used for pooling effect size. The heterogeneity of each pooled analysis was quantified with I2. Egger's regression test was performed to assess publication bias in each pooled analysis. RESULTS Sixteen trials conducted between 2011 and 2022 were included in the final analysis. Scenario-based simulation courses significantly improved nursing students' professional knowledge (pooled SMD 0.66; 95 % CI 0.33-0.98; p < 0.001), clinical practice skills (pooled SMD 1.45; 95 % CI 0.96-1.94; p < 0.001), and self-confidence in learning (pooled SMD 0.37; 95 % CI 0.12-0.63; p < 0.001). Substantial heterogeneity was observed in the pooled analyses of professional knowledge and clinical practice skills. CONCLUSION Scenario-based simulation courses appeared to be beneficial for increasing nursing students' professional knowledge, clinical practice abilities, and self-confidence in learning. Therefore, simulation-based learning should be regarded as an essential component of the nursing curriculum as it improves nursing students' skills and prepares them for real-world practice.
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Affiliation(s)
| | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana, Jakarta, Indonesia; School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Wei-Ting Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Taiwan.
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13
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Herzog M, Schönfelder B, Barton M, Gugler P, Aghaizu C, Nagl-Cupal M, Mayer H. [Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study]. Pflege 2024; 37:59-68. [PMID: 38497154 DOI: 10.1024/1012-5302/a000985] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study Abstract: Background: New fields of practice are emerging under the concept of "Advanced Nursing Practice" (ANP) that offer specialised care provided by nurses who hold master's degrees. In Austria, nurses are currently being trained as Advanced Practice Nurses (APN). Aim: The project aimed to investigate which advanced nursing practice tasks according to the Hamric model are undertaken by nurses at different levels of qualification in Austria. Methods: Certified nurses did participate in a cross-sectional survey through an online questionnaire based on the Role Delineation Model and tailored to the Austrian context. The tasks were assigned based on the Hamric model and were tested and evaluated descriptively according to the qualification level through factor analysis. Results: Completed data was available from 105 participants, among them 80% with undergraduate education, 20% with a master's degree. A tendency in the results showed that the level of qualification was related to the activities carried out. The higher the academic degree, the more activities were performed in the field of leadership. The central ANP-competencies, research and education, are rather weak among all respondents. Conclusion: The results show that activities corresponding to the competencies of an ANP are performed by a heterogeneous group of nurses. Conditions and a standardized understanding of ANP need to be established in order to offer a professional practice that matches the competency profile.
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Affiliation(s)
- Michaela Herzog
- Institut für Pflegewissenschaft, Universität Wien, Österreich
| | - Birgit Schönfelder
- Institut für Pflegewissenschaft, Universität Wien, Österreich
- Studiengang Allgemeine Gesundheits- und Krankenpflege, Fakultät Gesundheit, Fachhochschule Wiener Neustadt, Österreich
| | - Melanie Barton
- Institut für Pflegewissenschaft, Universität Wien, Österreich
| | - Pia Gugler
- Institut für Pflegewissenschaft, Universität Wien, Österreich
| | | | | | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien, Österreich
- Fachbereich Pflegewissenschaft mit Schwerpunkt Person-Centred Care Research, Department Allgemeine Gesundheitsstudien, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, Österreich
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Kengen B, Verwey WB, van Goor H, Luursema JM. Optical angle and visuospatial ability affect basic laparoscopic simulator task performance. Appl Ergon 2024; 116:104210. [PMID: 38157822 DOI: 10.1016/j.apergo.2023.104210] [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: 06/23/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Surgical trainees show decreased performance during laparoscopic surgery when the laparoscope (camera) is not aligned with their line of sight towards the operating area. In this study we investigate the influence of visuospatial ability on laparoscopic simulator performance under such non-zero optical angles. Novices were invited to participate in a laparoscopic training session. After completing a visuospatial ability assessment, they performed a simplified laparoscopic task on an in-house developed laparoscopic simulator under eight different optical angles ranging between 0° and 315° in steps of 45°. Data-analysis showed decreased performance under all non-zero optical angles for task duration (mean difference between 1506 and 5049 ms, standard error between 499 and 507, p < .05) and for accuracy under optical angles greater than ±45° (mean difference between 1.48 and 2.11, standard error 0.32, p < .01). Performance-zones were identified for various optical angle ranges and differed for task duration and accuracy. Participants of high visuospatial ability performed significantly better under non-zero angles for accuracy compared to participants of low visuospatial ability (mean difference 0.95, standard error 0.34, p < .01), except for the 180° optical angle (no difference).
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Affiliation(s)
- Bas Kengen
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - Willem B Verwey
- Department of Learning, Data-Analytics and Technology, Section Cognition, Data and Education, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Jan-Maarten Luursema
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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Kim Y, Cui CL, Williams ZF, Long CA. Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis. Vasc Endovascular Surg 2024; 58:302-307. [PMID: 37918823 DOI: 10.1177/15385744231213299] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
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Howard RA, Thelen AE, Chen X, Gates R, Krumm AE, Millis MA, Gupta T, Brown CS, Bandeh-Ahmadi H, Wnuk GM, Yee CC, Ryan AM, Mukherjee B, Dimick JB, George BC. Mortality and Severe Complications Among Newly Graduated Surgeons in the United States. Ann Surg 2024; 279:555-560. [PMID: 37830271 PMCID: PMC10939969 DOI: 10.1097/sla.0000000000006128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To evaluate severe complications and mortality over years of independent practice among general surgeons. BACKGROUND Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons. METHODS We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics. RESULTS The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice. CONCLUSIONS Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.
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Affiliation(s)
- Ryan A Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Angela E Thelen
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Xilin Chen
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Rebecca Gates
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
| | - Michael Andrew Millis
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Tanvi Gupta
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Hoda Bandeh-Ahmadi
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Greg M Wnuk
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Chia Chye Yee
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew M Ryan
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor, MI
| | - Bhramar Mukherjee
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
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17
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Grewal B, Kianercy A, Gerrah R. Characterization of Surgical Movements As a Training Tool for Improving Efficiency. J Surg Res 2024; 296:411-417. [PMID: 38310656 DOI: 10.1016/j.jss.2023.12.053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Surgical experience is often reflected by efficient, fluid, and well-calculated movements. For a new trainee, learning these characteristics is possible only by observation as there is no quantification system to define these factors. We analyzed surgeons' hand movements with different experience levels to characterize their movements according to experience. METHODS Hand motions were recorded by an inertial measurement unit (IMU) mounted on the hands of the surgeons during a simulated surgical procedure. IMU data provided acceleration and Eulerian angles: yaw, roll, and pitch corresponding to hand motions as radial/ulnar deviation, pronation/supination, and extension/flexion, respectively. These variables were graphically depicted and compared between three surgeons. RESULTS Participants were assigned to three groups based on years of surgical experience: group 1: >15 y; group 2: 3-10 y; and group 3: 0-1 y. Visualization of the roll motion, being the main motion during suturing, showed the clear difference in fluidity and regularity of the movements between the groups, showing minimal wasted movements for group 1. The angle of the roll motion, measured at the minimum, midpoint, and maximum points was significantly different between the groups. As expected, the experienced group completed the procedure first; however, the acceleration was not different between the groups. CONCLUSIONS Surgeons' hand movements can be easily characterized and quantified by an IMU device for automatic assessment of surgical skills. These characteristics graphically visualize a surgeon's regularity, fluidity, economy, and efficiency. The characteristics of an experienced surgeon can serve as a training model and as a reference tool for trainees.
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Affiliation(s)
- Bunraj Grewal
- Western University of Health Sciences, College of Osteopathic Medicine, Lebanon, Oregon
| | | | - Rabin Gerrah
- Clinical Assistant Professor of Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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Awad S, Turnnidge J, Cheung JJH, Taylor D, Dalgarno N, Schwartz A. Exploring perspectives of personal learning plans in a residency programme. Clin Teach 2024; 21:e13677. [PMID: 37969042 DOI: 10.1111/tct.13677] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Personal learning plans (PLPs) have gained traction in postgraduate medical education as an avenue for enhancing resident learning. However, implementing PLPs in real-world education settings presents unique challenges. To realise the potential of PLPs, we must understand the factors that influence the quality of PLP implementation. The purpose of this study was to explore the use and implementation of PLPs during residency training from the residents' and academic advisors' perspectives within a competency-based residency programme. METHODS We conducted semi-structured interviews with residents (n = 18) and academic advisors (n = 9) in an Internal Medicine residency programme at a Canadian academic centre. Interviews were audio recorded, transcribed verbatim and analysed using open coding. FINDINGS Three higher order themes were developed to represent the participants' perceptions of implementing PLPs in a competency-based residency programme: (a) setting the stage for learning, (b) fostering meaningful engagement and (c) learning through reflection. Results indicated that implementing PLPs requires collaboration between residents and academic advisors and supports from the broader programme and institution. PLP implementation is an iterative process that can provide a salient avenue for reflection and the development of self-regulation skills. DISCUSSION AND CONCLUSION PLPs can be a useful tool to foster self-regulated learning skills in residency education. It is imperative to consider how social and environmental supports can be enacted to facilitate engagement with, and implementation of, PLPs.
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Affiliation(s)
- Sara Awad
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jennifer Turnnidge
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Jeffrey J H Cheung
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Taylor
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
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Volcevska S, Luck L, Elmir R, Dickens G, Murphy G. Nurses' experiences when conducting the mental state examination (MSE): A scoping review. Int J Ment Health Nurs 2024; 33:224-240. [PMID: 37817424 DOI: 10.1111/inm.13237] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023]
Abstract
The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.
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Affiliation(s)
- Spasija Volcevska
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Lauretta Luck
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
- Nepean Blue Mountain Local Health District, Sydney, New South Wales, Australia
| | - Rakime Elmir
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Geoffrey Dickens
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
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Forbrig TA, Gellert P, Biniok M, Gräske J. [Status of the implementation of simulation-based education in Germany: A cross-sectional study]. Pflege 2024; 37:98-106. [PMID: 37772320 DOI: 10.1024/1012-5302/a000960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.
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Affiliation(s)
- Theresa Adele Forbrig
- Fachbereich II - Gesundheit und Bildung, Alice Salomon Hochschule Berlin, Deutschland
- Institut für Medizinische Soziologie und Rehabilitation, Charité - Universitätsmedizin Berlin, Deutschland
| | - Paul Gellert
- Institut für Medizinische Soziologie und Rehabilitation, Charité - Universitätsmedizin Berlin, Deutschland
| | - Maria Biniok
- Fachbereich II - Gesundheit und Bildung, Alice Salomon Hochschule Berlin, Deutschland
| | - Johannes Gräske
- Fachbereich II - Gesundheit und Bildung, Alice Salomon Hochschule Berlin, Deutschland
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Loeb D, Lautz A, Fleck J, Zackoff M. Experience informed procedural skills training. Clin Teach 2024; 21:e13719. [PMID: 38175794 DOI: 10.1111/tct.13719] [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] [Received: 05/22/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a 3-year fellowship. However, skill acquisition is not uniform. Individualised training, adapted to the unique experiences and requirements of each trainee, may enhance competency. APPROACH An individualised, longitudinal critical procedure course was initiated at a large academic paediatric medical centre in July 2022 for PCC fellows (n = 5). The course, informed by procedural performance profiles (P3) generated through real-time clinical assessments in the paediatric intensive care unit (PICU), was split into three phases: (1) an Initial Simulation Bootcamp-a 2-day introductory session; (2) Quarterly Structured Booster Sessions (QSBS)-spaced repetition of deliberate practice training individualised to each fellow; and (3) an Annual Refresher Training-a core skills and advanced technique training day. EVALUATION Fellows began with minimal experience, which formed their initial P3s. Ninety-two percent (166/180) of bedside procedures received real-time feedback, enabling longitudinal P3 modification, which identified focus areas for the QSBS. The sessions were well attended and received. Eighty-nine percent (QSBS #1 5/5, QSBS #2 3/4) of respondents reflected positively on the course's impact on procedural understanding. The course was perceived as more effective than traditional modalities, except bedside training. IMPLICATION Implementation of a spaced repetition, deliberate practice course informed by longitudinally tracked real-life performance data is feasible for educators and preferred by trainees. This educational construct can be applied to other clinical skills, bringing precision medicine approach to training.
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Affiliation(s)
- Daniel Loeb
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew Lautz
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jacob Fleck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew Zackoff
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Simulation Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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22
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Bruton L, Spewak M. Using simulation to teach paediatric complex care. Clin Teach 2024; 21:e13678. [PMID: 37850234 DOI: 10.1111/tct.13678] [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] [Received: 05/25/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Training paediatric residents regarding the care of children with medical complexity (CMC) remains an important challenge given how frequently these patients are treated by trainees and the lack of educational activities specific to these patients. Our goal was to develop and assess a novel simulation regarding the acute care of CMC to improve residents' perceived confidence in areas related to CMC care. APPROACH We developed a case of a patient with multiple chronic medical conditions who presented with acute vital sign changes and worsening discomfort due to an occult femur fracture related to a recent transfer. Paediatric residents worked in teams to complete a full physical exam, create a differential diagnosis, evaluate laboratory and imaging results and create a management plan. EVALUATION Thirty-three residents out of a total possible sample of 97 (34%) participated in the simulation, which was evaluated using pre- and post-surveys immediately before and after the simulation assessing resident confidence completing tasks related to CMC care. Residents perceived significant improvement in confidence regarding evaluating a differential diagnosis of vital sign and exam changes in CMC (p = 0.023), managing vital sign and exam changes in CMC (p = 0.009) and communicating with team members of CMC (p = 0.049). IMPLICATIONS An innovative high-fidelity and low-stakes simulation was effective in teaching trainees about acute management of concerns related to CMC. This simulation may be appropriate for implementation at other institutions, serving as a foundation for use in resident education regarding CMC.
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Affiliation(s)
- Lucas Bruton
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Spewak
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hospital-Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Granat LM, Ford A, Yim M, Hu B, Wardrop RM, Brateanu A. Consistency in residents assessments: A comparison of the ACGME Milestones 2.0 and 1.0 evaluations. Am J Med Sci 2024; 367:278-280. [PMID: 38278358 DOI: 10.1016/j.amjms.2023.10.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/03/2023] [Accepted: 10/30/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Lauren M Granat
- Department of Internal Medicine, Cleveland Clinic, Internal Medicine Residency Program, 9500 Euclid Avenue, NA 10, Cleveland, OH 44195, United States
| | - Andrew Ford
- Department of Internal Medicine, Cleveland Clinic, Internal Medicine Residency Program, 9500 Euclid Avenue, NA 10, Cleveland, OH 44195, United States
| | - Michael Yim
- Department of Internal Medicine, Cleveland Clinic, Internal Medicine Residency Program, 9500 Euclid Avenue, NA 10, Cleveland, OH 44195, United States
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Richard M Wardrop
- Department of Internal Medicine, Cleveland Clinic, Internal Medicine Residency Program, 9500 Euclid Avenue, NA 10, Cleveland, OH 44195, United States
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Internal Medicine Residency Program, 9500 Euclid Avenue, NA 10, Cleveland, OH 44195, United States.
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Montgomery KB, Mellinger JD, Jones A, McLeod MC, Zmijewski P, Sarosi GA, Brasel KJ, Klingensmith ME, Minter RM, Buyske J, Lindeman B. Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs. J Am Coll Surg 2024; 238:376-384. [PMID: 38224150 PMCID: PMC10942265 DOI: 10.1097/xcs.0000000000000967] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. STUDY DESIGN Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. RESULTS A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). CONCLUSIONS Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.
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Affiliation(s)
| | - John D Mellinger
- American Board of Surgery, Philadelphia, PA
- Department of Surgery, Southern Illinois University, Springfield, IL
| | | | - M Chandler McLeod
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - George A Sarosi
- Department of Surgery, University of Florida, Gainesville, FL
| | - Karen J Brasel
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Mary E Klingensmith
- Accreditation Council for Graduate Medical Education, Chicago, IL
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Donohue K, Davis N, Farber D, Retener N, Dittmar P. An internal medicine residency preparatory curriculum for fourth-year medical students. Clin Teach 2024; 21:e13703. [PMID: 38049309 DOI: 10.1111/tct.13703] [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] [Received: 04/06/2023] [Accepted: 10/09/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Intern preparation courses are often broad in scope; there are few published specialty-specific programs outside of General Surgery and Obstetrics. We designed an internal medicine (IM) residency preparatory course at the University of Maryland School of Medicine, which aimed to prepare graduating medical students for the rigours of IM residency training, mapped to Entrustable Professional Activities (EPAs). METHODS Fourteen fourth-year medical students who were matriculating into IM residency programs enrolled in a 4-week long residency preparation course. The course was designed to teach skills using case-based learning modules, specialty topic seminars, simulation laboratories, procedure laboratories and clinical practice. Participants were surveyed before and after the course on their perceived knowledge and ability with the skills tested. RESULTS With the exception of 'giving signout to a colleague', there was a significant difference in the participant's perceived ability for each skill taught within the course (P < 0.03 for each), with mean pre-course scores of 1.4-3.7 (SD = 0.5-1.2) and mean post-course scores of 3.2-4.2 (SD = 0.5-1.3). A second survey on course evaluation and perceived impact, completed 3 months after starting intern year, resulted in all respondents reporting that the information learned during the course had directly affected their care of patients on a daily or weekly basis. The modified Ottawa scale was the primary assessment means for the EPAs, with participants approaching entrustment at the conclusion of the course. CONCLUSIONS Implementation of an IM-specific residency preparation course is a useful adjunct in the fourth year of medical school.
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Affiliation(s)
- Katelyn Donohue
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dara Farber
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Norman Retener
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Philip Dittmar
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Abstract
Airway management, a defined procedural and cognitive skillset embracing routine tracheal intubation and emergency airway rescue, is most often acquired through an apprenticeship model of opportunistic learning during anesthesia or acute care residency training. This training engages a host of modalities to teach and embed skill sets but is generally time- and location-constrained. Virtual reality (VR)-based simulation training offers the potential for reproducible and asynchronous skill acquisition and maintenance, an advantage that may be important with restricted trainee work hours and low frequency but high-risk events. In the absence of a formal curriculum from training bodies-or expert guidance from medical professional societies-local initiatives have filled the VR training void in an unstructured fashion. We undertook a scoping review to explore current VR-based airway management training programs to assess their approach, outcomes, and technologies to discover programming gaps. English-language publications addressing any aspect of VR simulation training for airway management were identified across PubMed, Embase, and Scopus. Relevant articles were used to craft a scoping review conforming to the Scale for quality Assessment of Narrative Review Articles (SANRA) best-practice guidance. Fifteen studies described VR simulation programs to teach airway management skills, including flexible fibreoptic bronchoscopic intubation (n = 10), direct laryngoscopy (n = 2), and emergency cricothyroidotomy (n = 1). All studies were single institution initiatives and all reported different protocols and end points using bespoke applications of commercial technology or homegrown technologic solutions. VR-based simulation for airway management currently occurs outside of a formal curriculum structure, only for specific skill sets, and without a training pathway for educators. Medical educators with simulation training and medical professional societies with content expertise have the opportunity to develop consensus guidelines that inform training curricula as well as specialty technology use.
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Affiliation(s)
- Caoimhe C Duffy
- From the Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Yi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen O'Sullivan
- Department of Anaesthesia, Intensive Care, and Pain, St. James' Hospital, Dublin, Ireland
- Department of Anaesthesia, Trinity College, Dublin, Ireland
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Skinner CA. ACEM in midlife: Lessons from the emergency medicine building our future summit. Emerg Med Australas 2024; 36:176-177. [PMID: 38494427 DOI: 10.1111/1742-6723.14382] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Clare A Skinner
- Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
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Everett HM, Harrell KN, Giles WH, Bhattacharya SD. The Enneagram as a Tool for Resident Wellness and Correlation With Accreditation Council for Graduate Medical Education Milestone Achievements. J Surg Res 2024; 296:337-342. [PMID: 38306939 DOI: 10.1016/j.jss.2023.12.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 12/03/2023] [Accepted: 12/28/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION The Enneagram is an ancient personality typing system developed to improve self-knowledge. Broken down into nine personality types, each is driven by a core motivating factor. Other personality assessments have been used to study the personality profile of surgeons. The purpose of this study is to evaluate the variability in Enneagram type among a single institution's general surgery residents. METHODS All categorical general surgery residents at a single institution completed an online Enneagram assessment as part of a wellness initiative. Accreditation Council for Graduate Medical Education milestone levels for professionalism (PRO) and interpersonal and communication skills were collected for each resident's intern year. Milestone levels were compared between the nine Enneagram types. RESULTS All nine Enneagram types were represented among surveyed residents. The most frequent Enneagram type was type 3 (20.69%). There was no significant difference between PRO (P = 0.322) and interpersonal and communication skills (P = 0.645) scores among residents distributed by Enneagram type. CONCLUSIONS Regardless of core Enneagram type, general surgery residents in this study all achieved appropriate Accreditation Council for Graduate Medical Education milestone levels for entry level of training. The Enneagram can provide self-awareness and understanding of resident differences but does not impact initial assessment of competency in PRO and interpersonal communication skills.
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Affiliation(s)
- Hayley M Everett
- Department of Surgery, University of Tennessee College of Medicine - Chattanooga, Chattanooga, Tennessee.
| | - Kevin N Harrell
- Department of Surgery, University of Tennessee College of Medicine - Chattanooga, Chattanooga, Tennessee
| | - W Heath Giles
- Department of Surgery, University of Tennessee College of Medicine - Chattanooga, Chattanooga, Tennessee
| | - S Dave Bhattacharya
- Department of Surgery, University of Tennessee College of Medicine - Chattanooga, Chattanooga, Tennessee
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Godfrey CM, Rausch LA, Feurer ID, Rega SA, Shaffer D, DuBray B, Hickman L, Terhune K, Forbes R. Kidney Transplantation Anastomotic Time Is Jointly Associated With Resident and Attending Experience. J Surg Res 2024; 296:541-546. [PMID: 38335902 DOI: 10.1016/j.jss.2024.01.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Few studies evaluate the interplay of attending and resident learning curves in surgical education. Anastomotic time is known to be correlated with transplant outcomes in kidney transplantation. We aimed to evaluate the correlation between the combination of resident and attending experience and anastomotic time in kidney transplantation. METHODS We conducted a single-center retrospective cohort study of deceased donor kidney transplants from 2006 to 2019. To analyze the effect of attending and resident experience, dyads were classified as six combinations of early versus later practice attending and resident postgraduate year (PGY-2, PGY-3, and PGY-4/5). Attendings with less than 3 y of postfellowship practice were considered early practice. Linear mixed effects models tested the effects of attending experience, resident PGY, recipient body mass index, and technical operative characteristics (number of donor arteries, operative side) on anastomosis time. RESULTS The final linear mixed effects model included 1306 transplants. Compared to later practice attendings with PGY-4/5 residents as reference, early practice attendings paired with PGY-2 or PGY-3 residents had longer anastomotic times (P ≤ 0.005) when adjusted for recipient body mass index, number of donor arteries, and transplant side. When PGY-4/5 residents were paired with early practice attendings, no difference in anastomotic time was demonstrated. When paired with later practice attendings, PGY-2 residents had longer anastomotic times (P < 0.001) while PGY-3 anastomotic times did not differ from PGY-4/5. CONCLUSIONS This study demonstrates the correlation between trainee and attending experience jointly and anastomotic time, suggesting that pairing residents and attendings by experience may improve surgical training and potentially patient-related outcomes.
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Affiliation(s)
- Caroline M Godfrey
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Laura A Rausch
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Irene D Feurer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Rega
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Shaffer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bernard DuBray
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura Hickman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyla Terhune
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel Forbes
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Hulbert-Lemmel S, Madhuvu A, Team V. Acute care nurses' experience in providing evidence-based care for patients with laparotomy wounds: A scoping review. Int Wound J 2024; 21:e14591. [PMID: 38151989 DOI: 10.1111/iwj.14591] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023] Open
Abstract
To systematically search and synthesise available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses. Specifically, we focused on wound assessment, infection control techniques, wound products used, escalation of care, dressing application, documentation and holistic care. The Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents directed the review. The methodology framework created by Arksey and O'Malley, updated by Levac et al., and the Joanna Briggs Institute were utilised to assist the scoping review process. Data synthesis was guided by the Theoretical Domains Framework. Six qualitative and mixed methods studies were selected for the review. Most reported barriers and enablers were mapped to knowledge, skills, beliefs about consequences, environmental context and resources and beliefs about capability domains. The main barriers were limited access to and utilisation of wound assessment tools and clinical practice guidelines for wound management and suboptimal time management skills. Inconsistent management of laparotomy wounds was related to ward culture and nurses' lack of knowledge and skills in surgical wound assessment and aseptic technique during wound encounters. The reported enablers were knowledge of multi-factorial risk factors for surgical wound recovery, valuing education and reflective practice and believing that protocols should be utilised alongside comprehensive wound assessments. Holistic wound care included patient education on the role of mobilisation and nutrition in wound healing. Acute care nurses do not routinely incorporate comprehensive, evidence-based care recommendations for laparotomy wound management. Further research on evidence-based care behaviours in managing laparotomy wounds is required. The results indicate a need for standardising the practice of laparotomy wound management while acknowledging the current challenges faced in the ward environment.
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Affiliation(s)
- Sarah Hulbert-Lemmel
- Monash University, Nursing and Midwifery, Peninsula Campus, Frankston, Victoria, Australia
| | - Auxillia Madhuvu
- Monash University, Nursing and Midwifery, Peninsula Campus, Frankston, Victoria, Australia
| | - Victoria Team
- Monash University, Nursing and Midwifery Clayton Campus, Clayton, Victoria, Australia
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Fuller SL, Ambardekar AP, Diachun CAB, Kearney MD, Long TR, Miller Juve AK, Mitchell JD, Woodworth GE. Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions. Anesth Analg 2024; 138:848-855. [PMID: 37450642 DOI: 10.1213/ane.0000000000006625] [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: 07/18/2023]
Abstract
BACKGROUND Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. METHODS Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. RESULTS A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CONCLUSIONS CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT.
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Affiliation(s)
- Skylar L Fuller
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Carol Ann B Diachun
- Department of Anesthesiology, University of Florida-Jacksonville, Jacksonville, Florida
| | - Matthew D Kearney
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Timothy R Long
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy K Miller Juve
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Mitchell
- Department of Anesthesiology, Critical Care, and Perioperative Medicine, Henry Ford Health, Detroit, Michigan
| | - Glenn E Woodworth
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
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Wesemann D, Convoy S, Goldstein D, Melino K. How PMHNP Program Directors Facilitate Psychotherapeutic Skill Acquisition. J Am Psychiatr Nurses Assoc 2024; 30:288-299. [PMID: 35923067 DOI: 10.1177/10783903221091980] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of psychotherapy has a long history within psychiatric-mental health nurse practitioner (PMHNP) practice. Underutilization of psychotherapy in practice has potentially led to a reduced emphasis in the PMHNP curriculum. To date, no national survey has solely evaluated how PMHNP programs ensure psychotherapy skill acquisition. AIMS Survey the PMHNP programs within the United States on how psychotherapy skill acquisition is achieved, including (a) psychotherapeutic curricular content; (b) psychotherapy related clinical practicum hours, including simulation and preceptor-delivered hours; and (c) student interest in psychotherapy skills. METHOD Three rounds of e-mail invitations were sent to all PMHNP programs within the United States. Descriptive statistics and reflective thematic analysis were used to examine survey content. RESULTS There were 39 (27%) respondents, representing the U.S. regions equally. The most common forms of psychotherapy taught were cognitive-behavioral and motivational interviewing. The content was most often delivered through a hybrid program (65.8%). Psychotherapy clinical hours most often used in psychology and social work were varied (0-720, SD 132.9) and were usually (63.89%) separate from other clinical hours. Qualitative responses focused on increased emphasis on the use of psychotherapy within PMHNP programs and the need to develop competency checklists for psychotherapy skill acquisition to use with simulation. CONCLUSION This survey reported on both similarities and differences in how PMHNP programs ensure student competency in the skill acquisition of psychotherapy. While this article focuses on what skills are needed in psychotherapy education, direction on how programs deliver this content to their students to ensure this skill will be retained in practice is a critical next step.
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Affiliation(s)
- Daniel Wesemann
- Daniel Wesemann, DNP, MSW, APRN, PMHNP-BC, University of Iowa, Moline, IL, USA
| | - Sean Convoy
- Sean Convoy, DNP, PMHNP-BC, Duke School of Nursing, Durham, NC, USA
| | - Dawn Goldstein
- Dawn Goldstein, PhD, RN, PMHNP-BC, Psychiatric Mental Health Nurse Practitioner, Michigan State University, East Lansing, MI, USA
| | - Kate Melino
- Katerina Melino, MS, PMHNP-BC, University of California San Francisco, San Francisco, CA, USA
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Duprez V, Dhont L, van der Cingel M, Hafsteinsdóttir TB, Malfait S. Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review. J Adv Nurs 2024; 80:1248-1261. [PMID: 37849078 DOI: 10.1111/jan.15902] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION Prospero ID CRD42021292290.
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Affiliation(s)
- Veerle Duprez
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Laure Dhont
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Margreet van der Cingel
- Professorship Nursing Leadership and Research, NHL-Stenden University of Applied Sciences and Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Thóra B Hafsteinsdóttir
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Simon Malfait
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and health sciences, Ghent University, Ghent, Belgium
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Ingoglia C. Celebrating the Milestones to Integrated Care. J Behav Health Serv Res 2024; 51:147-150. [PMID: 38438688 DOI: 10.1007/s11414-024-09880-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Chuck Ingoglia
- National Council for Mental Wellbeing, Washington, DC, USA.
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Nguyen B, Solanki J, Ong E. Exploring pharmacists' perceptions of using a clinical supervision skills competency tool to reflect and develop their supervisory practices. Curr Pharm Teach Learn 2024; 16:231-243. [PMID: 38458841 DOI: 10.1016/j.cptl.2024.02.002] [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: 02/26/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION To date, there are no formal self-reflection tools routinely used by pharmacists within the Australian pharmacy profession. The study involved utilizing the Clinical Supervision Skills Competency Tool (CSSCT) at a metropolitan teaching hospital in Victoria, Australia. It explored pharmacists' perceptions of the CSSCT and its impact on their ability to self-reflect and develop their supervisory practices. METHODS The qualitative study involved adapting the Clinical Supervision Skills Review Tool (CSRT), a clinician-validated tool. Prior to tool completion, participants attended an orientation session on the CSSCT. Thematic analysis and an inductive approach was then applied to data collected from two semi-structured focus group sessions and an online survey, for those not able to attend the focus groups. RESULTS A total of 19 pharmacists were recruited and completed the CSSCT. The three major themes regarding the CSSCT identified were: feasibility of the tool, aspects of the CSSCT, and future planning. Use of rating scales and breakdown of the supervisory competencies were perceived to be helpful. Conversely, the tool's length, pharmacists' high workloads and time pressures, were identified as potential barriers to using the tool. CONCLUSIONS Given pharmacists internationally currently lack a formal tool to enhance their supervisory methods, the CSSCT or similar tools emerge as valuable resources for steering pharmacists towards self-reflection and goal setting. Notably, the CSSCT sheds light on previously overlooked yet critical aspects of clinical supervision in the pharmacy context, including the wellbeing and cultural sensitivity of learners.
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Affiliation(s)
- Bill Nguyen
- Monash Health, Monash Medical Centre, Pharmacy Department, 246 Clayton Rd, Clayton, VIC 3168, Australia.
| | - Janki Solanki
- Monash Health, Monash Medical Centre, Pharmacy Department, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Eugene Ong
- Monash Health, Monash Medical Centre, Pharmacy Department, 246 Clayton Rd, Clayton, VIC 3168, Australia
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Schmidbauer ML, Pinilla S, Kunst S, Biesalski AS, Bösel J, Niesen WD, Schramm P, Wartenberg K, Dimitriadis K. Fit for Service: Preparing Residents for Neurointensive Care with Entrustable Professional Activities: A Delphi Study. Neurocrit Care 2024; 40:645-653. [PMID: 37498455 PMCID: PMC10959831 DOI: 10.1007/s12028-023-01799-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Although the relevance of neurointensive medicine and high-quality training of corresponding physicians is increasingly recognized, there is high heterogeneity in the nature, duration, and quality of neurointensive care curricula around the world. Thus, we aimed to identify, define, and establish validity evidence for entrustable professional activities (EPAs) for postgraduate training in neurointensive care to determine trainees' readiness for being on-call. METHODS After defining EPAs through an iterative process by an expert group, we used a modified Delphi approach with a single-center development process followed by a national consensus and a single-center validation step. EPAs were evaluated by using the EQual rubric (Queen's EPA Quality Rubric). Interrater reliability was measured with Krippendorff's α. RESULTS The expert group defined seven preliminary EPAs for neurointensive care. In two consecutive Delphi rounds, EPAs were adapted, and consensus was reached for level of entrustment and time of expiration. Ultimately, EPAs reached a high EQual score of 4.5 of 5 and above. Interrater reliability for the EQual scoring was 0.8. CONCLUSIONS Using a multistep Delphi process, we defined and established validity evidence for seven EPAs for neurointensive medicine with a high degree of consensus to objectively describe readiness for on-call duty in neurointensive care. This operationalization of pivotal clinical tasks may help to better train clinical residents in neurointensive care across sites and health care systems and has the potential to serve as a blueprint for training in general intensive care medicine. It also represents a starting point for further research and development of medical curricula.
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Affiliation(s)
| | - Severin Pinilla
- University Hospital for Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Stefan Kunst
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anne-Sophie Biesalski
- Department of Neurology, Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Germany
| | - Julian Bösel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Freiburg, Germany
| | - Patrick Schramm
- Department of Neurology, Universitätsklinikum Giessen und Marburg, Standort Giessen, Justus-Liebig-University, Giessen, Germany
| | - Katja Wartenberg
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.
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Simpson AI, Sarode D, Boote T, Lockington D. Attitudes and access to surgical video recording among ophthalmology trainees in Scotland. J Cataract Refract Surg 2024; 50:426-427. [PMID: 38523278 DOI: 10.1097/j.jcrs.0000000000001376] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/21/2023] [Indexed: 03/26/2024]
Affiliation(s)
- Alasdair Innes Simpson
- From the Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
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Leeper WR, James N. Trauma Bay Evaluation and Resuscitative Decision-Making. Surg Clin North Am 2024; 104:293-309. [PMID: 38453303 DOI: 10.1016/j.suc.2024.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The reader of this article will now have the ability to reflect on all aspects of high-quality trauma bay care, from resuscitation to diagnosis and leadership to debriefing. Although there is no replacement for experience, both clinically and in a simulation environment, trauma clinicians are encouraged to make use of this article both as a primer at the beginning of a trauma rotation and a reference text to revisit after difficult cases in the trauma bay. Also, periods of reflection seem appropriate in the busy but, of course, rewarding career in trauma care.
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Affiliation(s)
- William Robert Leeper
- Department of Surgery, Western University, Victoria Campus, London Health Sciences Center, Room E2-215, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Division of Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas James
- London Health Sciences Center, Victoria Campus, Room E2-214, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Spencer B, Moreci R, Weller J, Evans J, Modi BP, Gray B, Ehrlich P, Ladd A, Lillehei C, Alaish S, Gadepalli S, Hirschl RB, Newman E, Zendejas B, Sandhu G. Defining Practice Readiness in Pediatric Surgery Fellowship: A Qualitative Analysis. J Surg Educ 2024; 81:503-513. [PMID: 38403502 DOI: 10.1016/j.jsurg.2024.01.003] [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: 07/03/2023] [Revised: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION While competency-based training is at the forefront of educational innovation in General Surgery, Pediatric Surgery training programs should not wait for downstream changes. There is currently no consensus on what it means for a pediatric surgery fellow to be "practice-ready". In this study, we aimed to provide a framework for better defining competency and practice readiness in a way that can support the Milestones system and allow for improved assessment of pediatric surgery fellows. METHODS For this exploratory qualitative study, we developed an interview guide with nine questions focused on how faculty recognize competency and advance autonomy among pediatric surgery fellows. Demographic information was collected using an anonymous online survey platform. We iteratively reviewed data from each interview to ensure adequate information power was achieved to answer the research question. We used inductive reasoning and thematic analysis to determine appropriate codes. Additionally, the Dreyfus model was used as a framework to guide interpretation and contextualize the responses. Through this method, we generated common themes. RESULTS A total of 19 pediatric surgeons were interviewed. We identified four major themes from 127 codes that practicing pediatric surgeons associate with practice-readiness of a fellow: skill-based competency, the recognition and benefits of struggle, developing expertise and facilitating autonomy, and difficulties in variability of evaluation. While variability in evaluation is not typically included in the concept of practice readiness, assessment and evaluation were described by study participants as essential aspects of how practicing pediatric surgeons perceive practice readiness and competency in pediatric surgery fellows. Competency was further divided into interpersonal versus technical skills. Sub-themes within struggle included personal and professional struggle, benefits of struggle and how to identify and assist those who are struggling. Autonomy was commonly stated as variable based on the attending. CONCLUSION Our analysis yielded several themes associated with practice readiness of pediatric surgery fellows. We aim to further refine our list of themes using the Dreyfus Model as our interpretive framework and establish consensus amongst the community of pediatric surgeons in order to define competency and key elements that make a fellow practice-ready. Further work will then focus on establishing assessment metrics and educational interventions directed at achieving such key elements.
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Affiliation(s)
- Brianna Spencer
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
| | - Rebecca Moreci
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennine Weller
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Evans
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Biren P Modi
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Gray
- Division of Pediatric General Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Alan Ladd
- Division of Pediatric General Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Craig Lillehei
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Alaish
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samir Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Erika Newman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Benjamin Zendejas
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Bolton L, Young K, Ray J, Chawdhary G. Virtual temporal bone simulators and their use in surgical training: a narrative review. J Laryngol Otol 2024; 138:356-360. [PMID: 37973532 DOI: 10.1017/s0022215123002025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Temporal bone dissection is a difficult skill to acquire, and the challenge has recently been further compounded by a reduction in conventional surgical training opportunities during the coronavirus disease 2019 pandemic. Consequently, there has been renewed interest in ear simulation as an adjunct to surgical training for trainees. We review the state-of-the-art virtual temporal bone simulators for surgical training. MATERIALS AND METHODS A narrative review of the current literature was performed following a Medline search using a pre-determined search strategy. RESULTS AND ANALYSIS Sixty-one studies were included. There are five validated temporal bone simulators: Voxel-Man, CardinalSim, Ohio State University Simulator, Melbourne University's Virtual Reality Surgical Simulation and Visible Ear Simulator. The merits of each have been reviewed, alongside their role in surgical training. CONCLUSION Temporal bone simulators have been demonstrated to be useful adjuncts to conventional surgical training methods and are likely to play an increasing role in the future.
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Affiliation(s)
- Lauren Bolton
- ENT Offices, York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York UK
| | - Kenneth Young
- ENT, Castle Hill Hospital, Hull University Teaching Hospital, Hull, UK
| | - Jaydip Ray
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gaurav Chawdhary
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Crowder V, Brady V, Johnson C, Whisenant M. Patient competence in chronic illness: A concept derivation. J Clin Nurs 2024; 33:1575-1581. [PMID: 38178571 DOI: 10.1111/jocn.16984] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
AIMS AND OBJECTIVES This paper aims to inform nursing and other healthcare disciplines by clearly defining patient competence and the skills required to improve self-care behaviours. BACKGROUND Competence has been defined in education and leadership. However, competence in persons with chronic disease has not been expanded upon since one publication in 1983. Patient competence needs to be developed and defined so that healthcare disciplines can understand the attributes necessary for a patient to be deemed competent to promote self-care behaviours. DESIGN A concept derivation. METHODS Walker and Avant's approach to concept derivation was used to identify a base concept (competence) that is well-defined in another field, define the concepts associated with the parent field, and transpose that definition to a new field to formulate a redefined concept. PsycINFO, Scopus, Web of Science and Medline were searched, and 21 articles were included. RESULTS Patient competence is defined as the ability of a person with a chronic illness to reach skill mastery, achieve knowledge, maintain a positive attitude and develop trust in themselves and in healthcare providers that will facilitate active engagement to improve self-care behaviours. CONCLUSIONS Defining patient competence is important in assisting nurses and other healthcare providers in understanding the attributes needed to deem a patient competent, especially those living with chronic illnesses requiring lifelong self-care behaviours. More research is needed to aid in the designing of a precise instrument for measuring this phenomenon. RELEVANCE TO CLINICAL PRACTICE Concept derivation of patient competence provides a framework for nurses and other members of the healthcare profession to understand the attributes needed to determine patient competence.
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Affiliation(s)
- Vivian Crowder
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Veronica Brady
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Constance Johnson
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Meagan Whisenant
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Conway KA, Scoloveno RL. The Use of Standardized Patients as an Educational Strategy in Baccalaureate Psychiatric Nursing Simulation: A Mixed Method Pilot Study. J Am Psychiatr Nurses Assoc 2024; 30:414-417. [PMID: 35673847 DOI: 10.1177/10783903221101049] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Prior psychiatric simulation experiences required our nursing students to role-play in an unknown area of nursing. Students confidence, clinical satisfaction, and use of clinical skills were negatively impacted leading to unmet course objectives. The aim of this pilot study was to strengthen our baccalaureate senior nursing students' simulation experience in their psychiatric nursing course with the use of standardized patients (SPs) instead of student role-play and measure the impact of this strategy on students' learning, satisfaction, and confidence in an unfamiliar area of nursing. METHODS A mixed method explanatory sequential design was used. Participants consisted of a convenience sample of senior nursing students enrolled in their psychiatric nursing course. A quantitative simulation tool and a four-item questionnaire were analyzed after completion of the simulations (n = 47). RESULTS Findings of this study identified greater than 80% of students had increased level of learning, confidence, and satisfaction with the SP simulation experience. Nurse faculty were able to overcome simulation barriers, that is, a patient hearing voices, non-verbal signs of depression, and evaluate students meeting course learning outcomes. CONCLUSIONS Findings from this study highlight students' positive simulation experiences. Using SPs as an educational strategy can be effective for students to reach competency, achieve higher knowledge, and improve confidence. It is believed the use of SPs as a simulation strategy in psychiatric nursing will assist students with clinical judgment and better prepare them to meet the needs of vulnerable persons with psychiatric conditions.
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Affiliation(s)
- Kimberly A Conway
- Kimberly A Conway, PHD, RN-BC, CNE, Seton Hall University, Nutley, NJ, USA
| | - Robert L Scoloveno
- Robert L. Scoloveno, PhD, RN, CCRN, Seton Hall University, Nutley, NJ, USA
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Chang SY, Chan KS, Oo AM. Can Computerized Simulation be Used to Assess Surgical Proficiency in Laparoscopic Colorectal Surgeries? A Systematic Review. Surg Innov 2024; 31:195-211. [PMID: 38373603 DOI: 10.1177/15533506241232791] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Computerized simulation (CS) of surgery in virtual reality (VR), augmented reality (AR) and mixed reality (MR) settings are used to teach foundational skills, but its applicability in advanced training is to be determined. This review aims to summarize the types of CS available for laparoscopic colorectal surgery (CRS) and its utility in assessment of proficiency. METHODS A systematic review of CS in laparoscopic CRS was done on PubMed, Embase, Scopus and Cochrane Library databases. RESULTS Eleven relevant observational studies were identified. The most common procedure simulated was laparoscopic colectomy. Assessment using performance metrics measured by the simulator such as path length moved by laparoscopic tools, procedure time and number of discrete movements had the most consistent differentiating ability between expert and non-expert cohorts. Surgeons fared similarly in proficiency scores in assessment with CS compared to assessment with traditional cadaveric or porcine models. CONCLUSION CS of laparoscopic CRS may be used in assessment of proficiency using performance metrics measuring economy of movement. CS may be a viable assessment tool in advanced surgical training, but further studies should assess utility of incorporating it as a formal assessment tool in training programs.
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Affiliation(s)
- Si Yuan Chang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- MOH Holdings Pte Ltd, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Aung Myint Oo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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O'Connell AC, Olegário IC. International teaching practices in dental trauma education. Dent Traumatol 2024; 40:152-160. [PMID: 37915297 DOI: 10.1111/edt.12906] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Several publications highlight the insufficient knowledge possessed by dentists and dental students regarding the management of traumatic dental injuries (TDIs). A lack of clinical experience during Undergraduate (UG) education could explain the reported deficits in managing dental trauma post-graduation. Despite its importance in dentistry, there are very few reports on how, where and who teaches Dental Traumatology (DT) in the UG curriculum. The aim of this study was to investigate teaching practices in DT around the world in UG education. MATERIALS AND METHODS UG educators involved in DT teaching activities were invited to complete an online questionnaire hosted on Qualtrics®. The survey consisted of close-ended and open-ended questions on their teaching practices in DT. Only one answer per institution was included in the final descriptive analysis. RESULTS A total of 203 responses from 164 institutions were obtained from 69 countries. All institutions reported that DT is included in their UG curriculum, and is mainly taught within Paediatric Dentistry and Endodontics. Most teaching and evaluation was delivered in traditional format. The number of contact hours dedicated to DT teaching activities ranged from 2 to 185 h (median = 10). Only 35% of institutions had a unified approach across disciplines. DT was taught as a separate course/module in 23% of the universities. Insufficient exposure to emergency care and the lack of formal clinical exposure to TDI was highlighted by many institutions. The need for a core curriculum was supported by 84% of the institutions with agreement on essential topics required at UG level. CONCLUSIONS Teaching practices in DT varied internationally. Very few teaching hours were devoted to DT and many institutions identified a need for increased clinical exposure. There was a desire for a standardised coherent approach to DT in the UG education with suggestions to improve educational resources.
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Affiliation(s)
- Anne C O'Connell
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Isabel C Olegário
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Dublin, Ireland
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Tellez JC, Radi I, Alterio RE, Nagaraj MB, Baker HB, Scott DJ, Zeh HJ, Polanco PM. Proficiency Levels and Validity Evidence for Scoring Metrics for a Virtual Reality and Inanimate Robotic Surgery Simulation Curriculum. J Surg Educ 2024; 81:589-596. [PMID: 38403503 DOI: 10.1016/j.jsurg.2024.01.004] [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: 07/23/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Our institution recently implemented a virtual reality (VR) skills curriculum for general surgery residents using the SimNow simulator. Based on a content alignment study, we revised the curriculum to include only 20 of 33 VR tasks and we added 3 previously validated inanimate tasks. The purpose of this study was to establish expert-derived proficiency levels for all tasks and to evaluate the validity of the scoring for the VR tasks. DESIGN Two expert robotic surgeons performed 5 repetitions of each VR and inanimate task. The trimmed mean (lowest scoring attempt and outliers [>2 standard deviations] were eliminated) was defined as the expert level for each task. For the VR tasks, expert levels were compared to resident performance to evaluate validity. SETTING This study was conducted at the University of Texas Southwestern Medical Center (Dallas, TX), a tertiary care academic teaching hospital. PARTICIPANTS Two expert robotic surgeons participated in this study. The data from 42 residents (PGY2-4) who completed the original curriculum was used to represent novice performance. RESULTS Comparison of expert levels and resident performance was statistically significant for 15 VR tasks (supporting validity) and approached significance (p = 0.06, 0.09) for 2 VR tasks; expert levels were designated as proficiency levels for these 17 tasks. Group comparisons were clearly not significant (p = 0.2-0.8) for 3 VR tasks; 2 of these 3 tasks were retained as introductory exercises (with 3 repetitions required) and 1 was excluded. For the 3 inanimate tasks, expert levels minus 2 standard deviations were designated as proficiency levels. CONCLUSIONS This analysis generated validity evidence for 15 VR tasks and established expert-derived proficiency levels for 17 VR tasks and 3 inanimate tasks. Our proposed curriculum now consists of 19 VR and 3 inanimate tasks using the selected proficiency levels. We anticipate that this design will maximize curriculum efficiency and effectiveness.
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Affiliation(s)
- Juan C Tellez
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imad Radi
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Rodrigo E Alterio
- Department of Surgery, Florida Atlantic University, Boca Raton, Florida
| | - Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haley B Baker
- Department of Otolaryngology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Jones B, Asberry C. Transitions in Video Laryngoscope Technology to Improve First-Pass Success. Crit Care Nurs Q 2024; 47:152-156. [PMID: 38419178 DOI: 10.1097/cnq.0000000000000505] [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: 03/02/2024]
Abstract
Prehospital intubation is a high-risk, relatively low frequency procedure. Provider experience plays a key role in first-pass success rates, especially in the setting of a difficult airway. While strong foundational knowledge is necessary to equip providers with an adequate understanding of intubation procedures and the skill set needed to manage a difficult airway, effective equipment may provide an extra boost in first-pass success for novice airway providers. First-pass success is correlated with decreased adverse events and should be maximized in the prehospital setting. After evaluating overall first-pass success of 66% to 83% from 2016 to 2020, AHN LifeFlight enacted changes in education, training, and video laryngoscopy equipment to successfully increase first-pass success to over 90%.
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Affiliation(s)
- Brandon Jones
- Allegheny General Hospital, Pittsburgh, Pennsylvania
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Balvardi S, Kaneva P, Semsar-Kazerooni K, Vassiliou M, Al Mahroos M, Mueller C, Fiore JF, Schwartzman K, Feldman LS. Effect of video-based self-reflection on intraoperative skills: A pilot randomized controlled trial. Surgery 2024; 175:1021-1028. [PMID: 38154996 DOI: 10.1016/j.surg.2023.11.028] [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] [Received: 06/09/2023] [Revised: 10/13/2023] [Accepted: 11/26/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based self-assessment to improve surgical performance of laparoscopic cholecystectomy in trainees. METHODS This parallel pilot randomized controlled trial included general surgery trainees performing supervised laparoscopic cholecystectomy randomized 1:1 to control (traditional intraoperative teaching) or intervention group (traditional teaching plus video-based self-assessment). Operative performance was measured by the attending surgeon blinded to group assignment at the time of surgery using standardized assessment tools (Global Operative Assessment of Laparoscopic Skills and Operative Performance Rating System). The intervention group had access to their video recordings on a web-based platform for review and self-assessment using the same instruments. The primary outcome for the estimation of sample size was the difference in faculty-assessed final operative performance (third submitted case). Feasibility criteria included >85% participation, >85% adherence to case submission and >85% completion of self-assessment. RESULTS Of 37 eligible trainees approached, 32 consented and were randomized (86%). There were 16 in the intervention group, 15 in the control group (55% male, 55% junior trainees), and 1 was excluded for protocol violation. Twenty-four (75%) of participants submitted 3 cases. Thirteen trainees (81%) accessed the platform and completed 26 (63.2%) case self-assessments. Fifty-five trainees per arm will be needed to power a full-scale laparoscopic cholecystectomy with Global Operative Assessment of Laparoscopic Skills and 130 trainees per arm with Operative Performance Rating System as the assessment tool. CONCLUSION This pilot study contributes important data to inform the design of an adequately powered randomized controlled trial of video-based self-assessment to improve trainee performance of laparoscopic cholecystectomy. Although a priori trial feasibility criteria were not achieved, automated video capture and storage could significantly improve adherence in future trials.
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Affiliation(s)
- Saba Balvardi
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Koorosh Semsar-Kazerooni
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melina Vassiliou
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Carmen Mueller
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kevin Schwartzman
- Respiratory Division, Department of Medicine, McGill University and McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
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Stem JM, Greenberg CC. Coaching your faculty and yourself. Surgery 2024; 175:1247-1249. [PMID: 38246838 DOI: 10.1016/j.surg.2023.11.034] [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] [Received: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024]
Abstract
Surgical skills vary drastically among practicing surgeons. This variation in skill has been demonstrated to translate directly into patient outcomes, highlighting the importance of skill development. Despite this, directed efforts to improve surgical skills and performance among practicing surgeons remain limited. The development of surgical coaching programs offers an exciting opportunity for surgeon performance improvement and lifelong development. In this article, we will discuss the promise of surgical coaching programs, some of the challenges met when developing a program, and future avenues and opportunities for growth within the field.
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Affiliation(s)
- Jonathan M Stem
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
| | - Caprice C Greenberg
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Acker RC, Kelz RR. Cutting Through the Learning Curve: The New Surgeon Battle Between Inexperience and Competence. Ann Surg 2024; 279:561-562. [PMID: 38116655 DOI: 10.1097/sla.0000000000006186] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Rachael C Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
- Leonard David Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, PA
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50
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Guo W, Liu X, Zhang Y, Chen R, Qi W, Deng J, Cui J. Competence and perceptions of spiritual care among clinical nurses: A multicentre cross-sectional study. J Clin Nurs 2024; 33:1432-1443. [PMID: 37994280 DOI: 10.1111/jocn.16932] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
AIMS To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors. BACKGROUND Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking. DESIGN Multicentre cross-sectional study. METHODS Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care-Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence. RESULTS In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care-related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence. CONCLUSIONS There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses. RELEVANCE TO CLINICAL PRACTICE The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training. REPORTING METHOD EQUATOR guidelines, STROBE checklist: cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION All participants were clinical nurses. Participants were informed they could withdraw from the study at any time.
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Affiliation(s)
- Wei Guo
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Xue Liu
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Yi Zhang
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Runan Chen
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Wenqian Qi
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Jiajia Deng
- Department of Nursing, Naval Medical University, Shanghai, China
| | - Jing Cui
- Department of Nursing, Naval Medical University, Shanghai, China
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