Simulation of Pediatric Life-Threatening Emergency Scenarios (SimPLES): The Development, Implementation, and Evaluation of an Undergraduate Immersive Simulation-Based Educational Intervention

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
Prashant Kumar ◽  
Simon Chitnis ◽  
Louise Lawrence ◽  
Niamh Langasco ◽  
Neil McGowan
Keyword(s):  
Medical Students ◽  
Pediatric Patients ◽  
Course Design ◽  
Medical Training ◽  
Technical Skills ◽  
Free Text ◽  
Simulation Based ◽  
Clinical Workplace ◽  
Emergency Scenarios ◽  
The Impact

Background: Clinical exposure to acutely unwell pediatric patients is often limited during undergraduate medical training. Although limited within undergraduate pediatric curricula, simulation-based education (SBE) offers a tool with which such exposure can be achieved in a safe and effective learning environment. This study describes the development, implementation, and evaluation of an undergraduate multi-center immersive pediatric SBE course. Objectives: We sought to increase medical students’ exposure to acutely unwell pediatric patients and provide practical experience to improve their understanding of the importance of non-technical skills within the clinical workplace, such as teamwork, communication skills, leadership, and situational awareness. Furthermore, we sought to evaluate the impact on students’ confidence in assessing and managing acutely unwell pediatric patients while exploring their perceptions and opinions of the course. Methods: The present study included all final-year students who were on a pediatric clinical placement during the study period. Tutorials on pediatric A-E assessment and fluid management were followed by a series of immersive simulation scenarios and structured debriefs, concentrating on the importance of non-technical skills in the clinical workplace. Also, some mini-tutorials were incorporated into the course design, focussing on the technical and pathophysiological aspects of each presentation. We employed a mixed-method research methodology to evaluate the impact of the course. Also, anonymized post-course and free-text feedback was sought to explore students’ experiences and perceptions of the course. Results: All 80 students completed the pre and post-course confidence questionnaires, reporting statistically significant improvements in confidence across all 11 domains tested. Thematic analysis of the qualitative data identified six core themes: knowledge acquisition, the value of debriefing, the importance of non-technical skills, the value of faculty expertise, the value of repeated practice, and opportunities for exposure to pediatrics. The innovative post-scenario mini-tutorials were favorably received. Conclusions: Our study shows that immersive SBE can improve medical students’ confidence in managing pediatric emergency scenarios. Also, incorporating mini-tutorials within an immersive simulation course design in an undergraduate setting can be helpful and well received by students.

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

scholarly journals ¿Cómo entrenar una habilidad compleja en cirugía?: Evaluación cualitativa de una estrategia basada en simulación

2021 ◽  
Vol 113 (1) ◽  
pp. 101-110
Author(s):  
Juan I. Cobián ◽  
◽  
Federico Ferrero ◽  
Martín P. Alonso ◽  
Alberto M. Fontana
Keyword(s):  
Work Teams ◽  
Technical Skills ◽  
Role Playing ◽  
Professional Activity ◽  
High Fidelity Simulation ◽  
Future Studies ◽  
Raising Awareness ◽  
Simulation Based ◽  
Overall Performance ◽  
The Impact

Background: Learning complex tasks in surgical requires the coordination and integration of technical and non-technical skills have an impact on the performance of work teams. Objective: The aim of this study is to report the results of a simulation-based educational strategy for training in complex surgical skills considering the participants’ perceptions. Material and methods: In 2019, 10 healthcare professionals participated in a 20-hour course divided in 6 hours of online training and 14 hours of onsite training. The strategy designed included the integration of case resolution activities, role-playing, practice with synthetic and virtual simulators and high-fidelity simulation. At the end of the course, a questionnaire was administered to explore participants’ perceptions on what they had learned and on their attitude changes. Results: Fifty percent of the participants perceived their skills and knowledge improved at the end of the course compared with their perception at the beginning of the course while 80% perceived the impact of the course on their professional activity was good or excellent. All the participants agreed with the need for improving non-technical skills. The experience was rated as positive or very positive by all participants, who were eager to repeat it. Conclusion: The participants’ perceptions of this educational program demonstrates that this method is highly accepted. Raising awareness of non-technical skills during the reflection stage suggests the need for changes in attitude and in self-perception of efficacy. We believe that simulation-based training offers the possibility of improving the overall performance of the surgical team. Future studies should focus on this goal.

scholarly journals Balancing Forces: Medical Students’ Reflections on Professionalism Challenges and Professional Identity Formation

2021 ◽  
Vol 53 (3) ◽  
pp. 200-206
Author(s):  
Amrapali Maitra ◽  
Steven Lin ◽  
Tracy A. Rydel ◽  
Erika Schillinger
Keyword(s):  
Medical Students ◽  
Professional Identity ◽  
Identity Formation ◽  
Medical Training ◽  
Health Care Team ◽  
Free Text ◽  
Self Awareness ◽  
Theory Approach ◽  
Professional Identity Formation ◽  
Medicine Clerkship

Background and Objectives: Professionalism is essential in medical education, yet how it is embodied through medical students’ lived experiences remains elusive. Little research exists on how students perceive professionalism and the barriers they encounter. This study examines attitudes toward professionalism through students’ written reflections. Methods: Family medicine clerkship students at Stanford University School of Medicine answered the following prompt: “Log a patient encounter in which you experienced a professionalism challenge or improvement opportunity.” We collected and analyzed free-text responses for content and themes using a grounded theory approach. Results: One hundred responses from 106 students generated a total of 168 codes; 13 themes emerged across four domains: challenging patients, interpersonal interactions, self-awareness, and health care team dynamics. The three most frequently occurring themes were interacting with emotional patients, managing expectations in the encounter, and navigating the trainee role. Conclusions: Medical students view professionalism as a balance of forces. While many students conceived of professionalism in relation to patient encounters, they also described how professionalism manifests in inner qualities as well as in health systems. Interpersonal challenges related to communication and agenda-setting are predominant. Systems challenges include not being seen as the “real doctor” and being shaped by team behaviors through the hidden curriculum. Our findings highlight salient professionalism challenges and identity conflicts for medical students and suggest potential educational strategies such as intentional coaching and role-modeling by faculty. Overall, students’ reflections broaden our understanding of professional identity formation in medical training.

scholarly journals 729 “I Don’t Feel Like I’m Learning How to Be A Doctor:” The Impact of Disruptions Due to Covid-19 On Professional Identity Formation in UK Medical Students

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Harvey ◽  
M E L Brown ◽  
M H V Byrne ◽  
J Ashcroft ◽  
J C M Wan ◽  
...  
Keyword(s):  
Medical Students ◽  
Professional Identity ◽  
Identity Formation ◽  
Medical Training ◽  
Professional Identity Formation ◽  
Clinical Environment ◽  
Clinical Exposure ◽  
Open Questions ◽  
Qualitative Responses ◽  
The Impact

Abstract Introduction Professional identity formation (PIF) is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted PIF through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between activities. Method A pragmatic survey was distributed in spring 2020. Thematic analysis was performed of qualitative responses to two open questions. A social constructivist approach linked participants’ comments to PIF theory. Results We analysed 928 responses. Three themes surrounding students’ activities during covid-19 and their impact on identity were constructed: Conflict arose at the intersections between these themes. Students noted lack of clinical exposure was detrimental, implicitly recognising that aspects of PIF require the clinical environment. Participants were keen to volunteer but struggled with balancing academic work. Participants worried about risk to their households and the wider community and wanted their skills to add value in the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. Conflict arises when different aspects of their identity demand different actions. Care must be taken to nurture PIF during periods of disruption.

scholarly journals Impact of the COVID-19 pandemic on the clinical training of last year medical students in Mexico: a cross-sectional nationwide study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Maximiliano Servin-Rojas ◽  
Antonio Olivas-Martinez ◽  
Michelle Dithurbide-Hernandez ◽  
Julio Chavez-Vela ◽  
Vera L. Petricevich ◽  
...  
Keyword(s):  
Medical Education ◽  
Public Schools ◽  
Medical Students ◽  
Private Schools ◽  
Clinical Training ◽  
Online Survey ◽  
Medical Training ◽  
Clinical Instruction ◽  
Cross Sectional ◽  
The Impact

Abstract Background The COVID-19 pandemic has brought unprecedented changes to medical education. However, no data are available regarding the impact the pandemic may have on medical training in Mexico. The aim of our study was to evaluate and identify the medical school students’ perceptions of the changes in their clinical training due to the pandemic in Mexico. Methods This was a cross-sectional study where a previous validated online survey was translated and adapted by medical education experts and applied to senior medical students from March to April of 2021. The 16-item questionnaire was distributed online combining dichotomous, multiple-choice, and 5-point Likert response scale questions. Descriptive and multivariate analyses were performed to compare the student’s perceptions between public and private schools. Results A total of 671 responses were included in the study period. Most participants were from public schools (81%) and female (61%). Almost every respondent (94%) indicated it was necessary to obtain COVID-19 education, yet only half (54%) received such training. Students in private schools were less likely to have their clinical instruction canceled (53% vs. 77%, p = 0.001) and more likely to have access to virtual instruction (46% vs. 22%, p = 0.001) when compared to students from public schools. Four out of every five students considered their training inferior to that of previous generations, and most students (82%) would consider repeating their final year of clinical training. Conclusions The impact of the COVID-19 on medical education in Mexico has been significant. Most final-year medical students have been affected by the cancellation of their in-person clinical instruction, for which the majority would consider repeating their final year of training. Efforts to counterbalance this lack of clinical experience with virtual or simulation instruction are needed.

scholarly journals Correlation of medical students' situational motivation and performance of non-technical skills during simulation-based emergency training

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Leonie Schulte-Uentrop ◽  
Jonathan S. Cronje ◽  
Christian Zöllner ◽  
Jens C. Kubitz ◽  
Susanne Sehner ◽  
...  
Keyword(s):  
Medical Students ◽  
Technical Skills ◽  
Theoretical Models ◽  
Medical Studies ◽  
Cross Sectional ◽  
Simulation Based ◽  
And Performance ◽  
Situational Motivation ◽  
Determining Factor ◽  
Study Student

Abstract Background Non-technical skills (NTS) are an indispensable element of emergency care and need to be prevalent alongside with good technical skills. Though, questions of how to teach (instructional design) and improve NTS effectively remain unresolved. One adjustment screw to enhance performance of NTS, which is detached from instructional designs and learning efforts might be motivation. Theoretical models and observational studies suggest that high levels of intrinsic (situational) motivation result in better performance and better learning. Therefore, this study analyzed the influence of motivation on performance of NTS, by exploring if high levels of intrinsic motivation lead to better performance of NTS in medical students. Methods In this prospective cross-sectional cohort study, the authors assessed the correlation of situational motivation and performance of NTS within a cohort of 449 undergraduates in their 1st to 4th year of medical studies, in a total of 101 emergency simulation trainings. Situational motivation was measured with the validated Situational Motivation Scale (SIMS), which was completed by every undergraduate directly before each simulation training. The NTS were evaluated with the Anesthesiology Students´ Non-Technical skills (AS-NTS) rating tool, a validated taxonomy, especially developed to rate NTS of undergraduates. Results Student situational motivation was weakly correlated with their performance of NTS in simulation-based emergency trainings. Conclusion Although motivation has been emphasized as a determining factor, enhancing performance in different fields and in medicine in particular, in our study, student situational motivation was independent from their performance of NTS in simulation-based emergency trainings (SBET).

Medical Students’ Non-Technical Skills (Medi-StuNTS): preliminary work developing a behavioural marker system for the non-technical skills of medical students in acute care

2018 ◽  
Vol 5 (3) ◽  
pp. 130-139 ◽  
Author(s):  
Ailsa L Hamilton ◽  
Joanne Kerins ◽  
Marc A MacCrossan ◽  
Victoria R Tallentire
Keyword(s):  
Medical Students ◽  
Acute Care ◽  
Situation Awareness ◽  
Rating Scale ◽  
Medical Training ◽  
Poor Performance ◽  
Technical Skills ◽  
Face Validity ◽  
Self Awareness ◽  
Marker System

IntroductionGood non-technical skills (NTS) are critical to the delivery of high-quality patient care. It is increasingly recognised that training in such skills should be incorporated into primary medical training curricula. This study aimed to develop an NTS behavioural marker system (BMS), specifically applicable to medical students, for use within simulated acute care scenarios.MethodsThe methodology used to develop other BMS was adopted and modified. Following ethical approval, 16 final year medical students participated in acute care simulated scenarios. Semistructured interviews were performed to gauge the understanding of NTS. A panel meeting of subject matter experts was convened to translate key NTS into skill elements and observable behaviours. A second expert panel was consulted to refine aspects of the BMS. Further refinement and initial face validity was undertaken by a third panel of experts using the prototype BMS to observe prerecorded simulation scenarios.ResultsFive categories of NTS were identified: situation awareness, teamwork and communication, decision-making and prioritisation, self-awareness, and escalating care. Observable behaviours in each category describe good and poor performance. Escalating care was identified as a unique component that incorporated behaviours related to each of the other four skill categories. A 5-point rating scale was developed to enable both peer-to-peer and tutor-to–student feedback.ConclusionThe Medi-StuNTS (Medical Students’ Non-Technical Skills) system is the first BMS for the NTS of medical students. It reinforces the importance of escalating care effectively. It provides an exciting opportunity to provide feedback to medical students and may ultimately aid their preparedness for professional practice.

scholarly journals Improving medical students’ communication competencies to deal with intimate partner violence using clinical simulations in Mozambique

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
B. Manuel ◽  
M. Valcke ◽  
I. Keygnaert ◽  
K. Roelens
Keyword(s):  
Intimate Partner Violence ◽  
Medical Students ◽  
Student Perceptions ◽  
Partner Violence ◽  
Medical Training ◽  
Clinical Skills ◽  
Intimate Partner ◽  
Communication Competency ◽  
Post Test ◽  
The Impact

Abstract Background During their medical training, medical students aim to master communication skills and professionalism competencies to foster the best possible patient-physician relationship. This is especially evident when dealing with sensitive topics. This study describes and analyses the outcomes of a simulation-based training module on clinical communication competency through interacting with simulated intimate partner violence (IPV) survivors. The training was set up as part of a broader IPV module within a Gynaecology and Obstetrics Bachelor of Medicine and Bachelor of Surgery of Medicine (MBBS). Methods In total, 34 (59%) of all fourth-year medical students from one medical school in Mozambique were involved. A mixed-method approach was adopted. First, a quasi-experimental pre-test/post-test design was adopted to study the impact of the intervention to tackle critical IPV knowledge, skills, and attitudes, underlying a patient communication script. Second, a qualitative analysis of student perceptions was carried out. Results The results of the paired sample t-tests point at a significant and positive change in post-test values when looking at the general IPV self-efficacy (IPV SE) score and the subscales mainly in attitudes. Participants expressed a desire for additional IPV communication competency and suggested enhancements to the module. Conclusion We conclude that due to IPV being a sensitive issue, simulation activities are a good method to be used in a safe environment to develop clinical skills. The results of this study are a good complement of the analysis of the competencies learned by the medical students in Mozambique with the current curriculum.

scholarly journals Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams

2020 ◽  
Author(s):  
Su Hwan Kim ◽  
Lara M. Sobez ◽  
Judith E. Spiro ◽  
Adrian Curta ◽  
Felix Ceelen ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Decision Making ◽  
Dual Energy ◽  
Structured Reporting ◽  
Free Text ◽  
X Ray ◽  
Report Quality ◽  
Radiology Residents ◽  
Referring Physicians ◽  
The Impact

Abstract Background In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA). Methods FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality. Results A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P<0.001). SRs were rated to answer the clinical question significantly better than FTRs (P<0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P<0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA. Conclusions Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.

Peer-assisted learning in simulation-based medical education: a mixed-methods exploratory study

2020 ◽  
pp. bmjstel-2020-000645
Author(s):  
Leo Nunnink ◽  
Andrea Thompson ◽  
Nemat Alsaba ◽  
Victoria Brazil
Keyword(s):  
Medical Education ◽  
Mixed Methods ◽  
Medical Students ◽  
Focus Group ◽  
Exploratory Study ◽  
Free Text ◽  
Perceived Benefits ◽  
Simulated Environment ◽  
Simulation Based ◽  
Peer Teachers

IntroductionPeer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE).MethodsNinety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers.This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts.ResultsStudent-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient’s perspective and learning to give feedback through debriefing.ConclusionPAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.

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