Alice in Simulation-Land

2020 ◽  
pp. 449-458
Author(s):  
Vanessa Bazan ◽  
Michael D. Jax ◽  
Joseph B. Zwischenberger
Keyword(s):  
Medical School ◽  
Surgical Simulation ◽  
Technical Skills ◽  
School Curriculum ◽  
First Year ◽  
High Fidelity Simulation ◽  
Residency Programs ◽  
Training Techniques ◽  
Surgical Residents ◽  
Simulation Based

Surgical education has been compressed by integrated residency programs and restrictions on the number of hours surgical residents are allowed to work. Instilling basic technical skills as early as the first year of medical school can help maximize preparedness for surgical rotation and residency. This overview includes a detailed description of low, medium, and high-fidelity simulation-based training techniques and recommends introduction of surgical simulation early in the medical school curriculum. A personal vignette highlights this recommendation.

scholarly journals Deferred Action for Childhood Arrivals (DACA) medical students – an examination of their journey and experiences as medical students in limbo

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christina Gillezeau ◽  
Wil Lieberman-Cribbin ◽  
Kristin Bevilacqua ◽  
Julio Ramos ◽  
Naomi Alpert ◽  
...  
Keyword(s):  
Medical Students ◽  
Medical School ◽  
First Year ◽  
Convenience Sample ◽  
Student Sample ◽  
Medical Specialties ◽  
Residency Programs ◽  
Deferred Action ◽  
The Status ◽  
Depth Interviews

Abstract Background Although the value of DACA medical students has been hypothesized, no data are available on their contribution to US healthcare. While the exact number of DACA recipients in medical school is unknown, DACA medical students are projected to represent an increasing proportion of physicians in the future. The current literature on DACA students has not analyzed the experiences of these students. Methods A mixed-methods study on the career intentions and experiences of DACA medical students was performed utilizing survey data and in-depth interviews. The academic performance of a convenience sample of DACA medical students was compared to that of matriculated medical students from corresponding medical schools, national averages, and first-year residents according to specialty. Results Thirty-three DACA medical students completed the survey and five participated in a qualitative interview. The average undergraduate GPA (SD) of the DACA medical student sample was 3.7 (0.3), the same as the national GPA of 2017–2018 matriculated medical students. The most common intended residency programs were Internal Medicine (27.2%), Emergency Medicine (15.2%), and Family Medicine (9.1%). In interviews, DACA students discussed their motivation for pursuing medicine, barriers and facilitators that they faced in attending medical school, their experiences as medical students, and their future plans. Conclusions The intent of this sample to pursue medical specialties in which there is a growing need further exemplifies the unique value of these students. It is vital to protect the status of DACA recipients and realize the contributions that DACA physicians provide to US healthcare.

scholarly journals Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach

2018 ◽  
Vol 5 ◽  
pp. 238212051876513 ◽  
Author(s):  
Lise McCoy ◽  
Robin K Pettit ◽  
Charlyn Kellar ◽  
Christine Morgan
Keyword(s):  
Active Learning ◽  
Medical School ◽  
School Curriculum ◽  
First Year ◽  
Group Instruction ◽  
Large Group ◽  
Curriculum Review ◽  
Learning Techniques ◽  
Learning Centered ◽  
Semistructured Interviews

Background: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Methods: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Results: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. Conclusions: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

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 LO096: Comfortable with your thoracotomy skills? An innovative simulation-based curriculum to teach rare procedures in emergency medicine

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
S.H. Gray ◽  
J. Owen ◽  
A. Petrosoniak
Keyword(s):  
Emergency Medicine ◽  
Experiential Education ◽  
Deliberate Practice ◽  
Technical Skills ◽  
Skills Training ◽  
Residency Programs ◽  
Ongoing Work ◽  
Life Saving ◽  
Simulation Based ◽  
Technical Skills Training

Introduction / Innovation Concept: Emergency medicine (EM) residents must demonstrate proficiency in several rare, life-saving procedures but few clinical opportunities exist to practice and master these skills. Currently no standardized curricula exist for the instruction of these skills during EM residency. Accordingly, many residents graduate without the experience to perform these critical procedures confidently. We developed a novel, simulation-based curriculum for six rare, life-saving, EM skills that integrates deliberate practice and Kolb’s theory of experiential education. Methods: We used existing EM training objectives and a recent national resident needs assessment to develop a simulation-based technical skills curriculum. The six station curriculum was underpinned by the pedagogical framework of experiential education and deliberate practice. Instructor and participant feedback directed subsequent curriculum modifications. Curriculum, Tool, or Material: This one-day intensive curriculum was successfully implemented at two Canadian EM residency programs for 54 EM residents, from both CCFP-EM and FRCP-EM streams. Participant feedback was highly favorable. An iterative approach to curriculum implementation at two separate residency programs effectively allowed educators to respond to participant needs. Conclusion: A novel simulation-based curriculum for rare procedures in EM is feasible, practical, and highly valued by participants. Ongoing work is underway to refine the curriculum and assess its efficacy in creating competence. Deliberate practice and Kolb’s theory of experiential education provide useful frameworks for technical skills training.

scholarly journals LO097: A novel curriculum for assessing competency in resuscitation at the foundations of discipline level of training

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
T. Chaplin ◽  
L. McMurray ◽  
A.K. Hall
Keyword(s):  
Assessment Tool ◽  
Professional Activity ◽  
First Year ◽  
Residency Programs ◽  
Modified Delphi ◽  
Simulation Based ◽  
Level Of Consciousness ◽  
Objective Structured Clinical Exam ◽  
Competency Based ◽  
Level Of Training

Introduction / Innovation Concept: Junior residents are often the first physicians who attend to the acutely unwell floor patient, especially at night and on weekends. The ‘Nightmares Course’ at Queen’s University was designed to address an Entrustable Professional Activity (EPA) relevant to several residency programs at the ‘Foundations of Discipline’ level of training: “to manage the acutely unwell floor patient for the first 5-10 minutes until help arrives”. In keeping with competency based medical education principles, this course offers longitudinal and repetitive practice and assessment. We have also designed a summative objective structured clinical exam (OSCE) in order to identify trainees who require additional remedial practice of this EPA. Methods: We developed simulated cases that reflect common but “scary” calls to the floor. We then, using a modified Delphi process with experts in resuscitation, defined relevant milestones applicable to the Foundations of Discipline level of training in order to inform our formative assessment. We also modified the Queen’s Simulated Assessment Tool (QSAT) to adopt CBME terminology and this will be used to provide a summative assessment during a four-scenario OSCE in the spring. Residents with QSAT scores below the competency threshold will be enrolled in a remediation course. Curriculum, Tool, or Material: Weekly sessions were led by staff physicians and were offered to first-year residents from internal medicine, core surgery, obstetrics and gynecology, and anesthesiology over the academic year. Each resident participated in one session every 4-week block. Sessions were organized into themes such as “shortness of breath” or “decreased level of consciousness” and involved three high-fidelity simulated cases with a structured debrief following each case. Formative feedback was given following each case. Conclusion: The Nightmares Course is a novel simulation-based, multidisciplinary curriculum in resuscitation medicine. It includes longitudinal practice and repetitive assessment, as well as summative testing and remediation of an EPA common to several residency programs.

Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes

2018 ◽  
Vol 128 (4) ◽  
pp. 821-831 ◽  
Author(s):  
Richard H. Blum ◽  
Sharon L. Muret-Wagstaff ◽  
John R. Boulet ◽  
Jeffrey B. Cooper ◽  
Emil R. Petrusa
Keyword(s):  
Effect Size ◽  
Rating Scale ◽  
Program Improvement ◽  
First Year ◽  
Chi Square ◽  
Residency Programs ◽  
Resident Performance ◽  
Simulation Based ◽  
Scenario Assessment ◽  
And Training

Abstract Background Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment. Methods Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail. Results Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room. Conclusions Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.

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