Simulation-based training improves polypectomy skills among practicing endoscopists

Background and study aims Practicing endoscopists have variable polypectomy skills during colonoscopy and limited training opportunities for improvement. Simulation-based training enhances procedural skill, but its impact on polypectomy is unclear. We developed a simulation-based polypectomy intervention to improve polypectomy competency. Methods All faculty endoscopists at our tertiary care center who perform colonoscopy with polypectomy were recruited for a simulation-based intervention assessing sessile and stalked polypectomy. Endoscopists removed five polyps in a simulation environment at pretest followed by a training intervention including a video, practice, and one-on-one feedback. Within 1–4 weeks, endoscopists removed five new simulated polyps at post-test. We used the Direct Observation of Polypectomy Skills (DOPyS) checklist for assessment, evaluating individual polypectomy skills, and global competency (scale: 1–4). Competency was defined as an average global competency score of ≥ 3. Results 83 % (29/35) of eligible endoscopists participated and 95 % (276/290) of planned polypectomies were completed. Only 17 % (5/29) of endoscopists had average global competency scores that were competent at pretest compared with 52 % (15/29) at post-test (P = 0.01). Of all completed polypectomies, the competent polypectomy rate significantly improved from pretest to post-test (55 % vs. 71 %; P < 0.01). This improvement was significant for sessile polypectomy (37 % vs. 65 %; P < 0.01) but not for stalked polypectomy (82 % vs. 80 %; P = 0.70). Conclusions Simulation-based training improved polypectomy skills among practicing endoscopists. Further studies are needed to assess the translation of simulation-based education to clinical practice.

Impact of an end-of-fourth-year emergency medicine bootcamp

Background The final months of the fourth-year of medical school are variable in educational and clinical experience, and the effect on clinical knowledge and preparedness for residency is unclear. Specialty-specific “bootcamps” are a growing trend in medical education aimed at increasing clinical knowledge, procedural skills, and confidence prior to the start of residency. Methods We developed a 4-week Emergency Medicine (EM) bootcamp offered during the final month of medical school. At the conclusion of the course, participants evaluated its impact. EM residency-matched participants and non-participants were asked to self-evaluate their clinical knowledge, procedural skills and confidence 1 month into the start of residency. Program directors were surveyed to assess participants and non-participants across the same domains. A Fisher’s exact test was performed to test whether responses between participants and non-participants were statistically different. Results From 2015 to 2018, 22 students participated in the bootcamp. The majority reported improved confidence, competence, and procedural skills upon completion of the course. Self-assessed confidence was significantly higher in EM-matched participants 1 month into residency compared to EM-matched non-participants (p = 0.009). Self-assessed clinical knowledge and procedural skill competency was higher in participants than non-participants but did not reach statistical significance. Program directors rated EM-matched participants higher in all domains but this difference was also not statistically significant. Conclusions Participation in an EM bootcamp increases self-confidence at the start of residency among EM-matched residents. EM bootcamps and other specialty-specific courses at the end of medical school may ease the transition from student to clinician and may improve clinical knowledge and procedural skills.

1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab

Aim This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures. Method we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training. Results We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath. Conclusions Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.

Determinants of Nursing Students’ Confidence in Peripheral Intravenous Catheter Insertion and Management

BACKGROUND: Peripheral intravenous catheter (PIVC) is one of the medical devices commonly inserted in hospitalized patients, both adults and pediatrics. PIVC has crucial functions for delivering drugs, fluids, blood transfusions, and diagnostic tests for patients. Thus, nursing students must be confident in terms of insertion and management of this device. However, studies assessing nursing students’ confidence and its determinants are still limited. AIM: This study aims to examine the internship nursing student’s confidence in PIVC insertion and management in adult patients and its contributing factors. METHODS: A cross-sectional study was conducted to measure internship nursing students’ confidence in PIVC cannulation and management in adult patients as well as its contributing factors. Purposive samples of 100 nursing students in Yogyakarta were recruited, and a 5-point Likert scale questionnaire consisting of 19 questions was used. Kruskal–Wallis test was utilized to investigate the association of the internship nursing student confidence on PIVC insertion and maintenance with the factors. A general linear regression analysis was performed to obtain adjusted estimates of the potential factors with students’ confidence. RESULTS: Results indicated that the internship nursing student’s confidence score ranged from 57 to 95, with a mean value of 75 (±8.1). Among determinants of the student’s confidence investigated in this study, t-test analysis showed that the students’ confidence was associated with their participation in expert lecture, bedside teaching, and direct observation of procedural skill assessment of PIVC insertion and care (p < 0.05). The general linear analysis showed that only bedside teaching and interaction of bedside teaching and direct observation procedural skill assessment were significant predictors of the internship nursing student’s confidence on PIVC insertion and care (β = 10.99, 95% confidence interval [CI] 2.00–20.00 and β = 13.15, 95% CI 1.20–25.15, p < 0.05, respectively). CONCLUSION: This result indicated that nursing students need direct simulation and assessment of PIVC insertion and care to the patients to improve their confidence in PIVC insertion and management in adult patients.

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

BACKGROUND: As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience. METHODS: We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures. RESULTS: Our synthesis of the literature characterizes contributors to hospitalists’ procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists. CONCLUSION: We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.

Teaching bone marrow procedures at pelvic and sternal sites: a high fidelity anatomy simulation

Implication Statement: The bone marrow aspirate and biopsy procedure are fundamental to the diagnosis of many hematologic pathologies. We describe a hands-on, anatomy-based workshop that allows learners to practice bone marrow procedures on cadavers. Notably, participants learned how to perform sternal aspirates: a procedure rarely performed in real-life practice. Learners valued the experience and described increased comfort with the procedure after the workshop. This workshop provides a valuable opportunity for trainees to learn a procedural skill in a safe, high fidelity environment. Given its hands-on nature, residency training programs could also adapt it for direct observation and trainee assessment.

The Role of Video-Assisted E-Learning in Intrauterine Contraceptive Device Insertion Training

Introduction: Intrauterine contraceptive device (IUCD) insertion is an important procedural skill for primary care physicians. Procedural skill training can be challenging. E-learning has been rapidly employed in medical education. The purpose of this study was to evaluate the role of a video-assisted e-learning module in knowledge and skill transfer for IUCD insertion training. Methods: We used a quasi-experimental, one-group, pre/posttest study design. Thirty-one primary care doctors (family medicine residents and new medial officers) at a primary care training center participated in the study. All participants assessed the e-learning module at the training center. We performed on-site pre/posttests of knowledge and procedural steps (posttest only). We obtained satisfaction with e-learning and perceived confidence level with an anonymous questionnaire survey. Results: There was a significant increase in the knowledge test scores from a median interquartile range score of 12 (10-15) to 18 (17-19) post-e-learning (P&lt;.01). All participants attained the minimum passing score of 15 of 20 (75%) post-e-learning. However, only 20 of 31 (64.5%) participants met the minimum passing standard for procedural step test post-e-learning. Ninety-three percent of the participants reported satisfaction with the e-learning course. The median score for confidence level in performing the procedure increased significantly after e-learning. Conclusion: The e-learning module may be an effective way of delivering instructional content in procedural training. It provides time and location flexibility and is useful for pretraining. Psychomotor skills for clinical procedures, however, may be difficult to acquire by e-learning alone. It must be supplemented with deliberate practice and hands-on learning in simulation workshops.

The Effect of Repeated Direct Observation of Procedural Skills (R-DOPS) Assessment Method on the Clinical Skills of Anesthesiology Residents

Background: The ultimate result of patient care is one of the most important outcomes in medical education. Several methods, including the direct observation of procedural skills (DOPS), have been proposed to assess professional competencies in clinical practice. Objectives: This study aimed to assess the effects of the Repeated DOPS (R-DOPS) method on the performance of procedural skills in anesthesiology residents. Methods: The procedural skill performance of anesthesiology residents was assessed using a standard DOPS protocol from May to October 2019. Their scores were then objectively recorded, and the satisfaction rates regarding the 2 DOPS exams were assessed. Results: We found a considerable improvement in anesthesiology residents’ procedural skill performance, especially in the anesthesiology residency curriculum’s basic items. Besides, anesthesiology residents’ satisfaction was significantly improved after the 2nd DOPS. Conclusions: R-DOPS leads to improved training outcomes, including assessing the procedural skills, time to feedback to trainees, and trainee satisfaction.