PTEBL Teaching Method Combined with Caesar (Trauma Patient Simulator) Versus Traditional Teaching Method in The Training of Outstanding Doctoral Candidates in STB Skills: A Randomized Controlled Trial

Background: The “Stop The Bleed” (STB) campaign has achieved remarkable results since it launched in 2016, but there is no report on the application of a STB course combined with a trauma patient simulator. This study proposes the “problem-, team-, and evidence-based learning” (PTEBL) teaching method combined with Caesar (trauma patient simulator) based on the STB course, and compares its effect with the traditional teaching method in outstanding doctoral candidates training of hemostasis skills.Method: Seventy-eight outstanding doctoral candidates program students (five-years and eight-years) were selected as the research subjects and were randomly divided into a control group (traditional teaching method, n=34) and an experimental group (PTEBL teaching method combined with Caesar, n=44). Their confidence of hemostasis skills and willingness to rescue were investigated before and after the course in both groups.Result: Students’ self-confidence of STB skills and willingness to rescue in both groups were improved after the class. Compared with the control group, students in the experimental group were more confident in compressing with bandages and compressing with a tourniquet after a class (compressing with bandages: control group 3.9±0.8 vs. experimental group 4.3±0.7, P=0.014; compressing with a tourniquet: control group 3.9±0.4 vs. experimental group 4.5±0.8, P=0.001) More students in the experimental group than the control group thought that the use of Caesar for scenario simulation could improve learning (control group 55.9% vs. experimental group 81.8%, P=0.024), and showed higher teacher-student interaction (control group 85.3% vs. experimental group 97.7%, P=0.042) The overall effectiveness of the teaching was better in the experimental group than the control group (control group 85.3% vs. experimental group 97.7%, P=0.042). There was a significant positive correlation between teacher-students interaction and overall effectiveness of teaching (R=1.000; 95%CI, 1.000-1.000; P<0.001).Conclusion: The PTEBL teaching method combined with Caesar can effectively improve students' mastery of STB skills, and overcome the shortcomings of traditional teaching methods, which has a certain promotional value in the training of outstanding doctoral candidates in STB skills.

Employment of color Doppler echocardiographic video clips in a cardiac auscultation class with a cardiology patient simulator: discrepancy between students’ satisfaction and learning

Background We have provided fourth-year medical students with a three-hour cardiac auscultation class using a cardiology patient simulator since 2010. The test results of 2010-2012 revealed that as compared with aortic stenosis murmur, students correctly identified murmurs of other valvular diseases less often. We investigated whether employment of color Doppler echocardiographic video clips would improve proficiency in identifying murmurs of aortic regurgitation and mitral regurgitation, and whether students’ favorable responses to a questionnaire were associated with improved proficiency. Methods A total of 250 fourth-year medical students were divided into groups of 7-9 students in 2014 and 2015. Each group attended a three-hour cardiac auscultation class comprising a mini-lecture, facilitated training, two different auscultation tests (the second test being closer to clinical setting than the first) and a questionnaire. We provided each student with color Doppler echocardiographic videos of aortic regurgitation and mitral regurgitation using a tablet computer, which they freely referred to before and after listening to corresponding murmurs. The test results were compared with those in 2010-2012. The students had already completed the course of cardiovascular medicine, comprising lectures including those of physical examination, echocardiography, and valvular heart diseases, before participating in this auscultation training class. Results Most students indicated that the videos were useful or somewhat useful regarding aortic regurgitation (86.3%) and mitral regurgitation (85.7%). The accuracy rates were 78.4% (81.2% in 2010-2012) in aortic regurgitation and 76.0% (77.8%) in mitral regurgitation in the first test, and 83.3% (71.4%) in aortic regurgitation and 77.1% (77.6%) in mitral regurgitation in the second test, showing no significant differences as compared to 2010-2012. Overall accuracy rate of all heart sounds and murmurs in the first test and that of second/third/fourth sounds in the first and second tests were significantly lower in 2014-2015 than in 2010-2012. Conclusions Referring to color Doppler echocardiographic video clips in the way employed in the present study, which most students regarded as useful, did not improve their proficiency in identifying the two important regurgitant murmurs, revealing a discrepancy between students’ satisfaction and learning. Video clips synchronized with their corresponding murmurs may contribute toward improving students’ proficiency.

Real-Time Feedback of the Applied Light-Curing Technique and Its Impact on Degree of Conversion of Composite Restorations—A Study with Undergraduate Dental Students

The objective of this study was to investigate the effect of individual instructions and training of dental students on the amount of applied light irradiance before and after training using a patient simulator with integrated visual feedback. Furthermore, the effect on the degree of conversion of composite restorations placed by the dental students was assessed. Forty-two dental students, split into two groups, light-cured a simulated restoration in tooth 27 of a dental patient simulator for 20 s. The irradiance (mW/cm2) received by the detector was measured in real-time before and after individual instructions and training, and the energy delivered (J/cm2) was calculated for each student. The degree of conversion at the bottom of incrementally placed composite restorations prior to individual instructions (group 1) and after individual instructions (group 2) was assessed using Fourier-transform infrared (FTIR) spectroscopy. The irradiance and degree of conversion measurements were re-assessed after all students received individual instructions. Data were analyzed using Wilcoxon signed-rank test and Mann–Whitney U-test at an overall level of significance of ⍺ = 0.05. A significant increase (p < 0.001) in applied light irradiance could be observed after individual instructions for both groups, with notably reduced data scattering. However, no significant difference was detected for the degree of conversion of placed composite restorations before or after instruction and training. Neither gender nor age of the dental students affected the obtained results. Consistent light energy delivered by dental students could be achieved through individual instructions and training with a patient simulator, also leading to less scattered irradiance results. However, the improved light-curing performance after the training did not affect the degree of conversion of the placed class II composite restorations.

High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences

BackgroundSimulation technology is widely used in medical education, providing an environment in which students can develop and practise a multitude of skills that are relevant to clinical practice, without the risk of harm to patients.MethodsWe conducted a mixed methods cross-over study with quantitative and qualitative outcomes. This analysed students’ perceptions of two simulation technologies: a high-fidelity patient simulator and virtual reality. Twenty final year medical students completed a questionnaire after having experienced both simulation modalities.ResultsStudents scored the patient simulator higher in domains such as developing team working and ‘ABCDE assessment skills’, whereas the virtual reality simulation was more immersive and fun. Participants found the patient simulator more useful in preparing them for clinical practice.ConclusionMedical students in this study expressed that a high-fidelity patient simulator, in a simulated clinical environment, was of greater value to their preparation for clinical practice than virtual reality simulation of a similar environment. However, the virtual reality simulation offered a near comparable experience, and was found to be was enjoyable, immersive and easily portable.

The Ability of Dental Practitioners to Light-Cure Simulated Restorations

Clinical Relevance Using a patient simulator, dental professionals were tested to determine their ability to light-polymerize simulated restorations in their dental practice. After receiving specific instructions and training using the simulator, their ability to deliver sufficient light to polymerize restorations was significantly and substantially improved. SUMMARY Objectives: To determine the ability of dental professionals to deliver a radiant exposure of at least six J/cm2 in 10 seconds to simulated restorations. Methods and Materials: The study initially examined 113 light-emitting-diode (LED) light polymerization units (LPUs) used in dental offices to determine if they could deliver at least 6 J/cm2 radiant exposure (RE) in 10s. This assessment was completed by using a laboratory-grade light measuring device (checkMARC, BlueLight Analytics, Halifax, NS, Canada). The participating dental professionals whose LPUs could deliver 6 J/cm2 then used their own LPU to light-cure simulated anterior and posterior restorations in the MARC Patient Simulator (BlueLight Analytics). They then received specific instructions and were retested using the same LPUs. Data were statistically analyzed with a series of one-way analysis of variance (ANOVA), two-way ANOVA, paired-samples t-tests, Fisher post hoc multiple comparison tests, and McNemar tests with a preset alpha of 0.05 (SPSS Inc). Results: Ten (8.8%) LPUs could not deliver the required RE to the checkMARC in 10s and were eliminated from the study. For the anterior restoration, most dental practitioners (87.3%) could deliver at least 6 J/cm2 before instructions. After receiving additional light-curing instructions, only two (1.9%) participants were unable to deliver 6 J/cm2 to the anterior location. At the posterior location, only 55.3% (57) participants could deliver at least 6 J/cm2 before the instructions. After receiving these instructions, an additional 32 participants delivered at least 6 J/cm2. Overall, after receiving instructions on how to use the LPU correctly, the participants improved the amount of RE they delivered to anterior and posterior restorations by 22.5% and 30%, respectively. Conclusion: This study revealed that at the baseline, 44.7% of participating dental professionals failed to deliver 6 J/cm2 in 10s to the posterior simulated restoration when using their own LPU.

Design Framework and Clinical Evaluation of a Passive Hydraulic Patient Simulator for Biceps Spasticity Assessment Training

This article presents the framework for developing a passive (unpowered) mechanical training simulator for replication of biceps spasticity to complement current clinical assessment training. The passive training simulator was developed to mimic three main behavioral features of spasticity, i.e., abnormal muscle tone, catch-release behavior, and range of motion (ROM) reduction. The simulator can replicate varied levels of spasticity (Modified Ashworth Scale (MAS) levels 0–4) using a combination of three adjustable mechanical design features, i.e., resistance level, catch angle, and ROM selectors. Bench-top evaluation examined the performance of individual mechanical design features, as well as their combined performance. Spastic muscle resistance profiles generated by the simulator qualitatively agreed with the clinical descriptions of spasticity in the MAS. Mean peak simulated resistive torque fell within the clinical measures from actual spasticity patients for MAS 1–4, but was lower for MAS 0 (0.9, 3.5, 4.2, 6.9, 9.8 Nm for MAS 0–4, respectively). Seven clinicians were invited to validate the simulator performance. They were asked to identify the simulated MAS level during a blinded assessment and to score the realism of each simulation feature using a five-point scale, where 3 was “about right,” during a disclosed assessment. The mean percent agreement of clinicians’ judgments was 76 ± 12%. The mean realism score throughout MAS 0–4 were 2.82 ± 0.15. Preliminary results suggested good potential for this simulator in helping future healthcare practitioners learn and practice the basics of spasticity assessment.

Distance assessment of counselling skills using virtual patients during the COVID-19 pandemic

Background: Reports on using virtual patients to assess counselling skills is scarce. Aim: This paper describes the feasibility and acceptability of assessing patient counselling skills of pharmacy students using a virtual patient simulator. Description: In this innovative method, a high quality simulator ‘Virtual Patient Learning’ (VPL) was developed at Gulf Medical University (GMU) and was used to assess the counselling skills of 15 pharmacy graduate students. Counselling skills were measured using a four-domain scoring rubric of 1 to 5 marks followed by instant feedback for improvements. Student and faculty satisfaction scores were collected based on the feasibility and acceptability of the assessment method. Evaluation: The average counselling skills score for all students was 68.4 (85.5%) out of 80 (range 54-76), with a standard deviation of 5.8. The overall student agreement on the feasibility and acceptability of the assessment method was 92.8%; it was 100% agreement for faculty. Conclusion: The use of a high quality VPL simulator in assessing counselling skills was deemed feasible and acceptable for students and faculty. The assessment was repeated among 30 Doctor of Pharmacy (Pharm.D.) graduates with similar outcomes. The virtual counselling method will be used in the programme exit exams, as well as in students entering their experiential year. Further studies are required to assess its validity and reliability with more students.