Student Participation and Interaction in Online Case-Based Discussions: Comparing Expert and Novice Facilitation

Discussion is an essential component in case-based learning (CBL), as it offers students the opportunity to consider diverse perspectives, clarify confusion, and construct understanding. As a facilitator bears most of the responsibility for the overall success of CBL, understanding how facilitation strategies influence interactions during discussions is worthwhile. However, previous CBL facilitation research has primarily considered student perspectives during case discussions, without examining relationships between facilitator experience and student interaction and participation. This study combined social network analysis and content analysis to compare the structure of expert and novice instructors’ discussion posts and to consider their relationship to student participation and interaction in online case discussions. Results showed that both the expert and novice instructors used facilitation strategies involving social congruence, cognitive congruence, and content expertise frequently in the discussions; however, when and how they used a combination of these strategies was noticeably different. These differences influenced student interaction. More specifically, students tended to interact with others more actively and densely as a result of questions initiated by the expert facilitator. Suggestions are provided for novice facilitators.

Blind Spots Reconsidered – Epistemic Injustice in Clinical Ethics Support

"Conducting ethical case discussions is a core aspect of any clinical ethics support service or work as an ethical consultant in a hospital. Numerous case discussion methods can be used to do this, many of which are based on Beauchamp and Childress’ four biomedical principles. Other commonly used types are the ‘moral case deliberations’ by prominent authors such as Widdershoven, Molewijk et al. However, based on our practical work as clinical ethicists, and doctoral students in the field of clinical ethics, we would like to hypothesize that most of the methods seem to be in need of philosophical supplementation, especially on the blind spots regarding the is-ought fallacy, i.e. how to relate empirical data to normative conclusions. A further weakness may be found in the inadequate handling of power structures, which may lead to an unjust handling of opinions. In our talk, we will therefore present Miranda Fricker’s conceptual idea of ‘epistemic injustice’ and we will apply these insights to clinical cases of our everyday practice. Epistemic injustice is injustice related to knowledge. The concept focuses on exclusion and silencing people in public discourse. This silencing leads to a systematic distortion or misrepresentation of one’s meanings or contributions and/or to an undervaluing of someone’s status in communicative practices. We think that this concept has not been considered in clinical ethics thus far, and we would like to discuss whether ethical case discussions should not help to avoid epistemic injustice. If so, then the case discussion methods of our discipline should be adapted accordingly. "

856 Mortality and Morbidity Meetings in Oral and Maxillofacial Surgery: Hindsight is 20/20

Aim Mortality and Morbidity (M&M) meetings form a critical part of clinical governance however they often suffer from hindsight bias and lack objectivity. To combat this, Kahoot surveys were disseminated to senior clinicians prior to M&M meetings. Each case to be discussed is presented as a survey item with the clinical and radiographic information that was available to the performing surgeon pre-operatively and participants are asked to detail their ideal treatment. The aims of this study were to determine if the introduction of Kahoot surveys prior to M&M meetings improves the objectivity of the discussions and reduces the effects of hindsight bias. Method A 12-item questionnaire relating to the introduction and utility of Kahoot surveys prior to M&M discussions was distributed to all registrars and consultants within our department. Result An 80% response rate was obtained (16/20 responses). Prior to the introduction of Kahoot surveys, 62.6% of surgeons felt case discussions were clouded by the benefit of hindsight. Comparatively, 68.8% indicated the use of pre-M&M surveys reduced the effects of hindsight bias. 56.3% of participants expressed the objectivity of case discussions improved and 50% felt the quality of feedback improved. Conclusions The use of Kahoot surveys prior to M&M meetings demonstrates that withholding the case outcome until each clinician has given their own opinion reduces the effect of hindsight bias. The surveys utilise the Bolam Test, thereby enabling us to determine the correct error classifications with greater objectivity. Furthermore, they facilitate a higher quality of discussion and feedback.

Hospital-Acquired COVID-19: Case Discussions of Two Patients Treated at a Level I Trauma Center

The community spread of COVID-19 is well known and has been rigorously studied since the onset of the pandemic; however, little is known about the risk of transmission to hospitalized patients. Many practices have been adopted by healthcare facilities to protect patients and staff by attempting to mitigate internal spread of the disease; however, these practices are highly variable among institutions, and it is difficult to identify which interventions are both practical and impactful. Our institution, for example, adopted the most rigorous infection control methods in an effort to keep patients and staff as safe as possible throughout the pandemic. This case report details the hospital courses of two trauma patients, both of whom tested negative for the COVID-19 virus multiple times prior to producing positive tests late in their hospital courses. The two patients share many common features including history of psychiatric illness, significant injuries, ICU stays, one-to-one observers, multiple consulting services, and a prolonged hospital course prior to discharge to a rehabilitation facility. Analysis of these hospital courses can help provide a better understanding of potential risk factors for acquisition of a nosocomial COVID-19 infection and insight into which measures may be most effective in preventing future occurrences. This is important to consider not only for COVID-19 but also for future novel infectious diseases.

Fascial plane blocks: a narrative review of the literature

Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As ‘new’ FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.

#59: Launching a Network-based Platform for Clinical Case Discussions of Infections in Immunocompromised Pediatric Patients Worldwide

Background Infectious in pediatric patients with cancer are common and can be life-threatening. Understanding risks for infections, mechanisms of progression, and diagnostic and therapeutic interventions is essential for quality care. Clinical guidance emerges frequently from high-income countries and dissemination of information using traditional methods takes time to reach resource-limited settings. By using case-based learning (CBL) strategies, we sought to expedite this process to improve practices worldwide. We report the implementation of a network-based platform for discussion of infections in the immunocompromised child in resource-limited settings and the potential for dynamic sharing of best care practices. Methods Using a virtual meeting platform, we established a weekly appointment and invited members of our regional networks, mainly comprising pediatricians with training / interest in infection care and prevention who care for children with cancer. We solicited cases for discussion by providing an electronic case submission form, a presentation template, a presentation checklist, and a protected health information reminder sheet. Materials were prepared in Spanish and English, launching initially in Spanish (October 2019), then expanding to English (September 2020) alternating between Spanish and English-led discussions. Based on the case of the week, a panel of experts, worldwide infectious disease experts, provided recommendations for care based on published evidence, standardized guidelines, and best practices. Detailed written summaries were captured and shared with case submitters. We recorded attendance and evaluated participant satisfaction and the use of discussed information. Additional CBL materials were developed post-launch to support and expand CBL beyond the live meeting sessions. Results From October 2019 to December 2020, we hosted 45 online meetings with clinical cases presented from 15 countries and 23 institutions across the globe. We have had a total of 1054 attendees, with an average of 28 participants per live meeting. Discussions included complications grouped by viral, fungal, and mycobacterial infection. A quarterly survey revealed that participants found the case discussions most beneficial for reviewing recent literature and learning practices from invited guest experts. Most respondents have very often or always adopted the recommendations discussed during online meetings for the management of patients locally. Additional materials include: a protected virtual community space for storing all CBL materials and promoting continued participant engagement; a growing index of infections with prepared PubMed searches for quick and easy navigation to peer-reviewed literature (n=9); and, written case summary reports, indexed by infection, made available to all audience members for reference (5=in draft, 12=published). During the first part of the COVID-19 pandemic, we incorporated a journal club structure to discuss emerging literature on the virus, and specifically the implications for children with / without cancer. Participants indicated that COVID-19 activities were extremely useful for discussing and digesting the rapidly evolving scientific literature for SARS-CoV-2 and being able to apply lessons learned in real-time. Conclusions A virtual platform for CBL provides a critical resource that expedites information-sharing and can potentially improve patient care by expanding access to expertise and experience for best care practices beyond geographic boundaries.

127 Standardising Access to Fracture Fixation Simulation for Core Surgical Trainees

Introduction Simulation is increasingly being used to augment clinical experience. However, access to simulation varies geographically and national courses can be costly. The Severn School of Surgery aimed to provide a locally run, cost-neutral “Basic Principles in Fracture Fixation” course to standardise access to simulation for core surgical trainees (CSTs). Method The course ran from a district general hospital, accommodating lectures, case discussions, and practical stations (screw fixation, plate fixation, dynamic hip screw, and external fixation). Faculty donated their time and a devices company provided kit and dry bones. CSTs organised the course. Pre- and post-course self-rated Intercollegiate Surgical Curriculum Programme (ISCP) global competency ratings in the practical stations were recorded and usefulness of aspects of the course was recorded. Results 32 candidates attended. Mean self-rated competency increased by at least one global rating in all practical stations (p < 0.05). All aspects of the course were deemed useful (pre-course reading by 27/28, lectures by 31/32, and case discussions by 31/32). No net cost was incurred. Conclusions Increases in self-rated competency in surgical skills can be obtained through a cost-neutral, trainee-organised, regional skills course. Pre-course reading, lectures, case discussions, and practical sessions are all useful. This model can be used by others to standardise the simulation curriculum.