Acquisition Of Procedural Skills Research Articles

Optimizing Individual Wound Closure Practice Using Augmented Reality: A Randomized Controlled Study.

Background Suturing requires repeated practice with guidance to prevent skill deterioration; however, guidance is often limited by expert availability. There is evidence that augmented reality (AR) may assist procedural skill acquisition among learners. This study examines the use of an AR suture guidance application to assist the independent practice of suturing. Methodology A novel suture guidance application was designed for the Microsoft HoloLens. The guidance system included a calibration system and holograms that projected over a suture pad in a stepwise manner. To assess the application, 30 medical students were recruited and randomly assigned to two groups. The control group (n = 16) was given 30 minutes of independent suture practice, while the experimental group (n = 14) utilized the suture guidance application. Both groups completed a pre- and post-test wound closure assessment. After the post-test, the control group trialed the suture guidance application. All participants completed a feedback survey on the application. Statistical analysis was completed using Stata (StataCorp., College Station, TX, USA) with paired Student's t-tests and Welch's t-tests with a significance of 95%. Results Both groups demonstrated a significant improvement in total time and time per stitch during the post-test. Additionally, comparing pre- and post-test assessments in the experimental group revealed a significant improvement in the total number of stitches (p = 0.007), the ratio of bisecting stitches (p = 0.02), and the symmetry of stitch bite (p = 0.03). The feedback survey supported the application for guiding suture placement and spacing. Participants identified limitations in the hologram stability and neck positioning. Conclusions This study suggests the potential to use AR to facilitate the independent practice of wound closure within simulation environments.

Hip Arthroscopy Simulator Training With Immersive Virtual Reality Has Similar Effectiveness to Nonimmersive Virtual Reality

PurposeThe purpose of this study was to (1) compare the efficacy of immersive virtual reality (iVR) to non-immersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. MethodsFourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n=7; PrecisionOS, Vancouver, Canada) or non-iVR simulator (n=7; ArthroS Hip VR; VirtaMed, Zurich, Switzerland). After training, performance was assessed on a cadaver by four expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. ResultsDemographic characteristics did not differ between treatment arms, by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6±4.4, non-iVR 21.0±4.1, p=0.55; ASSET: iVR 23.7±4.5, non-iVR 25.8±4.8, p=0.43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. ConclusionsHip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer-of-skill compared to non-iVR with a 132-times cost differential.

Comparison of Peyton's Four-Step Approach With the Conventional Bedside Technique in Teaching Clinical Examination Skills to Medical Students.

Conventional bedside teaching (CBT) is an integral and classical method for imparting clinical skills to undergraduates in medical schools. It is a traditionally successful approach, especially when it comes to imparting patient-doctor relationship skills and knowledge on clinical management.Peyton's four-step approach (PFSA) is one of the newer structured instructional approaches for teaching-learning, especially for imparting procedural and complex psychomotor skills.The present study compares the application of PFSA in teaching complex systemic examination skills to the CBT technique in teaching the same skill to MBBS students. The impact of the acquisition of this examination skill was assessed statistically to compare PFSA and CBT methodologies. The target population was MBBS (Bachelor of Medicine and Bachelor of Surgery)students; for this study, the phase II MBBS students were considered as the study population since they were relatively naïve to clinical bedside examination skills. Students were allotted groups and they were taught clinical skills through CBT and PFSA separately. Using the OpenEpi toolkit Version 3 open-source sample size calculator for comparing two means, the sample size was 30 students in each group. The students were assessed for their competency and were also made to fill out a feedback questionnaire to compare the two methods of education dispensing. Results: The results of this study showed that PFSA is definitely suitable for teaching clinical examination skills. The acquisition of skills was found non-inferior to CBT while the retention of these skills was found to be equally good or even superior with PFSA than with CBT. Conclusion:PFSA has already been proven to be a good teaching method for the acquisition of complex procedural skills. This study expands the role of PFSA in teaching clinical bedside examination skills to medical students.Further large-scale studies may clarify the learning impact and outcomes of PFSA in clinical bedside teaching.

Case Curve: A Novel Web-Based Platform and Mobile Phone Application to Evaluate Surgical Competence in Graduate Medical Education.

Competency-based medical education is well established, yet methods to evaluate and document acquisition of surgical skill remain underdeveloped. We describe a novel web-based application for competency-based surgical education at a single neurosurgical department over a 3-year period. We used a web-based application to track procedural and cognitive skills acquisition for neurosurgical residents. This process included self-assessment, resident peer evaluations, evaluations from supervising attending physicians, and blinded video reviews. Direct observation by faculty and video recordings were used to evaluate surgical skill. Cases were subdivided into component skills, which were evaluated using a 5-point scale. The learning curve for each skill was continuously updated and compared with expectations. Progress was reviewed at a monthly surgical skills conference that involved discussion and analysis of recorded surgical performances. During an escalating 3-year pilot from 2019 to 2022, a total of 1078 cases in 39 categories were accrued by 17 resident physicians with 10 neurosurgical faculty who participated as evaluators. A total of 16 251 skill performances in 110 categories were evaluated. The most evaluated skills were those that were common to several types of procedures, such as positioning, hemostasis, and wound closure. The concordance between attending evaluations and resident self-evaluations was 76%, with residents underestimating their performance in 17% of evaluations and overestimating in 7%. We developed a method for evaluating and tracking surgical resident skill performance with an application that provides timely and actionable feedback. The data collected from this system could allow more accurate assessments of surgical skills and deeper insights into factors influencing surgical skill acquisition.

Clinical Simulation for Procedural Expertise: State of Education and Application

Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.

Beyond the Procedure Log: Using Individualized Learning Plans to Set Learner-Specific Milestones for Procedural Skills Acquisition.

Procedural training for nonsurgical fields, such as internal medicine, is an important component of medical education. However, recent changes to accreditation guidelines have resulted in less formal guidance on procedural competency, not only leading to opportunities for individualizing training but also creating potential problems for trainees and training programs. In this article, the authors use internal medicine as an exemplar to review current strategies for procedural education in nonsurgical fields, including procedural simulation, dedicated procedural rotations, and advanced subspecialty training, and highlight an emerging need for learner-specific terminal milestones in procedural training. Individualized learning plans (ILPs), collections of trainee-specific objectives for learning, are arguably a useful strategy for organizing procedural training. The role of ILPs as a framework to support setting learner-specific terminal milestones, guide skill acquisition, and allocate procedural learning opportunities based on trainees' anticipated career plans is subsequently explored, and how an ILP-based approach might be implemented within the complex educational milieu of a clinical training program is examined. The limitations and pitfalls of an ILP-based approach, including the need for development of coaching programs, are considered. The authors conclude that, despite the limitations of ILPs, when combined with other current strategies for building trainees' procedural competence, these plans may help trainees maximize the educational benefits of their training period and can encourage effective, safer, and equitable allocation of procedural practice opportunities.

Neonatal airway management training using simulation-based educational methods and technology

Airway management is a fundamental component of neonatal critical care and requires a high level of skill. Neonatal endotracheal intubation (ETI), bag-mask ventilation, and supraglottic airway management are complex technical skills to acquire and continually maintain. Simulation training has emerged as a leading educational modality to accelerate the acquisition of airway management skills and train interprofessional teams. However, current simulation-based training does not always replicate neonatal airway management needed for patient care with a high level of fidelity. Educators still rely on clinical training on live patients. In this article, we will a) review the importance of simulation-based neonatal airway training for learners and clinicians, b) evaluate the available training modalities, instructional design, and challenges for airway procedural skill acquisition, especially neonatal ETI, and c) describe the human factors affecting the transfer of airway training skills into the clinical environment.

Advanced neonatal procedural skills: a simulation-based workshop: impact and skill decay

BackgroundTrainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay.MethodsWe designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers.ResultsThe DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments.ConclusionsThe simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention.Trial RegistrationNot applicable, not a health care intervention.

From Private Practice to Academia: The Experience of a General Academic Pediatrician.

After pediatric residency, the author worked in a rural community where he was able to immediately practice skills acquired during training such as intubations, bag-mask ventilation, IV placement, ear irrigation, foreign body removal from eyes and ears, abscess incision and drainage, intraosseous placement for rapid hydration of a severely dehydrated infant, EKG, X-ray readings, and ear-irrigations to cite but a few examples. Furthermore, the writer acquired other high-valued procedural skills such as neonatal male circumcision, frenotomy, ligation of supernumerary digits, and manual separation of labial adhesions. The author feels that he could only have acquired and maintained these skills by working in a busy rural pediatric practice. When the writer later became a faculty member, he was able to effectively train medical students and pediatric residents to acquire these same skills. Even though there is a paucity of research information on procedural skills acquisition among general pediatric residents, the writer proposes that the recruitment of full-time general academic pediatricians with real-world experience may be potentially beneficial for the training of medical students and pediatric residents.

Blended learning and simulation in nursing education: A quasi-experimental study on a nursing institute.

The nursing module teaches basic nursing principles and procedures to undergraduate nursing students. This course is important for the acquisition of procedural and psychomotor skills. The aim of the present study is to evaluate the influence of blended training on the acquisition of practical skills related to gastric insertion tubes. A quasi-experimental study was undertaken, containing three groups: The blended group benefited from e-learning, followed by simulation), while the two groups benefited from theoretical teaching and procedural simulation. Then, the degrees of acquisition of declarative and procedural knowledge and the time of completion were measured. The declarative knowledge grade was higher in the Simulation (16.07) and Blended (15.21) groups than in the Traditional Group (11.66), with a statistically significant difference (P < 0.001). The results also showed a statistically significant difference between the procedural knowledge grades of the three groups (P < 0.001). A statistically significant correlation was detected between declarative and procedural knowledge scores (r = 0.58, P < 0.001) and a negative correlation between procedural knowledge and the time of completion (r = -0.422, P < 0.001). The results of this experimentation confirm the positive effect of the blended learning approach on the acquisition of declarative and procedural knowledge as well as the time management allocated to teaching.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

BackgroundThe flipped skills lab is a student-centred approach which incorporates pre-class preparation (pre-skill conceptualization) followed by repeated, hands-on practice for practical skills training. Objective measures of skills acquisition in the flipped literature are few and conflicting. The importance of pre-skill conceptualization in flipped skills training suggests that pedagogically informed pre-skill conceptualization can enhance outcomes.MethodsA mixed quasi-experimental study was conducted on 41 final year medical students who followed a flipped newborn resuscitation skills lab. Pre-class preparatory material covered conceptual and procedural knowledge. Students in the traditional group (n = 19) and those in the interventionalmental group (n = 22) received identical reading material covering conceptual knowledge. Procedural knowledge was shared with the interventional group as demonstration videos, while the traditional group received a PowerPoint presentation with text and images covering the same material. Knowledge acquisition was assessed by 20 single best answer questions before and after hands-on practice in the skills lab and skill performance was tested post-intervention with a simulated scenario. Students’ perceptions were collected by survey. Quantitative data was analysed using Wilcoxon Signed Ranks test and Mann–Whitney U test as appropriate. Qualitative data was analysed by thematic analysis.ResultsOverall student rating of the intervention was positive with ratings of 4.54 and 4.46 out of 5 by the traditional group and the experimental group respectively. Post-intervention skill performance in the experimental group was significantly better (p < .05) in the interventional group (M = 87.86%, SD = 5.89) than in the traditional group (M = 83.44, SD = 5.30) with a medium effect size (r = .40). While both groups showed significant knowledge gains, only students in the experimental group showed a statistically significant gain in procedural knowledge (p < .05) following the flipped skills lab. Finally, while both groups self-reported feeling more knowledgeable and confident following the intervention, the level of confidence was superior in the experimental group.ConclusionsFlipping the skills lab with pre-skill conceptualisation combining text-based conceptual knowledge and video-based procedural knowledge followed by simulation-based hands-on practice improves procedural knowledge and skills acquisition in newborn resuscitation training for medical students. This study shows that in addition to temporal benefits, pedagogically informed pre-skill conceptualization can confer procedure-specific cognitive and emotional benefits supporting skills acquisition.

Science learning in biodiversity citizen science: Inputs from the analysis of online social interactions within a contributory project for pollinators' monitoring

Biodiversity citizen science projects are both valued for their contribution to scientific research and for their impact on participants' science learning and engagement towards the environment. In this paper, we assess the impact of participation in a biodiversity citizen science project (the Spipoll, dedicated to pollinators' monitoring) through the analysis of online interactions within the program's data sharing platform. By drawing on a previous qualitative analysis of the comments exchanged by the participants within this platform, we focus on those comments which share items on aspects of biology and ecology related to the Spipoll program. This sample gathers 2009 comments from 2010 to 2018. We first classified the different constitutive elements from these comments into seven categories following the topics they deal with. We then studied the temporal change in occurrence of each of these topics from 2010 to 2018. We show that long-term participation is associated with the growing expression of scientific procedural skills: formulation of hypothesis and explanation, proposition of new research questions. To our knowledge, our study is the first one that detects the acquisition of such procedural skills in biodiversity citizen science. We also show that long-term participation is associated with the growing attention to natural seasonal cycles. This study finally illustrates the value of the online traces of citizen scientists' activities to analyze participants' outcomes of citizen science. Consequently, it should encourage the development of such online communication spaces within contributory projects, without restricting them to online citizen science.

Improving procedural skills acquisition of students during medical device training: experiments on e-Learning vs. e-Learning with hands-on

In the context of medical device training, e-Learning can address problems like unstandardized content and different learning paces. However, staff and students value hands-on activities during medical device training. In a blended learning approach, we examined whether using a syringe pump while conducting an e-Learning program improves the procedural skills needed to operate the pump compared to using the e-Learning program only. In two experiments, the e-Learning only group learned using only the e-Learning program. The e-Learning + hands-on group was instructed to use a syringe pump during the e-Learning to repeat the presented content (section “Experiment 1”) or to alternate between learning on the e-Learning program and applying the learned content using the pump (section “Experiment 2”). We conducted a skills test, a knowledge test, and assessed confidence in using the pump immediately after learning and two weeks later. Simply repeating the content (section “Experiment 1”) did not improve performance of e-Learning + hands-on compared with e-Learning only. The instructed learning process (section “Experiment 1”) resulted in significantly better skills test performance for e-Learning + hands-on compared to the e-Learning only. Only a structured learning process based on multi-media learning principles and memory research improved procedural skills in relation to operating a medical device.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents’ procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development.

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

267 Improving the Surgical Teaching Opportunities: A QI Project to Deliver a Course at a Local Hospital Level During COVID-19 Pandemic

Abstract Aim During the COVID-19 pandemic, the training opportunities were markedly disrupted particularly, the surgical teaching which usually requires face to face teaching to help the acquisition of procedural skills. We implemented a QI project in a district hospital to improve the training opportunities for medical students &amp; foundation doctors. The project was a face-to-face free course for teaching generic procedural and clinical skills in surgery. Method The course was a mixture of two well-known surgical courses in the UK, Basic Surgical Skills and the CCrISP courses. It included clinical and procedural skills sessions on models which simulated the basic wound closure techniques and types of knots, as well as skin lesion excision training. The course was delivered to medical students, foundation year one &amp; two doctors and core surgical trainees. The improvement achieved by the course was measured by a questionnaire assessing the level of confidence between the candidates before and after each session. The questionnaire’s answers were categorised into (not confident, neutral, confident &amp; very confident). The course was delivered on two occasions. Results The qualitative analysis of the results on two different occasions showed a considerable improvement in the level of confidence between the candidates. They were able to demonstrate engagement throughout the course especially with the procedural skills sessions. Conclusions Formulating a course at a local hospital level was an efficient alternative for maximising the training opportunities reduced during the pandemic. It was an impressive opportunity for newly graduated doctors and medical students having any surgical placement.

Training in soft tissue resection using real-time visual computer navigation feedback from the Surgery Tutor: A randomized controlled trial

BackgroundIn competency-based medical education, surgery trainees are often required to learn procedural skills in a simulated setting before proceeding to the clinical environment. The Surgery Tutor computer navigation platform allows for real-time proctor-less assessment of open soft tissue resection skills; however, the use of this platform as an aid in acquisition of procedural skills is yet to be explored. MethodsIn this prospective randomized controlled trial, 20 final year medical students were randomized to receive either training with real-time computer navigation feedback (Intervention, n = 10) or simulation training without navigation feedback (Control, n = 10) during resection of simulated non-palpable soft tissue tumors. Real-time computer navigation feedback allowed participants to visualize the position of their scalpel relative to the tumor. Computer navigation feedback was removed for postintervention assessment. Primary outcome was positive margin rate. Secondary outcomes were procedure time, mass of tissue excised, number of scalpel motions, and distance traveled by the scalpel. ResultsTraining with real-time computer navigation resulted in a significantly lower positive margin rate as compared to training without navigation feedback (0% vs 40%, P = .025). All other performance metrics were not significantly different between the 2 groups. Participants in the intervention group displayed significant improvement in positive margin rate from baseline to final assessment (80% vs 0%, P < .01), whereas participants in the Control group did not. ConclusionReal-time visual computer navigation feedback from the Surgery Tutor resulted in superior acquisition of procedural skills as compared to training without navigation feedback.

Procedural Fundamentals for Medical Students: Institutional Outcomes of a Novel Multimodal Course

There is a gap in current medical student education pertaining to procedural skills' exposure and acquisition. The aim of this study is to evaluate the institutional experience of a novel medical student procedural course and its impact on procedural confidence. This is a single-center prospective study performed at a public medical school and its associated tertiary care medical center between June 2020 and January 2021. This study was deemed exempt by our Institutional Review Board and was performed with participant consent. The multimodal course developed by the radiology department consisted of four didactic lectures, four simulation sessions, and a minimum of 16 clinical rotation hours with the department's vascular access team. Primary outcomes were assessed by comparing participant pre and post course surveys including twenty-five 5-point Likert scaled questions. Twenty-five self-selected students completed the course in its entirety. The curriculum and the corresponding survey analysis were stratified into sections by procedure modality. An increase in participant confidence to a moderate or greater level was observed when comparing pre and post course survey data for each procedure: vascular access (4% vs 52%, p < 0.01), thoracentesis (8% vs 48%, p < 0.01), paracentesis (8% vs 72%, p < 0.01), lumbar puncture (4% vs 44%, p < 0.01), and bone marrow biopsy (0% vs 48%, p < 0.01). The creation of a medical-student-centric procedural course is feasible and fills a potential gap in undergraduate medical education. This study demonstrated that a comprehensive multimodal course, designed to include didactic, simulation and clinical experiences, increases participant exposure to, participation with, and confidence in bedside procedural performance abilities.

Regular rhythmic and audio-visual stimulations enhance procedural learning of a perceptual-motor sequence in healthy adults: A pilot study.

Procedural learning is essential for the effortless execution of many everyday life activities. However, little is known about the conditions influencing the acquisition of procedural skills. The literature suggests that sensory environment may influence the acquisition of perceptual-motor sequences, as tested by a Serial Reaction Time Task. In the current study, we investigated the effects of auditory stimulations on procedural learning of a visuo-motor sequence. Given that the literature shows that regular rhythmic auditory rhythm and multisensory stimulations improve motor speed, we expected to improve procedural learning (reaction times and errors) with repeated practice with auditory stimulations presented either simultaneously with visual stimulations or with a regular tempo, compared to control conditions (e.g., with irregular tempo). Our results suggest that both congruent audio-visual stimulations and regular rhythmic auditory stimulations promote procedural perceptual-motor learning. On the contrary, auditory stimulations with irregular or very quick tempo alter learning. We discuss how regular rhythmic multisensory stimulations may improve procedural learning with respect of a multisensory rhythmic integration process.

Simulation of tracheal intubation for medical students. The effects of anticipatory study

Clinical simulation allows the acquisition of procedural skills among medical students. The anticipatory study of these skills may improve the efficiency of simulation sessions. To Compare two anticipatory study guides in the simulation of airway management, in a cohort of medical students from Chile. Fifth year medical students were randomly assigned to prepare the simulation of tracheal intubation with a theoretical guide, an audiovisual guide, and a control group without study. The skills acquired were evaluated in a simulated scenario. All groups increased their successful orotracheal intubation (OTI) rate and decreased the time to achieve a successful OTI after each attempt. The study group with a theoretical guide had the higher rate of success in the 1st OTI attempt without feedback. In contrast, the group without any anticipatory study had more failed attempts (1st and 2nd attempt), achieving their first successful OTI in the 3rd attempt after feedback. Study guides improve practice effectiveness. Our results indicate that the best results are obtained by simulation accompanied with immediate directed feedback and opportunities to repeat the procedures, independent of the type of anticipatory study.