Bedside Teaching Research Articles

Education and Training for the Rapid Response System: Courses or Bedside?

The first consensus conference on rapid response systems defined four main components namely, the afferent arm, (to identify the deteriorating patient and escalate care), the efferent arm (the responding team), a process improvement arm, and an administrative arm [1]. As a consequence, it is possible to assume that there are at least four different teams to educate and train in every established rapid response system [1]. Members of each of the four arms have different background and expectations. These teams need also to be able to integrate their knowledge in order to deliver an efficient patientcentred care. The evidence shows that there are different ways to structure a rapid response system to rescue deteriorating patients in the ward in hospitals around the world [1,2]. Moreover, the efferent arm responding to the calls needs to work efficiently engaging different health care professionals around the hospital. It is intuitive that there are no unique answers to the question “are courses better than bedside teaching?” There are multiple levels of education and training that should be offered. Knowledge must be also maintained, and this could be achieved using again either courses or bedside teaching. The goal of this manuscript is to identify the needs and the limitations of training and education provided to an established rapid response system. A structured rapid response system means a configuration reflecting the four arms defined by the experts during the first consensus conference [1]. Principles of adult learning will be presented in the context of education and training using both courses or bedside tutoring. Technology will be acknowledged given the enormous contribution that this has given to improve the activation rate and the performance of the rapid response system. Luckily, bedside teaching can be integrated with alternative solutions such as immersive learning, virtual reality and simulation This possibility is relevant in relation to time limitation during training and high costs of dedicated study time. This manuscript will explore solutions to face challenges based on rapid response systems specific needs.

964. Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study

BackgroundThe COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education. MethodsWe conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings; senior residents; interns; and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn. ResultsTopics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms; use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001). ConclusionOur results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics.Disclosures Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)

Getting to know you: implementing an interprofessional education program for medical and respiratory therapy students in mechanical ventilation – challenges and lessons learned

ABSTRACT The physician and respiratory therapist function as an interprofessional team caring for patients on mechanical ventilation. There is a paucity of research devoted to interprofessional education (IPE) of students from different professions in mechanical ventilation during clinical rotations in the medical intensive care unit (MICU). Student interprofessional education could develop team communication and shared decision-making skills early in training. The uniqueness of this introductory IPE programme is that it occurs during a clinical rotation in a real MICU, as opposed to a pre-clinical simulated campus setting, and it blends students from various educational backgrounds. Medical students and respiratory therapy students from different academic institutions participated in traditional lectures, small interprofessional group case-based problem-solving sessions, MICU bedside teaching sessions, written assessments, and focus groups. Quantitative responses were analyzed using descriptive statistics. Qualitative responses were categorised using the core competencies for Interprofessional Collaborative Practice. The purpose of this introductory IPE programme was to foster opportunities for interprofessional interaction during the student clinical experience while improving knowledge about mechanical ventilation. Qualitative expectations and feedback were predominantly positive. Quantitative responses suggest that students from both disciplines gained knowledge about mechanical ventilation in an IPE setting.

Preceptorship and its effect on the clinical performance of nursing students

This study aims to explore the application of preceptorship and its effects on the clinical performance of nursing students in the Indonesian public and teaching hospitals. A quantitative method with a descriptive survey approach was used in this study. A total of 57 participants were included using a non-probability sampling technique. A modified preceptor evaluation of student instrument was applied to measure students’ clinical performances. This study found that the average score of nursing students’ clinical performances at the Indonesian public hospital was 107.2, while those at the teaching hospital was 105.7. Role modeling, case discussion, clinical skill demonstration, and bedside teaching were revealed effective to achieve the desired clinical learning outcomes. The application of preceptorship in Indonesian public and teaching hospitals had significant effects on nursing students to conquer their clinical performances. This study suggests nurse educators fully implement preceptorship in their clinical teaching strategies.

Teaching psychiatry in a low-income country during the COVID-19 pandemic: A hybrid collaborative psychiatry course.

Amoud University in Borama is located in the self-declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in-person "teaching missions." This was recently led by a Borama-native psychiatry resident in Ethiopia. COVID-19 added further hardships due to restrictions to travel and in-person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self-sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020-2021 and will continue in 2021-2022. An international, 'online-connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty-led, hybrid-delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020-2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross-cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health.

Анкетування здобувачів освіти як засіб моніторингу якості медичної освіти в умовах дистанційного навчання

The aim of the work is a comprehensive assessment of the teaching quality at the Department of Internal Medicine №1 of the Poltava State Medical University. The assessment of monitoring was an anonymous online survey of VI year education medical students that was trained at the modules “Current practice of internal medicine” and “Emergency conditions in the clinic of Internal Medicine” in the context of the COVID-19 pandemic. It was shown that, despite the greatest difficulty of the “Cardiology” and “Hematology” cycles, the overall assessment of the teaching availability for all cycles was 4,16±0,416 points and the value of any cycle was not lower than 4 (5-point system). Given the conditions of distance learning in connection with the COVID-19 pandemic caused by the coronavirus SARS-CoV-2 the average score of student satisfaction with the skills acquired was 3.59 ± 0.593. Students noted that the most difficult mastering practical skills were on the “Emergency” (16.14%) and “Cardiology” (15.18%) cycles. This indicates that any cases, situational tasks, demonstration videos can’t replace live communication with the patient, under the guidance of a teacher-mentor, work with modern equipment and simulators. These results reflect that students need bedside teaching activities on patients’ experiences with teacher-mentor. A targeted approach to teaching and evaluating the learning process encourages feedback from students to improve the quality of educational services. Thus, the data allow us to analyze the effectiveness of distance educational quality using anonymous questionnaires, to get feedback and respond to the identified shortcomings.

Experience-based learning: how a crisis solution informed fundamental change in a clinical education curriculum.

Clinical education represents the most important formative period in undergraduate medical education. It is often criticised as haphazard and inefficient. Experience-based learning (ExBL) is a novel clinical education design that utilises practices of support, learner participation and real patient learning to enhance students' development of vital professional capabilities. We introduced ExBL to address the challenges of a 50% reduction in clinical placement time that arose during the COVID-19 pandemic. Final year medical students were assimilated into clinical teams as co-workers to facilitate learning through participation rather than observation. Placement education was supported by an integrated case-based learning and high-fidelity simulation program. Real patient learning in workplace contexts was supported by a network of clinician mentors. A qualitative evaluation revealed that granting students co-worker status strongly supported participatory learning and professional identity formation. Furthermore, the triangulation of placements with cognitive coaching and high-fidelity simulation greatly enhanced skills development and students' sense of readiness for practice. Utilisation of ExBL significantly enhanced the quality of informal learning on clinical placements despite the reduced clinical placement time. In addition, the integration of cognitive coaching with simulation opportunities meant students were better prepared for meaningful participation as members of clinical teams. The introduction of ExBL increased the workload of clinical teachers. Moreover, favouring learning through participatory experience reduced exposure to more traditional formal bedside teaching encounters. Despite these challenges, we have adopted an ExBL model created in a crisis as our core educational design for our final year clinical programme.

Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?

HintergrundDer Beginn der ersten SARS-CoV-2-Pandemie-Welle im März 2020 erforderte erhebliche Umstellungsmaßnahmen in der medizinischen Lehre mit vollständigem Verzicht auf direkten Kontakt von Studierenden und Patienten. Vor diesem Hintergrund wurde das Lehrformat „Unterricht am Patienten“ (UaP) als interaktiver, videobasierter Distanzunterricht am Patienten etabliert und durchgeführt.FragestellungZiel der Studie war die Erfassung der studentischen Beurteilung dieses Lehrkonzeptes im Fach Hals-Nasen-Ohren-Heilkunde.Material und MethodenDie Live-Übertragung erfolgte aus einem HNO-Untersuchungsraum zu den im Hörsaal befindlichen Studierenden, welche mit den Patienten interagieren konnten. Makro-, mikro- und endoskopische Untersuchungsbefunde wurden in Echtzeit in den Hörsaal übertragen. Die Evaluation erfolgte anhand eines Online-Fragebogens, welcher 13 geschlossene Fragen (Likert-Skala) beinhaltete, sowie als offenes Feedback in freier Textform.ErgebnisseDie Rücklaufquote lag bei 16,8 % (42 von 250 Studierenden). Davon hatten 85,7 % einen positiven Gesamteindruck, und Tenor war, dass das Konzept angesichts der Umstände gut umgesetzt wurde. Dennoch könne auf einen direkten Patientenkontakt eher nicht verzichtet werden, auch wenn eine teilweise Kompensation durch Videoschaltung möglich sei. Insgesamt wurde das Lehrkonzept als lehrreich empfunden, und die Studierenden konnten sich vorstellen, zukünftig häufiger auch ein solches UaP-Lehrkonzept zu nutzen.SchlussfolgerungDieses Lehrkonzept kann den direkten Patientenkontakt nicht ersetzen, stellt jedoch speziell im HNO-Gebiet eine gute Alternative dar, wenn durch pandemiebedingte Umstände ein „klassischer“ UaP nicht möglich ist. Aspekte des interaktiven, videobasierten Distanzunterrichts am Patienten könnten auch zukünftig in andere Lehrformate integriert werden.

Function focused care in hospital: A mixed-method feasibility study.

During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidence-based intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) 'Environmental and policy assessment'; (2) 'Education'; (3) 'Goal setting with the patient' and (4) 'Ongoing motivation and mentoring'. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Mixed method design. A Neurological and a Geriatric ward in a Dutch Hospital. 56 Nurses and nursing students working on these wards. The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0-10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components 'Education' and 'Ongoing motivation and mentoring'. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals.What is already known•Function Focused Care is an evidence-based intervention that prevents functional decline among hospitalized elderly;•It is proven to be effective in assistant living facilities, nursing homes, home care, and acute care settings in the United States;•It is unknown if the intervention can be implemented in the Dutch Hospital Setting.What this paper adds•This study showed the feasibility of Function Focused Care in Hospital and the challenges in some elements of the intervention;•Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were added to FFCiH to improve future implementation.•This feasibility study can guide the use of process evaluation in examining the feasibility of an intervention in daily practice.

A new reality: Bedside geriatric teaching in an age of remote learning

Population ageing poses many challenges in the landscape of general medicine. One of these is the requirement for more geriatricians to minimise future strain on healthcare systems. Previous studies have identified that, while demand for geriatricians is on the rise, interest among medical students for a career in geriatrics falls behind. We utilised a new augmented reality technology (the Microsoft HoloLens 2) to deliver students a remote bedside teaching experience. Features of this teaching included bi-directional communication, exposure to physical signs, and use of holograms around the patient bedside as a teaching aid. Given its convenience, scope and engagement potential, this educational tool has potential to be used effectively throughout medical training.

Auswahlgespräche an der Medizinischen Hochschule Hannover: Determinanten der Studierendenauswahl im Studiengang Medizin

IntroductionIn order to incorporate social and communicative skills in its student admissions process, Hanover Medical School (MHH) has conducted selection interviews (in combination with the high-school GPA) to choose 60 % of its freshmen in medical studies. The present article analyses if applicants’ performances in the interviews were the determining criterion of student selection, despite a higher weighting of school grades in the admission process. Furthermore, this article checks whether the grading of the interviews was independent of the applicants’ gender, age, origin and educational background. MethodsFor a sample of more than 3,000 successful and unsuccessful participants in the MHH student admission process in the years 2010–2017, we employ variance analysis and logistic regression analysis to determine those factors that have contributed to the chances of being offered a place at the MHH after a successful interview. ResultsThe scores received in the selection interview were the sole determinant of being offered a place at the MHH; neither the applicants’age nor their gender or origin biased the decisions of the selection committees. The grading of the interview was also not affected by school GPAs. DiscussionThe selection interviews at the MHH have been costly in terms of both financial and human resources. However, this selection method has been popular among students and lecturers alike, not least because its elements fit the MHH's focus on early bedside teaching and social skills of prospective physicians. However, there is no evidence that selection interviews are effective in predicting academic success. ConclusionsThe present article has shown that the selection interviews acted up to the principles defined by the MHH: very homogenous high school GPAs were complemented by differentiated interview assessments that did not discriminate by sociodemographic characteristics. It is, however, unclear if the MHH will resume the interviews after the end of a federally mandated halt to stand-alone selection methods at medical schools in Germany.

995 Bedside Teaching from A Distance; Surgical Education in The COVID Era

Abstract Introduction The COVID pandemic resulted in a shutdown of facilities and resources globally. With drastic changes in the provision of services available in the health sector, so too were medical students’ provision of learning. With the onslaught of COVID and the need for ongoing learning resources for students, novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required was devised using a virtual platform to compliment current pedagogical approaches. Method This was a randomised control trial to evaluate the perceived use of remote learning in place of surgical bedside teaching in the COVID-19 era. Medical students in a regional hospital were recruited and randomised to undergo the bedside teaching in person or receive the teaching virtually through a Xpert eye, smart glasses to facilitate connections remotely. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits, and limitations. Results Feedback demonstrated greater engagement, satisfaction, involvement, and learning (p &amp;lt; 0.01) in the bedside teaching group. Content analysis yielded three main themes: Interpersonal content, technological features, and provision of content. Students reported the virtual teaching was an acceptable alternative in the current climate of social distancing and reduced patient access. Conclusions The current pandemic poses a risk to adequate patient exposure to patient centred learning. Teaching sessions received remotely are an acceptable alternative in the current climate of reduced clinical access, however bedside teaching remains the preferred method of learning.

685 Implementation of Education Fellows on General Surgery Medical School Rotations Facilitates Student Learning and Improves Learning Experience

Abstract Aim A UK teaching hospital expanded their established education fellow programme to the General Surgery department to assist with departmental teaching of third-year medical students from the affiliated medical school on clinical placement. Teaching on ward rounds, bedside teaching and clinical tutorials were three areas identified as requiring improvement based on previous student feedback. Observation of Upper and Lower Gastrointestinal (GI) malignancy multi-disciplinary meetings (MDMs) via Microsoft Teams was also introduced as a new teaching initiative. Method Four post-foundation training education fellows were allocated on alternating weeks to supervise third-year medical students on upper and lower GI ward rounds and during GI MDM observation, conduct bedside teaching and facilitate blended-learning clinical tutorials in accordance with the 2020 GMC Medical Licensing Assessment curriculum. A mixed-methods survey was sent to students after surgical placement and the results compared to student feedback from previous years. Results 31 out of 52 students (60%) on placement responded. 100% rated the fellow-led clinical tutorials as “excellent”. 87% of respondents rated the upper and lower GI ward rounds as either “excellent” (52%) or “good” (35%). All respondents rated the implementation of education fellows as either “very helpful” (94%) or “helpful” (6%) for their learning. Most students rated the MDM observation initiative as “good” (36%) or “average” (36%). Conclusions Implementation of education fellows on third-year medical student placements in General Surgery facilitates self-reported student learning and is associated with a drastically improved student learning experience. More work is required to develop GI MDM-based teaching to improve student learning experiences from MDMs.

756 Adapting Undergraduate Teaching in the COVID 19 Era

AimThe COVID-19 pandemic has drastically impacted medical education, particularly in terms of content delivery and clinical placement efficacy. The initial suspension of placements was devised to limit exposure and redirect medical staff to critical areas. Nevertheless, clinical placements are an important pillar of the undergraduate curriculum and new techniques must be developed to better facilitate its delivery. Our aim was to create a programme that effectively met the required curriculum learning outcomes for medical students.MethodIn September 2020, students from Queen’s University, Belfast, returned to placement following months of online and distance learning. Having previously focused on bedside and case-based teaching, our priority remained with patient and student safety. Complimentary non-clinical and simulation methods were introduced including laparoscopic skills, suture and knot tying sessions and foundation competencies. Rating scale questionnaires were distributed over a four-week period following each session.Results32 sessions were carried out and 53 questionnaires returned. Three key areas were reviewed; teaching delivery, usefulness of session and content/relevance, with each area scored out of 10. Collectively across all sessions, 94.3%, 92.4% and 88.7% respectively were scored 9 or greater for each key area.ConclusionsThe COVID-19 crisis has led to the development of alternative methods of undergraduate teaching. The insurance of patient safety whilst preparing students for their future career is a priority. We have successfully developed an effective and useful placement that blends clinical knowledge and skill-based learning. Given the ongoing pandemic and redirection of resources, further novel ways of teaching should be considered.

VIRTUAL CARDIOLOGY CLINICAL SKILLS TEACHING FOR MEDICAL STUDENTS USING AN ELECTRONIC STETHOSCOPE DURING THE COVID-19 PANDEMIC: FEASIBILITY AND FEEDBACK.

BACKGROUNDThe provision of teaching within medical schools, particularly at the pre-clerkship level, has been difficult during the COVID-19 pandemic due to the need for limited patient contact. The opportunities for Med I and Med 2 students for bedside teaching have been a particular challenge. During the Cardiology clinical skills unit at Dalhousie University there was a shift in Public Health recommendations necessitating a quick change in teaching strategy during the second wave of the pandemic. With medical students no longer able to enter the hospital for practice histories and physicals on ‘real’ cardiac patients, an effort was made to provide a similar experience using a virtual platform.METHODS AND RESULTSBedside teaching for cardiology at Dalhousie (Halifax site) involves three 4-week rotations of roughly 28 students per group. One of these groups was provided with a virtual experience using a hospitalized patient with cardiac disease on week one, followed by in-person clinical skills teaching with a standardized patient without cardiac disease in weeks 2-4. For the virtual experience the history portion was conducted using Zoom, and the physical examination was demonstrated using an iPhone connected to an electronic stethoscope which allowed broadcast of heart sounds to the students over the Zoom platform. The stethoscope used was the Thinklabs OneTM digital. The three in-person sessions were provided in groups of 4 students to one standardized patient along with a cardiologist. At the end of the four-week session the students were asked to evaluate the experience of the virtual history and physical examination with the ‘real’ patient in a short survey and compare it to the standardized patient experience. Of the 28 students, 16 completed the evaluation survey (57%). All students (100%) selected either ‘Agree’ or ‘Strongly agree’ on a 5-point Likert scale when asked if the virtual session provided a valuable learning experience for both history taking and physical examination. The majority of students (87.5%) also felt that the virtual bedside teaching was either equivalent or preferable to the in-person learning experience with the standardized patient.CONCLUSIONVirtual clinical skills teaching using a Zoom platform and an electronic stethoscope was both feasible and provided a valuable alternative learning experience for medical students during the COVID-19 pandemic.

Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic.

Resident physicians are expected to recognize patients requiring escalation of care on day 1 of residency, as outlined by the Association of American Medical Colleges. Opportunities for medical students to assess patients at the bedside or through traditional simulation-based medical education have decreased because of coronavirus disease 2019 restrictions. Virtual reality (VR) delivered remotely via video teleconferencing may address this educational gap. A prospective pilot study targeting third-year pediatric clerkship students at a large academic children's hospital was conducted from April to December 2020. Groups of 6 to 15 students participated in a 1.5-hour video teleconferencing session with a physician facilitator donning a VR headset and screen sharing interactive VR cases of a hospitalized infant with respiratory distress. Students completed surveys assessing the immersion and tolerability of the virtual experience and reported its perceived effectiveness to traditional educational modalities. Comparisons were analyzed with binomial testing. Participants included third-year medical students on their pediatric clerkship. A total of 140 students participated in the sessions, with 63% completing the survey. A majority of students reported VR captured their attention (78%) with minimal side effects. Students reported remote VR training as more effective (P < .001) than reading and online learning and equally or more effective (P < .001) than didactic teaching. Most students (80%) rated remote VR as less effective than bedside teaching. This pilot reveals the feasibility of remote group clinical training with VR via a video conferencing platform, addressing a key experience gap while navigating coronavirus disease 2019 limitations on training.

Flying Solo: Effectiveness of Attendingless Family-Centered Rounds on Improving Resident Autonomy

The Accreditation Council for Graduate Medical Education requires that residents demonstrate increasing autonomy during their training. Although residents report a better educational environment with hospitalists present during family-centered rounds (FCRs), there is a concern that attending presence may reduce resident autonomy. We aim to determine the effect of FCRs without an attending during rounds on senior residents' sense of autonomy. We conducted a multicenter, retrospective, preintervention-postintervention study at 5 children's hospitals to evaluate the effect of rounding without an attending on senior residents' self-efficacy, using a questionnaire developed by using Bandura's principles of self-efficacy and Accreditation Council for Graduate Medical Education milestones. Questions addressed skills of diagnosis and/or management, communication, teaching, and team management. We compared preintervention and postintervention results using paired t tests and Wilcoxon rank tests. One-way analysis of variance tests were used to compare means among >2 groups. 116 (82% response rate) of 142 eligible senior residents completed the questionnaire, which yielded a high reliability (α = 0.80) with a 1-factor score. The average composite score of self-efficacy significantly improved after intervention compared with the preintervention score (66.71 ± 6.95 vs 60.91 ± 6.82; P < .001). Additional analyses revealed meaningful improvement of each individual item postintervention. The highest gain was reported in directing bedside teaching (71.8% vs 42.5%; P < .001) and answering learner questions on rounds (70.7% vs 47.0%; P < .001). Conducting FCRs without an attending increases resident reported self-efficacy regarding core elements of patient care and team leadership. In future studies, researchers should examine the impact of rounding without the attending on other stakeholders, such as students, interns, patients and/or families.

POINT-OF-CARE ULTRASOUND CURRICULUM FOR INTERNAL MEDICINE RESIDENTS: A SINGLE-CENTER EXPERIENCE

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Point-of-care ultrasound (POCUS) has been used widely by pulmonary and critical care physicians/trainees for years with the recent trend of integrating similar curriculums in internal medicine resident training. It is known to supplement the physical exam, aide to accurate diagnosis and improved patient care. Here, we demonstrate that a curriculum including didactics combined with single hands on session not only increases the knowledge of ultrasound basics among the internal medicine trainees but also enhance their skill level, accuracy and confidence to image acquisition and interpretation. METHODS: Internal medicine residents and internal medicine-pediatric residents were invited to participate in this internal medicine ultrasound curriculum. As a part of curriculum all residents first attended two detailed POCUS didactic sessions and completed online ultrasound modules followed by hands on sessions which started with an hour of quick review of previously held didactics and three hours of performing ultrasound image acquisition and interpretation on standardized patients on three stations. Each station had a specific task assigned including lung ultrasound, limited cardiac views, abdominal ultrasound as well as basics of ultrasound including knobology and artifacts. Residents took a pretest with 20 questions on the subject of POCUS basics and organ system findings then same questions were posed in posttest after conclusion of the session. Standardized feedback was then obtained from residents. Each station was supervised by a critical care physician or an internal medicine physician with formal training in basic ultrasound. Session also included a computerized ultrasound manikin to familiarize residents with pathological ultrasonographic findings. RESULTS: 54 residents of all post graduate years participated in our pilot POCUS curriculum. For the pre-test the mean score is 15.87(81%) (Minimum 11 and maximum 20) whereas for post-test the mean score is 17.47 (88.95%) (Minimum 14 and maximum 20). This difference was statistically significant with p < 0.001 (Mann Whitney U test). Standardized feedback obtained from the trainees revealed that 99% felt the session stimulated their interest and thinking and they would like more hands on session to enhance their skills. 98% of the trainees said the session motivated them to continue learning ultrasound, found it practical and relevant to their field of practice and improved their ability to manage patients. All appreciated practicing ultrasound on a standardized patient to learn normal anatomy. CONCLUSIONS: This pilot confirmed that the didactics combined with single hands on session did improve knowledge, skills and confidence to use ultrasound in the internal medicine residents. CLINICAL IMPLICATIONS: We plan to make this curriculum a yearly activity with integration of new ultrasound elective for two weeks along with continued bedside teaching. DISCLOSURES: No relevant relationships by Harmeen Goraya, source=Web Response No relevant relationships by Gayathri Krishnan, source=Web Response No relevant relationships by Keyur Vyas, source=Web Response No relevant relationships by Cody Webster, source=Web Response

Student Acceptance of Virtual Bedside Surgical Tutorials During COVID-19: A Randomized Controlled Trial

BackgroundThe social distancing recommendations from the WHO during the pandemic has resulted in a pivot point in the delivery of medical education. With the medical student clinical experience constantly under threat; novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required were devised using a virtual platform to compliment current pedagogical approaches.MethodsA parallel randomized controlled trial evaluated the perceived use of remote learning in place of bedside teaching. Participants were randomized to undergo surgical bedside teaching in person or virtually. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits and limitations to each modality.ResultsFeedback demonstrated greater engagement, satisfaction, involvement and learning (P < 0.001) in the bedside teaching group. Content analysis yielded three main themes; Technological, Interpersonal Component, Provision of Content. Participants in the virtual group reported a limited ability to elicit clinically relevant findings in surgical patients. Students however reported the virtual teaching was an acceptable method of learning with 90% satisfaction reported for learning via the virtual platform.DiscussionThe pandemic posed challenges to adequate student-patient exposure. Delivering surgical bedside teaching remotely is a method amenable to learning for students, with advantages including convenience, fewer reports of information fatigue, and decreased perceived pressure identified with this learning modality.

The 'sleeping elephant': The role of mentorship of critical care nurses in Zambia.

To develop and evaluate a Zambian context-specific mentorship model that supports registered nurses completing emergency, trauma and critical care programmes in Zambia. In Zambia, emergency and trauma and critical care nursing are relatively new specialties, with education and training programmes less than a decade old. A train the trainer mentorship programme was developed and delivered at two colleges of nursing. Ethics approval was gained in both Zambia and the UK. Documentary data analysis and focus groups were used. Focus groups included stakeholders and nurses in practice who had completed the train the trainer programme and were using the mentorship model. The critical review of the literature revealed there was a paucity of evidence on the role of mentors in critical care. However, national documentation identified that most post basic education programmes are at Diploma Level with limited content that focuses on bedside teaching, mentorship and assessment content. Feedback from representatives attending the stakeholder workshops and focus groups which included participants who had completed the training programme enabled the mentorship model and workshop to be developed and evaluated. Nurses are the backbone of healthcare systems in Africa and the world. Mentorship and assessment in practice enables nurses to develop the competence and skills to lead practice, support peers and junior colleagues. This paper has identified the need for a context-specific formalised mentorship model to support specialist practice and this project has provided the foundations for mentorship of emergency, trauma and critical care nurses in Zambia.