Bedside Training Research Articles

Simulation-Based Echocardiography Training Enhanced Competence and Self-Confidence in Neonatal Residents.

Mastering echocardiography scans is essential in neonatology, but bedside training can be difficult due to the instability of neonatal patients. The aim of this study was to demonstrate the benefits of simulation-based training for residents learning echocardiography. This multicentre randomised controlled trial involved residents from three French neonatology departments. The authors compared a control group with theoretical and bedside training and a simulation group with additional simulation-based training. Evaluations were conducted three and 6 months after training using two scoring methods: a reference score for the quality of the echocardiographic sections and a custom-made score for recognising anatomical structures. We randomised 52 residents from 1 May 2021 to 31 May 2023. After 3 months, the residents in the simulation group achieved a higher mean score than the residents in the control group for both the reference score (11.5 ± 2.3 points vs. 7.4 ± 3.4 points, p < 0.001) and the custom-made score (25.8 ± 5.3 points vs. 16.9 ± 7.8 points, p < 0.001). The difference remained significant at 6 months and the custom-made score showed good agreement with the reference score. Simulation-based training was a valuable approach for training neonatal residents to perform echocardiography and more extensive training courses should be developed. ClinicalTrials.gov identifier: NCT06442683.

The Impact of a Structured Onboarding and Education Program on the Professional Advancement of a Pediatric Sonographer

Objective: The purpose of this study was to determine the quality and effectiveness of a structured, competency milestone-based pediatric sonographer onboarding program and continuing educational curriculum and to ascertain if these experiences influence their professional development, job satisfaction, and retention. Materials and Methods: A survey was distributed to the sonographers in a single echocardiography laboratory. The anonymized data were collected and analyzed to generate descriptive statistics. Results: There were 36 sonographers who responded (80%) and 15 (42%) training with the new onboarding curriculum. The majority reported a positive feeling of preparedness for independent practices (80%) with hands-on teaching, timely feedback, and case-based learning rated as the most effective teaching methods. Physician feedback was preferred over sonographer trainer feedback. Most sonographers perceived the advancement of their knowledge as important for professional growth, job satisfaction, and retention. Conclusion: A structured onboarding program for new hires based on competency milestones was effective in preparing pediatric cardiac sonographers for independent practice. Hands-on bedside training, timely constructive feedback, and case-based learning should be included in the curriculum to ensure high-quality teaching. Physician engagement is highly valued and should be incorporated into the workflow. This study may suggest that continuing education helps positively influence the sonographer’s attitudes toward professional development, job satisfaction, and retention.

AIIMS ICU Rehabilitation (AIR): development and description of intervention for home rehabilitation of chronically ill tracheostomized patients

Background The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients. Methods The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders’ experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention. Results The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future. Conclusions Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.

Long Round-Trip Time Delay Effects on Performance of a Simulated Appendectomy Task.

INTRODUCTION: No current astronauts have surgical training, and medical capabilities for future missions do not account for it. We sought to determine the effect of communication delays and text-based communication on emergency medicine physician (EMP) performance of a simulated surgical procedure and the ideal training paradigm for remote surgery.METHODS: In this study, 12 EMPs performed an appendectomy on a virtual reality laparoscopic simulator after tutorial. EMPs were randomized into two groups: one (bedside) group performing with bedside directing from a surgeon and the second (remote) group performing with text-based communications relayed to the surgeon after a 210-s time delay. Both groups performed a second simulated surgery 7 mo later with 240-s delay. Collected data included time to completion, number of movements, path length, economy of motion, percentage of time with appropriate camera positioning, texts sent, and major complications.RESULTS: The remote group took significantly longer to complete the task, used more total movements, had longer path length, and had significantly worse economy of motion during the initial trial. At the 7-mo simulation, there were no significant differences between the two groups. There was a nonsignificant increase in critical errors in the remote group at follow-up (50% vs. 20% of trials).DISCUSSION: EMPs are technically able to perform a surgical operation with delayed just-in-time telementoring guidance via text-based communication. However, the ideal paradigm for training non-surgeons to perform surgical operations is unclear but is likely real-time bedside training rather than remote training.Kamine TH, Siu M, Stegemann S, Formanek A, Levin D. Long round-trip time delay effects on performance of a simulated appendectomy task. Aerosp Med Hum Perform. 2024; 95(9):703-708.

Comparison of the SBAR method and modified handover model on handover quality and nurse perception in the emergency department: a quasi-experimental study

BackgroundEffective information transfer during nursing shift handover is a crucial component of safe care in the emergency department (ED). Examining nursing handover models shows that they are frequently associated with errors. Disadvantages of the SBAR handover model include uncertainty of nursing staff regarding transfer of responsibility and non-confidentiality of patient information. To increase reliability of handover, written forms and templates can be used in addition to oral handover by the bedside.AimsThe purpose of this study is to compare the ‘Situation, Background, Assessment, Recommendation (SBAR) method and modified handover model on the handover quality and nurse perception of shift handover in the ED.MethodsThis research was designed as a semi-experimental study, with census survey method used for sampling. In order to collect data, Nurse Perception of Hanover Questionnaire (NPHQ) and Handover Quality Rating Tool (HQRT) were used after translating and confirming validity and reliability used to direct/collect data. A total of 31 nurses working in the ED received training on the modified shift handover model in a one-hour theory session and three hands-on bedside training sessions. This model was implemented by the nurses for one month. Data was analyzed with SPSS (version 26) using paired t-tests and analysis of covariance.ResultsResults indicated significant difference between the modified handover model and SBAR in components of information transfer (P < 0.001), shared understanding (P < 0.001), working atmosphere (P = 0.004), handover quality (P < 0.001), and nurse perception of handover (P < 0.001). The univariate covariance test did not show demographic variables to be significantly correlated with handover perception or handover quality in SBAR and modified methods (P > 0.05).ConclusionsThe results of this study can be presented to nursing managers as a guide in improving the quality of nursing care via implementing and applying the modified handover model in the nursing handover. The resistance of nurses against executing a new handover method was one of the limitations of the research, which was resolved by explanation of the plan and goals, as well as the cooperation of the hospital matron, and the ward supervisor. It is suggested to carry out a similar investigation in other hospital departments and contrast the outcomes with those obtained in the current study.

Perspectives of Nursing Students toward High-Fidelity Simulation Learning During COVID-19 Pandemic

While evidence of the impact of simulation in nursing education is growing, COVID-19 pandemic may carry further evaluation beyond the existing perception. To explore Jordanian nursing students' perspectives toward utilizing high-fidelity simulation learning as alternative clinical bedside training during COVID-19 pandemic. A qualitative thematic analysis approach was employed through direct focus group discussions. Transcripts were thematically analyzed using Marshall and Rossman's (1999) process. Thirty-five nursing students joined seven focus group discussions. Two major themes emerged from data analysis as follow: "Restored factual training environment", and "Proficiency devoid from self-confidence". Students articulated the implication of using HFS on their knowledge, practical skills, communication, and team working. However, a criticism on HFS inability to promote self-confidence was addressed. Despite the effectiveness of HFS in nursing education, it was viewed as incompetent for building sufficient confidence required for direct interaction with contagious patients in real settings.

Exploration of Competency-oriented Standardized Training Model for Clinical Pharmacists

Objective: This study aims to explore a training model suitable for hospital pharmacy work, namely, a competency-oriented standardized training model for clinical pharmacists, and evaluate the teaching effectiveness of clinical pharmacists trained under this model, providing reference for improving the pharmaceutical service level of clinical pharmacists. Methods: A survey was conducted on students who participated in the standardized training for clinical pharmacists in our hospital from October 2020 to September 2023. By comparing assessment scores, the study explored the learning outcomes of clinical pharmacists under the competency-oriented training model compared to traditional training models. Results: The competency-oriented training model led to higher scores in bedside assessments, case assessments, training processes, and overall evaluation scores for trainees compared to traditional training methods. This teaching model exploration strengthens the core competencies of clinical pharmacists, making the training content more relevant to clinical work. Conclusion: The competency-oriented standardized training model aimed at enhancing the on-job competency of clinical pharmacists can improve the core professional competitiveness of pharmacists and promote the transformation and development of hospital pharmacy.

Using Cloud Healthcare to Improve Home Learning Efficacy in Congenital Heart Disease Infants

During the COVID-19 pandemic, visitation restrictions in line with infection control policies curtailed opportunities for family members to learn essential caregiving skills in the intensive care unit. This limitation decreased satisfaction among family members, possibly indicating their increased difficulties in care due to the lack of face-to-face guidance. Thus, increasing family member understanding of and ability to apply learning content without direct interaction presents a significant and urgent challenge. Moreover, because of lack of caregiving confidence, some family members may be reluctant to facilitate the discharge of critically ill patients, causing delays in discharge planning. These challenges underscore the obstacles faced by nursing health education during the pandemic. This study was designed to utilize cloud technology to enhance the knowledge and skills of families caring for infants with congenital heart disease at home and to assess their satisfaction with the associated homecare learning platform. Based on our hospital's cloud-based health education platform, a series of personalized instructional video materials was developed for families of infants with congenital heart disease. These materials cover comprehensively the entire treatment process, from diagnosis to post-discharge home care skills, for these patients. To facilitate autonomous learning, the videos in this series were made accessible to the families anytime, anywhere via personal devices such as smartphones and tablets. Concurrently, a chatbot tool was integrated to provide guidance on inpatient care for infants with congenital heart disease, including fundamental aspects of newborn care, with the aim of equipping parents and caregivers with the knowledge and skills necessary to provide basic post-discharge care. To ensure the families acquired personalized care skills, after completing the learning modules, practical bedside training sessions incorporating knowledge and skills assessments were organized for family members. After project implementation, the average knowledge score for family members increased significantly from 79.1 to 100 (perfect score). The proportion of family members proficient in executing caregiving techniques autonomously also rose impressively from 30% to 95%. Furthermore, average overall satisfaction with cloud-based technology-assisted caregiving learning among the family members rose 31.4% from 3.5 to 4.6. This project represents a viable solution to providing clinical nursing guidance independent of the constraints of time and location, and effectively enhances homecare-skill-related learning outcomes in family members, especially with regard to caring for infants with congenital heart disease.

The impact of healthy nutrition education based on traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome: a randomized clinical trial

BackgroundAcute Coronary Syndrome is the most common heart disease and the most significant cause of death and disability-adjusted life years worldwide. Teaching a healthy eating style is one preventive measure to prevent the disease’s recurrence. This study aimed to determine the effect of healthy nutrition education with the help of traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome.MethodsThis randomized, single-blinded clinical trial was conducted with 139 participants (66 in the intervention group and 73 in the control group) from January 2021 to August 2021 in Shaheed Rajaie Hospital, Tehran, Iran. The control group received standard training. The intervention group, besides this, received additional bedside training with an educational poster on traffic light labels from the research team during their final hospitalization days. Data were collected using a researcher-made questionnaire on food selection, preference, and consumption.ResultsThe Brunner-Munzel test showed no significant difference between the two groups in terms of selection (P = 0.127), preference (P = 0.852), and food consumption (P = 0.846) in the baseline, while after the intervention, there were significant differences in selection (P > 0.001), preference (P > 0.001), and consumption (p < 0.004). Comparing the difference between the two groups in the difference between the before and after scores for selection (p < 0.001), preference (p < 0.001), and food consumption (p = 0.011) with the Brunner-Munzel test indicated a significant difference in all outcome variables.ConclusionsTeaching healthy eating styles with the help of traffic light labels affected food selection, preference, and consumption and led to healthier diets in these patients.Clinical trial registration numberClinical trial registration: It was prospectively registered in the Iran Clinical Trials Registration Center on this date 30/10/2020 (IRCT20200927048857N1).

Bedside critical care training: A quasi-experimental study in the paediatric emergency department of a referral hospital in Nigeria.

There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. To evaluate the impact of bedside training on emergency critical care practices of clinical staff. This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants' actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p<0.05 was considered significant. A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male:female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants' understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting. Paediatric emergency department clinical staff desire hands-on critical care training in developing settings. Bedside training improves the knowledge and skills of nursing staff in non-invasive ventilation. Bedside training also builds the capacity of medical staff in invasive ventilation in the emergency department. Overall, short-term bedside training enhances the clinical knowledge and self-reported critical care practice of clinical staff in Children's Emergency Room.

Crafting British medicine in the Empire: the establishment of medical schools in India and Canada, 1763-1837.

In the early nineteenth century, medical schools became a growing means of regulating medicine in the British Empire, both in the metropole and in two colonies: India and Canada. By examining the establishment of medical schools in Calcutta, Bombay, Madras, Quebec City, Montreal and Toronto between the end of the Seven Years' War and the beginning of the Victorian era, this article argues that the rise of the British Empire was a key factor in the gradual replacement of private medical apprenticeships with institutional medical education. Although the imperial state did not implement a uniform medical policy across the British Empire, the medical schools established under its jurisdiction were instrumental in devising a curriculum that emphasised human dissection, bedside training in hospitals and organic chemistry as criteria of medical competence.

Effective implementations to reduce medication administration errors in a tertiary care teaching hospital

Background: Medication Administration Errors (MAEs) can lead to unmet therapeutic objectives as these errors can directly harm the patient and affect the outcome of therapy. Materials and Methods: This was an implementation research planned to evaluate the effect of interventions on the prevalence and severity of MAEs over three years, from 2020 to 2022, at a tertiary care hospital where clinical pharmacists were allotted to look into medication-related activities. Amedication error reporting form, developed by the pharmacologist, was used to collect MAE data. Analysis of this information aided in the planning of interventions to curtail the occurrence of such errors in the future. Interventions included drug and disease education leaflets, bedside training, vial/ampoule reading training, understanding different dose strengths, maintaining patient bedside boxes, antibiotic reconstitution leaflets for reference, and charts to guide safe drug administration. Results: The effect of these interventions was analyzed at the end of each year on the prevalence and nature of MAEs, where a decline of 38.97% was found in 2021 and a further 34.88% in 2022, considering the number of opportunities. The most prevalent was the wrong dose (~57%) errors commonly found with oral solid dosage forms and the cardiovascular group of drugs (42.5%). These MAEs were mainly of no harm category C (64%), while only 1.5% of them had caused harm (category E) to the patient, but none of these was sentinel. Conclusion: Interventions by clinical pharmacists successfully helped reduce MAEs and prevented patient harm in the further study period.

AIIMS ICU Rehabilitation (AIR): development and description of intervention for home rehabilitation of chronically ill tracheostomized patients

Background The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients. Methods The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders’ experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention. Results The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future. Conclusions Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.

Benefits of simulation for ultrasound-guided midline placement training: MC-in-Sim pilot study.

Ultrasound-guided placement of Midlines catheters (MCs) is a standard procedure with many benefits for patients. Even if there are some guidelines worldwide, this invasive technique is still taught at the patient's bed and relies on mentoring in many care centers. The performance of this care by novice practitioners raises ethical and quality of care issues mainly because of its risk of complications. This study aimed to propose and assess a simulation-based learning method for the placement of MCs in novice practitioners. A single-center prospective observational study was conducted with anesthesia residents who had no prior experience of Midline placement. Two workshops were planned. The first one consisted of a theoretical training and a simulated practical phase. The second workshop included an assessment of theoretical memorization, a practical exercise and adherence to the training program. The median score of the theoretical memorization was 14.6 (interquartile range [IQR]: 13.5-15.8). The MCs placement time was significantly higher (Med: 12.23 min; IQR: 12.21-12.80) for novice practitioners who did not successfully complete solo MCs placement in simulation versus novice practitioners who successfully completed solo MCs placement in simulation 6.66 min (IQR: 5.92-8.93) (p = 0.002). The number of attempts was significantly higher (p = 0.034) for the novice practitioners who did not successfully complete solo MCs placement in simulation with 67% having performed three punctures, against 0% for the novice practitioners who successfully completed solo MCs placement in simulation. All novice practitioners found this training model efficient for learning how to place MCs and considered it allows for reproducibility in care situations. This ultrasound-guided MCs training on simulation is an agile and fast alternative to traditional bedside training for anesthesia novice practitioners.

Experience informed procedural skills training.

Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a 3-year fellowship. However, skill acquisition is not uniform. Individualised training, adapted to the unique experiences and requirements of each trainee, may enhance competency. An individualised, longitudinal critical procedure course was initiated at a large academic paediatric medical centre in July 2022 for PCC fellows (n = 5). The course, informed by procedural performance profiles (P3) generated through real-time clinical assessments in the paediatric intensive care unit (PICU), was split into three phases: (1) an Initial Simulation Bootcamp-a 2-day introductory session; (2) Quarterly Structured Booster Sessions (QSBS)-spaced repetition of deliberate practice training individualised to each fellow; and (3) an Annual Refresher Training-a core skills and advanced technique training day. Fellows began with minimal experience, which formed their initial P3s. Ninety-two percent (166/180) of bedside procedures received real-time feedback, enabling longitudinal P3 modification, which identified focus areas for the QSBS. The sessions were well attended and received. Eighty-nine percent (QSBS #1 5/5, QSBS #2 3/4) of respondents reflected positively on the course's impact on procedural understanding. The course was perceived as more effective than traditional modalities, except bedside training. Implementation of a spaced repetition, deliberate practice course informed by longitudinally tracked real-life performance data is feasible for educators and preferred by trainees. This educational construct can be applied to other clinical skills, bringing precision medicine approach to training.

Assessment of knowledge and utilization of electrocardiogram by primary health care physicians and nurses in Qassim Region, Saudi Arabia

Objective: This study aimed to assess primary care physicians&amp;apos; and nurses&amp;apos; knowledge and utilization of electrocardiograms (ECG) in primary health care centers (PHCCs) in Qassim, Saudi Arabia. Methods: A cross-sectional study was conducted among PHCC physicians and nurses in Qassim Region, Saudia Arabia. An online self-administered questionnaire was used to obtain information about the knowledge and use of ECG. Results: A total of 320 physicians, family medicine residents, and nurses participated in the survey. Out of the participants, 174 (54.4%) were females. The majority (n=130, 40.6%) were aged between 31 and 40 years. In terms of the number of ECGs requested per week, approximately half of the participants, 158 (49.4%), requested ECGs two to five times per week. The most common reason for ECG requests was angina at 279 (87.2%), followed by arrhythmia at 139 (66.3%) and hypertension at 80 (25.0%). A majority of the doctors (56.3%) reported receiving ECG interpretation from senior colleagues. The most common ECG diagnosis reported was normal ECG among 296 (92.5%). Furthermore, 114 (35.6%) of the participants stated that they believed bedside teaching was the most effective way to improve ECG knowledge and its practical use. Conclusion: This study revealed that primary care physicians and nurses in Qassim, Saudi Arabia, had a limited understanding of and limited use for ECGs. It is strongly recommended to provide bedside training, hands-on tutorials during clinical rotations, and workshops/continuous medical education (CMEs) to enhance ECG knowledge, attitude, and utilization.

Студенты в клинике: этические аспекты

The article is devoted to ethical aspects of bedside training. Education of future specialists in the clinical setting is important to acquire knowledge, skills, professional competencies and to form clinical thinking. Transfer of professional medical experience occurs simultaneous to the development of communication skills which are required to deal with patients, their relatives, colleagues and mentors. It is about comprehension of how the normal standards of medical deontology are implemented in real practice and how important the effective therapeutic alliance is while interacting with the patient. Though bedside training is a long-standing tradition of medical education, the origins of which are associated with the Ancient Greek Healing Practices, it is not always understood and supported by patients and their relatives, and requires students to get more familiar with ethical standards regulating similar education and their behavior within a medical group and institution.

Perception and attitude of nursing students toward e-learning

Background: Information technology (IT) has undeniably eased out online teaching in days of social isolation. The sudden closure of institutions during the COVID-19 pandemic brought a halt in academics; later resumed through the inception of e-learning. Pandemics can neither be forecast nor overruled. Striding through this trying trend, it was thought prudent to determine nursing students’ attitude toward acceptance and practice of e-learning. Aims and Objectives: Striding through this trying trend, it was thought prudent to determine nursing students’ attitude toward acceptance and practice of e-learning. Materials and Methods: A descriptive cross-sectional study was conducted among 144 randomly selected nursing students of a Nursing College in Kolkata during August–October 2022. A self-administered structured questionnaire with demographic details incorporating a standard scale admeasuring attitude of students was used. Data were analyzed and validated statistically. Results: The majority used mobile set and cellular data as data-source (95 and 99%, respectively). Advantages of e-learning were screenshot of slides (96%), home-stay (94%), and reduced cost of hostel/transport (84%). Disadvantages included internet problems (83%) and inadequate bedside training (74%). Domain means for perceived usefulness, e-learning versus conventional learning, intention to adapt, ease of learning, and learning stresses were more than scale means reverberating higher acceptability. About 62.5% exhibited a favorable attitude toward e-learning. Family income, age, origin, and past experience were significantly associated with domains of e-learning; of which “Intent to get accustomed” was relevant. All domains related to e-learning found having significant positive correlation with each other indicating the strong value of e-learning among participants. Conclusion: As an alternative during the pandemic, 62.5% of prospective nurses showed a positive attitude toward e-learning. It is recommended that e-learning be made student-friendly through IT training making it a vital option for teaching-learning during catastrophic challenge.

A Comparison of Online Self-Training and Standard Bedside Training in Lung Ultrasonography for Medical Students.

Point-of-care ultrasonography (POCUS) is increasingly integrated into medical education. Traditionally taught at the bedside using a hands-on approach, POCUS is limited by cost, time, faculty availability, and access to POCUS resources. With the recent transition to digitalization in medical education, the authors compare lung POCUS performance and pathology identification among medical students to examine whether using an online, self-learning lung POCUS module is noninferior to traditional bedside, faculty-led lung POCUS training. This study assessed the performance of 51 medical students from August to October 2021 on an elearning lung POCUS course with traditional bedside training and no training. POCUS students were scored on use of a simulator to identify pathologies, ability to identify lung ultrasonographic pathological clips, and scanning technique. The elearning group had a significantly higher median (interquartile range [IQR]) total test score (15/18 [10.5-16] vs. 12/18 [9-13]; P = .03) and scanning technique score (5/5 [4-5] vs. 4/5 [3-4]; P = .03) compared with the standard curriculum group. The median (IQR) accuracy in the clip segment of the examination was 7.5 of 10 (4-9) in the self-learning group and 6 of 10 (4-7) in the standard curriculum group ( P = .18). The median (IQR) grade on the simulator segment of the examination was 2 of 3 (2-3) in the self-learning group and 2 of 3 (1-2) in the standard curriculum group ( P = .06). This study suggests that self-directed elearning of lung POCUS is at least noninferior to bedside teaching and possibly even a superior method of learning lung POCUS. This teaching method POCUS is feasible for medical students to learn lung ultrasonography and has potential to complement or augment the traditional learning process or eliminate or lessen the requirement for bedside teaching by reaching a larger audience while minimizing costs and human resources.

Peripheral intravenous therapy infiltration/extravasation (PIVIE) risks and the potential for earlier notification of events using a novel sensor technology in a neonatal population.

Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.