Clinical Skills Research Articles

Perception of Nigerian Dental Students on the Effectiveness of Teaching Platforms Used for Orthodontics Lectures During the Covid-19 Pandemic

Objective: This research was to assess how Nigerian dental students perceived the effectiveness of the teaching platforms adopted by Orthodontic lecturers during the COVID-19 pandemic. Methods: A descriptive survey which involved 10 accredited Nigerian dental schools with clinical students during COVID-19 pandemic across the geo-political zones of Nigeria was carried out. One hundred and forty-five clinical students who had been taught Orthodontics before COVID-19 pandemic were surveyed using a three-Section Google forms semi-structured questionnaire, administered through WhatsApp and emails. Section A comprised socio-demographic variables, B centred on information on teaching platforms adopted for Orthodontics before and during COVID-19 pandemic), and C was about the perceived effectiveness of adopted teaching platform during COVID-19 pandemic. Data obtained were quantitative, analyzed using SPSS version 26. Hypothesis was tested using independent samples t-test at 0.05 significant level. Results: The participants included 83(57.2%) males and 62 (42.8%) females, with mean age of 25.738 +/- 2.94 years. One hundred and forty two (97.2%) affirmed to having more face-to-face teaching before COVID-19 pandemic. The most T popular online teaching platform adopted during COVID-19 pandemic was WhatsApp, 58 (40%). More than half of the participants, 99 (68.3%), had a positive perception towards the adopted teaching platforms. Most of them, 120 (82.7%), perceived the adopted platforms were effective in providing quality Orthodontic lectures, clinical skills and soft skills. More males 83 (57.2%) than females 62 (42.8%), perceived the platforms to be more effective with no statistical difference, while most, 120 (82.7%), accepted the adopted teaching platforms for orthodontics during COVID-19 pandemic. Conclusion: Orthodontic learning occurred largely on-line during COVID-19 pandemic and the perception of the students was positive towards the effectiveness of the adopted teaching platform as most participants accepted the platforms.

Special Issue on Informatics Education: Vanderbilt Clinical Informatics Center Education Strategy: To Infinity and Beyond!

The Vanderbilt Clinical Informatics Center (VCLIC) is based in the Department of Biomedical Informatics (DBMI) and operates across Vanderbilt University Medical Center (VUMC) and Vanderbilt University (VU) with a goal of enabling and supporting clinical informatics research and practice. VCLIC supports several types of applied clinical informatics teaching, including teaching of students in courses, professional education for staff and faculty throughout VUMC, and workshops and conferences that are open to the public. In this paper, we provide a detailed accounting of our center and institution's methods of educating and training faculty, staff, students, and trainees from across the academic institution and health system on clinical informatics topics, including formal training programs and informal applied learning sessions. Through a host of informal learning events, such as workshops, seminars, conference-style events, bite-size instructive videos, and hackathons, as well as several formal education programs, such as the Clinical Informatics Graduate Course, Master's in Applied Clinical Informatics, Medical Student Integrated Science Course, Graduate Medical Education Elective, and Fellowship in Clinical Informatics, VCLIC and VUMC provide opportunities for faculty, students, trainees, and even staff to engage with Clinical Informatics topics and learn related skills. The described programs have trained hundreds of participants from across the academic and clinical enterprises. Of the VCLIC-held events, the majority of attendees indicated through surveys that they were satisfied, with the average satisfaction score being 4.63/5, and all events averaging a satisfaction score of greater than 4. Across the 20 events VCLIC has held, our largest audiences are DBMI, HealthIT operational staff, and students from the medical and nursing schools. VCLIC has created and delivered a successful suite of formal and informal educational events and programs to disseminate clinical informatics knowledge and skills to learners across the academic institution and healthcare system.

The impact of a professional development workshop on healthcare professionals' knowledge and readiness to use telehealth etiquette in virtual care.

Telehealth is a growing part of the healthcare field, and healthcare professionals and trainees require training not only on the clinical skills relevant to telehealth but also on professionalism skills or telehealth etiquette. As healthcare outcomes are influenced by the patient-provider relationship, training healthcare professionals on telehealth etiquette skills is imperative. Forty-eight healthcare professionals across different disciplines, work settings, and experience levels participated in a telehealth etiquette skills educational intervention workshop wherein their knowledge and readiness to use the skills (specific to technology, environment, confidentiality, and communication) were assessed before and after the workshop. Paired sample t-tests revealed that participating in the educational intervention resulted in statistically significant improvements in knowledge and perceived readiness to use telehealth etiquette skills pertinent to technology, environment, and communication. There were no associations between participants' personal factors and post-educational intervention changes. Study findings are significant and suggest that training healthcare professionals in telehealth etiquette have a positive impact. Since there is a known positive association between provider communication and patient satisfaction and a known association between patient satisfaction and healthcare outcomes, gaining telehealth etiquette skills is critical for promoting a positive patient-provider relationship via telehealth.

Teaching and learning clinical reasoning skill in undergraduate medical students: A scoping review.

Clinical reasoning involves the application of knowledge and skills to collect and integrate information, typically to arrive at a diagnosis, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes. It is a vital competency that medical students must acquire, as it is considered the heart of medicine. This scoping review aimed to identify and summarize the existing literature on learning and teaching strategies for improving clinical reasoning skill in undergraduate medical education. We conducted electronic searches in Scopus, PubMed/Medline (NLM), Web of Science (WOS), and ERIC to retrieve articles published between January 1, 2010, and March 23, 2024. We also performed hand searches by scanning the reference lists of included studies and similar reviews and searching three key journals. After removing duplicates, two reviewers independently extracted data from primary articles using a standard data extraction form. The authors used Arksey and O'Malley's framework. Among the 46581 retrieved records, 54 full-text articles were included in the present review. We categorized the educational strategies based on their aspects, focus, and purpose. Included studies used various educational strategies for improving clinical reasoning skill in undergraduate medical education by serial cue or whole clinical cases that presented as process-oriented or knowledge-oriented. This scoping review investigated various dimensions of educational intervention for improving clinical reasoning skill in undergraduate medical education. There is a need for more precision studies with larger sample sizes, designing studies according to randomized controlled trials standards, determining MCID, or performing meta-analyses to acquire robust and conclusive results.

Preparing Graduate Registered Nurses for Independence in Aged Care.

Graduate registered nurses (RNs) start their careers working in a variety of clinical areas including aged care. However, they may not be fully prepared to work in aged care settings that often require them to work independently as the only RN on the premises. A list of essential clinical skills is crucial for supporting the development and effective transition of graduate nurses into aged care. To identify and rank a list of essential clinical skills for graduate RNs working in aged care settings on commencement of practice. An explanatory sequential mixed-methods design was applied and included a modified Delphi Study and semi-structured interviews. Five expert aged care RNs engaged in the three iterative Delphi rounds and five graduate aged care RNs were interviewed to confirm the clinical skills and ranking from their perspective. Quantitative data were presented through descriptive statistics. Qualitative data were analysed using thematic analysis. Thirty-six essential clinical skills for graduate RNs working in aged care settings were identified and ranked by the experienced aged care RNs. Graduate RNs supported this list of essential clinical skills on commencement and identified palliative care as an additional skill required by graduate RNs working in aged care. The derived essential skills offer aged care a guided approach to ensure that graduate RNs are work-ready, safe practitioners and supported to work independently. The study recommends the essential clinical skills for graduate nurses transitioning in their role as RNs in aged care that will support safe, quality clinical care.

Enhancing clinical reasoning skills for medical students: a qualitative comparison of LLM-powered social robotic versus computer-based virtual patients within rheumatology.

Virtual patients (VPs) are increasingly used in medical education to train clinical reasoning (CR) skills. However, optimal VP design for enhancing interactivity and authenticity remains unclear. Novel interactive modalities, such as large language model (LLM)-enhanced social robotic VPs might increase interactivity and authenticity in CR skill practice. To evaluate medical students' perceptions of CR training using an LLM-enhanced social robotic VP platform compared with a conventional computer-based VP platform. A qualitative study involved 23 third-year medical students from Karolinska Institutet, who completed VP cases on an LLM-enhanced social robotic platform and a computer-based semi-linear platform. In-depth interviews assessed students' self-perceived acquirement of CR skills using the two platforms. Thematic analysis was employed to identify themes and sub-themes. Three main themes were identified: authenticity, VP application, and strengths and limitations. Students found the social robotic platform more authentic and engaging. It enabled highly interactive communication and expressed emotions, collectively offering a realistic experience. It facilitated active learning, hypothesis generation, and adaptive thinking. Limitations included lack of physical examination options and, occasionally, mechanical dialogue. The LLM-enhanced social robotic VP platform offers a more authentic and interactive learning experience compared to the conventional computer-based platform. Despite some limitations, it shows promise in training CR skills, communication, and adaptive thinking. Social robotic VPs may prove useful and safe learning environments for exposing medical students to diverse, highly interactive patient simulations.

Enhancing fieldwork readiness in occupational therapy students with generative AI.

The rapid integration of artificial intelligence (AI) into health professions education is revolutionizing traditional teaching methodologies and enhancing learning experiences. This study explores the use of generative AI to aid occupational therapy (OT) students in intervention planning. OT students often lack the background knowledge to generate a wide variety of interventions, spending excessive time on idea generation rather than clinical reasoning, practice skills, and patient care. AI can enhance creative ideation but students must still adhere to evidence-based practice, patient safety, and privacy standards. Students used ChatGPT v. 3.5 in a lecture and assignment to integrate generative AI into intervention planning. Students analyzed a case study, generated ideas with ChatGPT, selected interventions that aligned with the client's needs, and provided a rationale. They conducted evidence-based searches and wrote an analysis on how the research influenced their decisions. The results demonstrate generative AI's potential as a valuable tool for OT students, enhancing their comfort with AI and understanding of ethical and safety considerations. Qualitative feedback highlighted AI's role in boosting efficiency and creativity in intervention planning, with most students expressing strong intent to use ChatGPT in clinical practice due to its ability to reduce cognitive load and generate innovative ideas. These findings suggest that integrating generative AI into the OT curriculum could enhance intervention planning and improve clinical readiness.

Burnout level evaluation of undergraduate dental college students at middle eastern university

BackgroundPressure faced by dental students from academic activities, clinical skills training, and patient care may lead to high stress and potential burnout, negatively impacting their well-being and patient safety.AimThe study aimed to explore the burnout level of dental students at Qassim University, Saudi Arabia and to identify the factors that are associated with the level of burnout.MethodsThe descriptive cross-sectional study was carried out at Dental College, Qassim University, Saudi Arabia, from January to February 2024. The study was conducted to evaluate burnout levels among first to final-year undergraduate dental students enrolled at Qassim University using a pre-validated questionnaire; Burnout Clinical Subtype Questionnaire, via Google Forms. Analysis was performed with IBM SPSS-24, utilizing descriptive statistics and non-parametric tests, Mann-Whitney-U and Kruskal-Wallis. A multiple linear regression analysis was conducted to predict Burnout from demographic and academic factors.Results151 participants responded to the survey, with 49.7% male and 50.3% female. Results showed that burnout scores increased significantly (p < 0.05) with age and decreased family support. Males had lower burnout levels in comparison to their counterparts. The survey had three domains: Overload, Neglect, and Development, with ‘Overload’ having the highest mean score of 17.79 and a median score of 17.00. Age showed significant difference (p < .05) in the burnout scores amongst the groups across all three domains. 70.9% of the participants agreed that they invested an unhealthy amount of time towards their studies. The multiple regression model statistically significantly predicted Burnout, F (21, 129) = 2.190, p = .004, adj. R2 = 0.143. Gender was significant predictor, with female students reporting lower burnout scores compared to males (B=-5.633, p = .012). Family support also emerged as significant, with students reporting merely good family support showing higher burnout scores compared to those reporting very good family support (B = 6.147, p = .009).ConclusionFactors like age, family support and gender were found to have a significant with burnout levels and its domains. The study highlighted overload as the main contributing the most towards burnout in dental students of Qassim University, emphasizing the importance of tailored interventions to promote student well-being.

Impact of telehealth implementation on medical non-consultant hospital doctors training experience

Telehealth is defined as the provision of health care services over a distance. Major health systems, including outpatient clinics and check-ups alike, turned to telehealth and teleconsultation amid the COVID19 pandemic. There are many recognized advantages of telehealth and its increasing implementation, however, not much is known about the specific impact of remote consultation on the quality of non-consultant hospital doctors (NCHD) training experiences in medicine. This study aimed to gain rich descriptive insights into the specific impact of remote consultation on the quality of medical NCHD training experiences and their perceptions, through purposeful sampling. Data was collected via semi-structured virtual interviews of fifteen NCHD participants. The interviews were recorded, transcribed and analysed using thematic analysis. The collective transcripts were analysed using NVIVO data software for common themes. The themes identified suggested that there were both advantages and disadvantages to telehealth and its impact on training across a spectrum of entities including; doctor-patient relationships, peer relationships, service provision, work morale, working hours, clinical skills experience and general feedback as a trainee. NCHD perspectives expressed were mixed across all themes. Further research is recommended to advance understanding of the potential impact of telehealth on current and prospective doctors in training. With a greater understanding of general insights, future changes, including telehealth training programmes, could be implemented to build confidence and familiarity with telehealth utilization and potentiate its conceivable benefits.

Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning.

Educators need tools for the assessment of clinical reasoning that reflect the ambiguity of real-world practice and measure learners' ability to determine diagnostic likelihood. In this study, the authors describe the use of the Brier score to assess and provide feedback on the quality of probabilistic diagnostic reasoning. The authors describe a novel format called Diagnostic Forecasting (DxF), in which participants read a brief clinical case and assign a probability to each item on a differential diagnosis, order tests and select a final diagnosis. DxF was piloted in a cohort of senior medical students. DxF evaluated students' answers with Brier scores, which compare probabilistic forecasts with case outcomes. The validity of Brier scores in DxF was assessed by comparison to subsequent decision-making in the game environment of DxF, as well as external criteria including medical knowledge tests and performance on clinical rotations. Brier scores were statistically significantly correlated with diagnostic accuracy (95 % CI-4.4 to-0.44) and with mean scores on the National Board of Medical Examiners (NBME) shelf exams (95 % CI-474.6 to-225.1). Brier scores did not correlate with clerkship grades or performance on a structured clinical skills exam. Reliability as measured by within-student correlation was low. Brier scoring showed evidence for validity as a measurement of medical knowledge and predictor of clinical decision-making. Further work must evaluated the ability of Brier scores to predict clinical and workplace-based outcomes, and develop reliable approaches to measuring probabilistic reasoning.

A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom

BackgroundAttempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding...

It’s all about the patients: a shift in medical students’ approach to learning during a novel distributed integrated clinical rotation

IntroductionTo ensure that pre-final year medical students at Stellenbosch University were able to resume clinical training during the COVID-19 pandemic, a 12-week integrated rotation was introduced, during which students were distributed across a widespread training platform in two provinces of South Africa, utilizing a range of health care facilities in both rural and urban areas, rather than the central academic hospital (CAH) in which they would have been doing clerkships. Called the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation, this clerkship was based on supervised engagement in healthcare services, focusing on patient-based clinical training, self-regulated learning and student participation as integral members of clinical teams. The success of this emergency intervention has led to its formal incorporation into the medical curriculum. This study aimed to understand the factors that influenced learning among students undertaking the IDEAL rotation at multiple sites on a distributed training platform.MethodsUsing an interpretive paradigm, we sought to conduct focus group interviews with students who completed the first iteration of the IDEAL rotation in the year after they had undertaken it to understand their experiences. All 252 students who were eligible were invited to participate by email on several occasions. Ultimately three focus group discussions and two individual interviews were undertaken, based on volunteers. Using a semi-structured interview guide, these explored student perceptions of their learning and growth through the rotation. Inductive and deductive analysis was carried out to identify themes.FindingsStudent descriptions of their learning experiences coalesced in 6 themes. The rotation was an enabling learning experience, which was more practically focused and assisted students in developing confidence in their clinical skills. It was seen to be a humanizing learning experience with greater opportunities for the development of relationships with patients and families, as well as with health professionals, who made them feel part of the team, so it was also a more collegial learning experience. At the same time, it was a variable learning experience with a lack of standardization on a number of levels and challenges being experienced at particular sites regarding both logistics and the nature of the exposure. Students perceived it to be a very different learning experience from what they had encountered in the CAH in terms of relationships, the kinds of patients and problems they saw, and their active participation. Through this, they also learned more about themselves and their roles, making it a personal learning journey. The findings confirm the importance of the dimensions of person, participation and place for being and becoming a doctor in a clinical environment.ConclusionsStudent learning experiences in the IDEAL rotation emphasize the importance of context, reinforcing the value of a distributed training platform in developing health professionals who are responsive to their environment. They emphasize the vital role of active participation in learning and the centrality of relationships in medical training, helping to develop graduates who are human beings and not only human doings.

A change of mind: Error motivation is shaped by error perceptions in different learning environments

Background The medical profession has traditionally had a culture of “blame and shame,” despite the importance errors have for learning, motivation, and improvement of clinical skills. This study aimed to explore how medical students and newly graduated doctors perceive errors across different learning contexts and levels of expertise, and how error perceptions influence motivation and engagement in learning activities. Methods Semi-structured interviews were conducted, and thematic analysis was used to identify themes. Survey questions were developed based on the themes. The final survey included 27 questions divided into three sections. The survey was distributed via RedCap to medical students in year 1, year 4, and year 6 together with newly graduated doctors in Denmark. Results Of the 541 respondents, a majority anticipated making errors in both non-clinical (77.4%) and clinical (61.5%) learning situations, finding them motivating for participation (91.9% and 96.2%, respectively). A psychologically safe learning environment was seen to enhance the perception of errors as learning opportunities (96.9%) and increase risk willingness (96.3% non-clinical, 97.7% clinical). Respondents focused on the specific errors they made (86.0%), and their supervisors were perceived to focus more on correct handling of errors (70.7%). Respondents expected to conduct fewer errors in non-clinical learning situations in PGY-1 compared to medical students in year 1 (F(3529) = 3.0, adjusted p = 0.03). They showed an increase in risk willingness in clinical learning situations from year 6 to PGY-1 (F(3520) = 2.7, adjusted p-value 0.006) as long as the learning situations were considered psychologically safe. Conclusion The study suggests that a psychologically safe learning environment mitigates the “shame and blame culture” associated with errors. Respondents generally embraced errors as valuable learning experiences but noted a lack of specific error-related feedback. These findings underscore the nuanced relationship between errors, explicit learning activities, and supervisor support in medical education.

Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency.

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared to their 4-year MD (4YMD) counterparts. Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies. Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 8.3 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared to all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones. The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.

Effectiveness of a virtual reality triage simulation program for nursing students: A mixed-methods study

AimsTo examine the effectiveness of a virtual reality simulation (VRS) triage in improving students’ learning motivation, attitudes, satisfaction and learning experiences in an emergency nursing course. BackgroundVR facilitates the realization of clinical scenarios that are significant for teaching emergency nursing. Triage presents a unique challenge in emergency nursing courses, where practical learning opportunities are seldom available. DesignThe study employed a convergent parallel mixed-methods design. MethodsA total of 164 third-year nursing students were recruited from an emergency nursing course. The experimental group of 73 students participated in a VRS triage program and the control group of 91 students received a traditional program based on written case studies. The learning outcomes were evaluated using the Attention, Relevance, Confidence and Satisfaction motivational learning inventory together with questionnaires on learning attitudes and satisfaction. Qualitative data were collected through phenomenographic interviews. ResultsThe learning outcomes from the experimental group showed significant improvement in motivational learning inventory scores, with the greatest increase in satisfaction, followed by confidence, attention and relevance. Qualitative interviews with 30 students revealed four main themes in their learning experiences: “reflecting a real-world clinical environment,” “enabling the internalization of knowledge,” “enhancing clinical skills proficiency,” and “cultivating a positive attitude toward patient care.” The core theme was the establishment of professional core competency. ConclusionsVRS learning shows positive outcomes in enriching students’ learning experiences. This study contributes to the literature on the use of VR technology in nursing education by offering insights into the effectiveness of VRS learning.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants.

Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants. A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders. In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum. Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.

The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review.

Blunt abdominal trauma in childhood has always been full of diagnostic and therapeutic challenges that have tested the clinical and radiological skills of pediatric surgeons and radiologists. Despite the guidelines and the studies carried out so far, to this day, there is no absolute consensus on certain points of view. Around the world, a paradigm shift towards non-operative treatment of hemodynamically stable children, with low complication rates, is noticeable. Children with blunt abdominal trauma require a standardized methodology to provide the best possible care with the best possible outcomes. This comprehensive review systematizes knowledge about all aspects of caring for children with blunt abdominal trauma, from pre-hospital to post-hospital care.

A place to call our home: innovative rural physical therapy training in Canada

BackgroundTo promote rural practice and increase enrollment in the entry-level Master of Science Physical Therapy program at the University of Alberta, the Department of Physical Therapy developed a rural physical therapy satellite campus located in a farming region in central Alberta. A distributed learning format was used to connect the rural cohort to the main urban campus. Real time video conferencing was used to connect the two campuses for all lectures, seminars and clinical skills classes. This evaluation aimed to describe a unique rural training program for physical therapy students and its effectiveness in promoting work in rural communities after graduation.MethodsPhysical Therapy students in the first three years (2012–2015) of commencing the rural satellite program (n = 280) were surveyed, and six focus groups were held to capture student experiences, satisfaction and engagement. Data were collected on employment locations of the 2012–2019 graduates’ first physical therapy position and current employment.ResultsSurvey results suggested comparable levels of satisfaction and engagement for all physical therapy students regardless of campus. Focus group data revealed that students quickly accepted the distributed learning technological interface, enjoyed their local campuses, and felt connected to instructors and student colleagues. Compared to the overall physical therapy workforce, a higher percentage of physical therapists graduating from the rural campus reported working in rural centers for both their first and current jobs.ConclusionRegardless of campus, students were satisfied and equally engaged in the physical therapy program. Students who completed the physical therapy program in a rural setting tended to work rurally after graduation. A distributed learning model may be useful for other healthcare training programs to promote engagement in rural health.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.