Teaching Of Clinical Skills Research Articles

Nursing Provision in Psychological Aspect Management of Natural Disaster

Natural disasters are an event or series of events caused by natural phenomena such as earthquakes, tsunamis, volcanoes, floods, droughts, hurricanes and landslides, resulting in human casualties, environmental damage, property losses objects, and psychological effects. Therefore, the need for nurse preparedness is especially special on the psychological aspect aside from the physical aspect. Nurse personnel is the first milestone that will be sought by the people affected by disaster, because nurses as the front line in a health service has a responsibility and a big role in handling the patient's daily emergency and disaster strikes. To know nurse preparedness in psychological aspect in facing natural disaster. The writing of this journal uses a literature study approach from several sources selected based on the criteria set by the author. The research journal was obtained from several databases, namely PubMed and BioMedCentral (BMC) Psychiatry. In total, the literature review consists of 10 journals, 4 studies report effective outcomes including knowledge, skills, self-awareness, interest, intellectual, cooperation, and motivation need to be prepared to support disaster management, 5 research reports that nurses need to prepare themselves on the psychological aspect in the form of cognitive, intellectual, interest, attitude, clinical skills education and rescue comprehension with basic principles of psychosocial support. Last 1 study reported the result that the need for training for administrators on hospital management in disaster preparedness. The psychological aspect is very important that must be prepared by the nurse in facing natural disaster, thus preventing the occurrence of psychological impact (in the form of psychological disorders such as depression, anxiety and other mental disorders) either self-nurse or victim to be handled by natural disaster happen.

The development of a clinical skills laboratory at Ross University School of Medicine.

Dedicated clinical skills laboratories (CSLs) that make use of models, mannequins and simulators, are being increasingly established in medical and veterinary schools. These have been commonplace in medical schools for more than two decades, but their incorporation within the teaching of veterinary curricula has occurred much more recently. In 2007, a decision was taken to establish a CSL at Ross University School of Veterinary Medicine. We considered the range of skills that we wished to teach, the physical space and equipment needed, the storage and air conditioning requirements, the facilities needed to deliver PowerPoint lectures and case study presentations, and other essentials necessary to handle cadaver specimens. We converted an appropriate campus building to our needs, hired teaching staff, and started to source models and mannequins for the teaching of veterinary clinical skills. In 2010, 177 senior students completed a survey evaluating their experiences within our CSL. Student satisfaction was generally high, with 95% of respondents feeling that the CSL had improved their psychomotor skills. However, 15% of them felt that the models were insufficiently realistic. Our clinical skills programme has since developed considerably, and it currently offers instruction in a diverse array of surgical, medical and other clinical skills. We hope that this description of our experiences may assist others embarking on similar projects elsewhere.

"Doctors' Lounge" podcast to teach clinical reasoning to first-year medical students.

This article was migrated. The article was marked as recommended. In the first year of medical school, our students have a comprehensive course in history taking, physical examination skills, clinical reasoning, and patient-centered care. We have observed that first year students struggle to conduct a focused history and perform a focused physical examination on a given chief complaint. We developed an innovative program to address this concern in our Essentials of Medicine- Physical Diagnosis course. We created an online outline and audio podcast for students to review illustrating the key elements of the history of presenting illness, review of systems, other historical patient information, and focused physical examination for 3 specific chief complaints to assist them in their approach to these patients. This resource also included the discussion of the work up and treatment plans and was created in collaboration of Internal, Family, and Emergency Medicine to account for the various approaches to the same chief complaint within the various specialites of medicine. Students completed a brief pre- and post-session survey to assess their utilization of the resource, quality of the content, and delivery of the session materials. The preceptor's were also surveyed regarding the students' ability to conduct a patient encounter and discuss their assessment and plan comparing current students to those in previous years who did not use this resource. We also asked for feedback on how these resources might be improved for future use. The resource was highly effective for first-year medical students in preparation for focused history taking and physical examination of a patient with a specific chief complaint. Students were more engaged in the critical reasoning discussion of the case assessment and plan after using this resource and preceptors were in agreement. We believe this model we called the "Doctors' Lounge" developed for the chief complaints of sore throat, chest pain, and abdominal pain can be replicated at any medical school desiring to introduce or enhance teaching of clinical reasoning skills to their preclinical students.

An integrated 2-year clinical skills peer tutoring scheme in a UK-based medical school: perceptions of tutees and peer tutors.

BackgroundSeveral benefits of peer tutoring in medical school teaching have been described. However, there is a lack of research on the perceptions of peer tutoring, particularly from tutees who partake in a long-term clinical skills scheme integrated into the medical school curriculum. This study evaluates the opinions of preclinical tutees at the end of a 2-year peer-tutored clinical skills program and peer tutors themselves.MethodsA cross-sectional study was conducted in a UK-based medical school that primarily utilizes peer tutoring for clinical skills teaching. A questionnaire was designed to assess the views of preclinical tutees and peer tutors. Likert scales were used to grade responses and comment boxes to collect qualitative data.ResultsSixty-five questionnaires were collected (52 tutees, 13 peer tutors). Seventy-nine percent of students felt satisfied with their teaching, and 70% felt adequately prepared for clinical placements. Furthermore, 79% believed that peer tutoring is the most effective method for clinical skills teaching. When compared to faculty teaching, tutees preferred being taught by peer tutors (63%), felt more confident (73%), and were more willing to engage (77%). All peer tutors felt that teaching made them more confident in their Objective Structured Clinical Examination performance, and 91% agreed that being a tutor made them consider pursuing teaching in the future. Thematic analysis of qualitative data identified 3 themes regarding peer tutoring: a more comfortable environment (69%), a more personalized teaching approach (34%), and variation in content taught (14%).ConclusionPreclinical tutees prefer being taught clinical skills by peer tutors compared to faculty, with the peer tutors also benefitting. Studies such as this, looking at long-term schemes, further validate peer tutoring and may encourage more medical schools to adopt this method as an effective way of clinical skills teaching.

The Development and Impact of Clinical Skills Handbooks in Undergraduate Medical Education

Introduction: Traditional teaching of clinical skills in medical school commonly entails didactic teaching followed by practice sessions with Standardized Patients (SPs) for particular skills, such as the cardiovascular exam. To address the need for briefer and more concise reference guides from standard textbooks and to consolidate skills expectations, the University of Ottawa developed clinical skills handbooks for students. The purpose of this study was to evaluate students’ use of these handbooks in the pre-clinical and clinical years. 
 Methods: We distributed a survey to second, third, and fourth year medical students at the University of Ottawa from November 2016 to January 2017. The survey assessed how frequently students used the booklets and their opinions on the usefulness of the booklets as a learning tool.
 Results: There were 121 respondents of 492 students eligible for the survey. Of the respondents, 96.7% claimed to have used the booklets, and 75% claimed it was their primary resource for physical exam skills education. The majority of pre-clinical students used the booklets when learning a physical exam – 65% almost always, and 97% at least sometimes. The majority of clinical students (also referred to as clerkship students) used the booklets when reviewing a physical exam – 25% almost always, and 64% at least sometimes. Most students used the booklets when studying for OSCEs – 65% almost always, and 94% at least sometimes. 
 Conclusions: Students at the University of Ottawa found the clinical skills handbooks to be a valuable resource during their medical training and for the majority, it was their most commonly used reference. These findings support the need for further development and use of these resources.

Erzincan Üniversitesi Tıp Fakültesi Klinik Eğitim Dönemi Öğrencilerinin Staj Kurulları ile İlgili Görüşleri, Öğrenci Merkezli Tıp Eğitimi Metotlarına İlişkin Bilgi Düzeyi ve Yaklaşımları

Objective: The aim of the study is to investigate the students’ opinions about their clinical rotations, learn their level of knowledge and opinion about student centered education methods; brain storming, small group study, task based learning, problem based learning, Objective Structured Practical Examination (OSPE), student clinics, clinical skills education. Methods: It is a cross-sectional study. The all clinical year students were called and invited respectively to attend the study. The volunteer students answered the survey for their clinical rotations and the level of knowledge about student centered education methods. Than, researcher made a presentation to give information about student centered education methods approximatelly 40 minutes. Than a survey about students’ experience with student centered education methods and their willingness to get training with these methods were applied. Descriptive statistics was used. Results: The student assessed clinical rotations over 10 and the mean score was 5,35 (min: 1, max.: 8, SD: ±1,62). It was indicated that the students didn’t get training with student-centered education methods. Students support to use student-centered education methods; brain stroming-small group study-homework based learning (%83.9), task based learning (%87.1), OSPE(%93,5), student clinics (96,8), clinical skills laboratory educations (%96,8), in our school’s new curriculum is high. Conclusion: Clinical year students indicated that the getting feedback during clinical rotations, interdisiplinnary interactive educations, the diversity and number of patient-disease are insufficient in clinical rotations. They also support and believe that student-centered education methods have more benefits. Furthermore, it’s mentioned that they want to take education with student centered education methods.

Evaluating the preceptor–preceptee relationship among Pharm D students at the King Saud University School of Pharmacy

ObjectiveTo evaluate preceptee satisfaction concerning preceptorship and the preceptor–preceptee relationship among pharmacy students. MethodsA cross-sectional study was conducted from May 2017 to August 2017 on senior Pharm D students at King Saud University (KSU) College of Pharmacy. A survey instrument was used to get feedback from students regarding their clinical rotations and internships and to evaluate their satisfaction toward preceptorship to meet the goals of the curriculum. Data were entered into SPSS, version 24. ResultsOf the 52 students surveyed, 36 (69.2%) were female. More than half of respondents were somewhat satisfied with their preceptors and 11.5% were satisfied. Additionally, only 17% of students rated their preceptors as having excellent clinical teaching skills; about 19% of students rated them as “needs improvement.” About 40% of students rated their preceptors as very good, concerned, competent, and safe in their care for persons living with serious co-morbidities and diseases. About half of students (48.1%) rated their non-faculty KSU preceptors’ teaching behavior as not satisfactory compared with only four respondents with respect to KSU faculty preceptors’ teaching behavior. ConclusionPharm D students were somewhat satisfied with their preceptors’ teaching behaviors in communication skills, practice, and teaching skills as well as feedback and evaluation to students. To enhance the quality of experiential education, preceptors should be trained to develop programs that direct and energize advancement.

Teaching of Manual Clinical Skills in Podiatric Medicine Theory and Recommendations.

In the podiatric medicine profession, there are a variety of manual tasks that require precision and skill beyond what would be usually expected in everyday living. It is the expectation of employers, regulatory bodies, and the public that graduating podiatric physicians sufficiently meet certain minimum competencies for that profession, including those for manual skills. However, teaching and evaluation methods seem to be inconsistent between countries, institutions, and programs. This may be the consequence of uncertainty regarding the safest and most effective methods to do so. A review of available international literature pertaining to psychomotor learning across a range of health professions was undertaken. As a result of this broad review, we present herein the available evidence and make recommendations for the teaching of psychomotor skills in the podiatric medicine profession. Specific aspects considered important include methods of teaching, practice, and feedback.

Residency Evaluation and Adherence Design Study III: Ophthalmology residency training in India: Then and now-Improving with time?

Purpose:To gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century.Methods:A survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014–2016, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program.Results:Of the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003–2012 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0–10 in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20.Conclusion:Teaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.

YouTube as a source of clinical skills education

YouTube as a source of clinical skills education

Application of clinical skill standard operating procedure in clinical skill teaching practice

By formulating the standard operating procedures for clinical skills, and standardizing the operation steps, the Affiliated Hospital of Inner Mongolia Medical University further refines and quantifies the scoring criteria, and this is also applied in the teaching practice of medical students' clinical skills. The two operations of clean wound dressing and diagnostic peritoneal puncture are taken as an example for description. The assessment results shows that the level of medical students' clinical skills has improved significantly. Questionnaire survey also shows that teachers' training efficiency and students' learning efficiency have been improved, indicating that clinical skills standard operation procedures have achieved good teaching results in clinical skills teaching practice. Key words: Clinical skill; Standard operation procedure; Teaching practice

The Teaching of Clinical Skills and the Applicability of a Simplified Guide to Physical Examination in Undergraduate Medical Training

ABSTRACT Introduction: Despite technological advances, anamnesis and physical examination remain the most important and effective diagnostic tools in a clinical case. However, many students complete their medical degree lacking these essential skills. The unstandardized character of the physical examination is considered one of the major hurdles in the teaching-learning of this practice. Objective: To evaluate the clinical skills of medical students and the applicability of a simplified physical examination guide for the improvement of these skills. Methods: This was an analytical and quantitative-approach study, which compared before-and-after information among general medicine student interns from January to February 2014. The students were trained with the simplified guide for a 3-week period. The students had their clinical examination evaluated in 13 items: vital signs, oral cavity examination, ophthalmoscopy, otoscopy, thyroid examination, cardiovascular, pulmonary, abdominal examination, lymph nodes, anthropometric measurements, ankle-brachial index (ABI), neurological examination, examination of the breast (female patients) or testicles (male patients). The result of each part of the examination was classified into three categories: complete assessment, partial assessment and absent assessment. Results: A total of 31 students participated. Significant improvement was found in almost all items in relation to the complete evaluation after training with the guide: cardiovascular system (3.23% versus 74.19%, before and after training, respectively, p &lt; 0.01), pulmonary system (22.58% versus 90.32%, p &lt; 0.01), abdomen (22.58% versus 74.19%, p = 0.01), vital signs (16.13% versus 100%, p &lt; 0.01), palpation of lymph nodes (6.45% versus 77.42%, p &lt; 0.01), neurological examination (0% versus 22.58%, p = 0.02), thyroid palpation (0% versus 61.29%, p &lt; 0.01), examination of oral cavity (6.45% versus 67.74%, p &lt; 0.01), anthropometric measurements (0% versus 45.16%, p &lt; 0.01), breast examination (0% versus 36.84%, p = 0.02), ophthalmoscopy (0% versus 32.26%, p &lt; 0.01), otoscopy (0% versus 64.52%, p &lt; 0.01); evaluation of the ankle-brachial index (0% versus 83.87%, p &lt; 0.01), examination of the testicles (0% versus 8.33%, p = 1.0). A 280.7% increase was also observed in the students’ median score after training (1.92 versus 7.31 points, P &lt; 0.001). There was no significant correlation between student performance and time on the medical course (R2 = 0.1242; P = 0.0515). Conclusions: There is a large deficit in teaching clinical skills during undergraduate medical courses. As an effective solution, a simplified sequential clinical examination guide can serve as training for medical students.

A pilot study to assess the utility of a freely downloadable mobile application simulator for undergraduate clinical skills training: a single-blinded, randomised controlled trial

BackgroundMedical simulators offer an invaluable educational resource for medical trainees. However, owing to cost and portability restrictions, they have traditionally been limited to simulation centres. With the advent of sophisticated mobile technology, simulators have become cheaper and more accessible. Touch Surgery is one such freely downloadable mobile application simulator (MAS) used by over one million healthcare professionals worldwide. Nevertheless, to date, it has never been formally validated as an adjunct in undergraduate medical education.MethodsMedical students in the final 3 years of their programme were recruited and randomised to one of three revision interventions: 1) no formal revision resources, 2) traditional revision resources, or 3) MAS. Students completed pre-test questionnaires and were then assessed on their ability to complete an undisclosed male urinary catheterisation scenario. Following a one-hour quarantined revision period, all students repeated the scenario. Both attempts were scored by allocation-blinded examiners against an objective 46-point mark scheme.ResultsA total of 27 medical students were randomised (n = 9 per group). Mean scores improved between baseline and post-revision attempts by 8.7% (p = 0.003), 19.8% (p = 0.0001), and 15.9% (p = 0.001) for no resources, traditional resources, and MAS, respectively. However, when comparing mean score improvements between groups there were no significant differences.ConclusionsMobile simulators offer an unconventional, yet potentially useful adjunct to enhance undergraduate clinical skills education. Our results indicate that MAS’s perform comparably to current gold-standard revision resources; however, they may confer significant advantages in terms of cost-effectiveness and practice flexibility.Trial registrationNot applicable.

English

The teaching model based on objective, measurable, and linear knowledge no longer seems to be the most appropriate, given the new responsibilities of pharmacists, who should focus their practices on patient care. The objective of the present study was to analyze students' perception about preparedness to pharmacy practice and to patient-centered care, and identify experiential training barriers Two discussion groups were formed with 12 and 13 individuals to present their perceptions about teaching and learning for pharmaceutical care. The analysis followed the methodology of Bardin. The analysis of the answers indicates that there is a significant gap in the training of pharmacists, with a strong emphasis on theoretical issues and less focus on knowledge acquisition and interpersonal communication, generating poor professional training and relationship barriers. In general, students do not feel prepared to deal with patients. These students identify the lack of infrastructure, such as the lack of a pharmacy and underutilization of the hospital, deficiencies in the curriculum such as the lack of key subjects, lack of clinical practice, and lack of preparation of some teachers, with an excess of classes following the lecture format. These factors influence the teaching and learning of clinical and communication skills, which undermine the pharmacists' ability to carry out clinical interventions, as well as affect the pharmaceutical-patient and pharmaceutical-physician relationship. These results suggest that for the pharmacists' clinical training it is necessary to rethink whether the infrastructure, the curriculum, and the teaching method are adequate for the development of skills and competences. Key words: Pharmaceutical care, pharmacy education, skills, competences.

Acute Medicine Nurses facilitating Patient Flow – A National Unscheduled Care Clinical Skills and Competencies Education Programme

Context: Acute medicine nursing is an emerging discipline within unscheduled care. To September 2016 73,175 patients registered in Ireland’s acute medicine units, of which 26,830 (36.7%) were admitted to acute medical short stay or specialist wards, or discharged on the same day (n=46,345 / 63.3%). Nursing staff in these units (560) come from a variety of clinical general and specialist backgrounds with few possessing specialist acute medicine nursing qualifications to support patients on unscheduled care pathways inclusive of ambulatory care. Aim: To provide clinical education programmes to maximise the development Acute Medicine nurses’ skills and competence’ (H.S.E. 2016, p. 18) to meet identified patient needs. A particular focus being on improving patient access, assessment, care, and management across the patient pathway. Method: Nationally there are 32 acute hospitals which have either an AMAU or an MAU. To identify gaps in knowledge, skills and competencies: An education needs assessment to determine baseline knowledge, skills and competencies of nurses in these units a national survey was undertaken. All 32 hospitals were surveyed. A similar assessment was conducted amongst ED nurses The survey instrument was designed based on a Developmental Framework for Nursing Skills and Competencies in AMAUs, MAUs and MSSUs which was co-designed with the Acute Medicine Nurse Interest Group (AMNIG) and which identified the skills and competencies required of acute medicine nurses at core, specialist, enhanced/advanced levels. Outcome/Results: A 100% response rate was achieved. Hospitals were asked to provide information on numbers of nurses trained in a skill; those currently using the skill; and nurses requiring training in the skill. Demographics were captured in Section 1. Responses to, clinical skills and competencies needs (Section 2), were analysed using six broad categories. Results will be presented. Results were mapped to patient presentations and age profiles using NQAiS Medicine. Findings from the ED nurse survey were cross referenced to enable common core unscheduled care skills and competencies education needs to be identified. A Foundation Programme in Unscheduled Care, Acute Medicine Nursing was designed. On-line clinical skills programmes and currently provided in service programmes were excluded from the programme. 5 key skills and competency areas were validated by the Acute Medicine Programme Nurse Interest Group as required for inclusion. Provision of ongoing Level 8 education foundation programmes’ of 12 weeks duration with Nursing and Midwifery Board accreditation planned to commence 2017. Conclusion: A foundation programme will enable nurses to access educational and professional practice pathways in acute medicine at specialist and advanced practice levels. Having skilled and competent nurses educated to a national standard of skills and competencies in unscheduled acute medicine care inclusive of ambulatory and short stay acute medicine care will improve the patient outcomes,experience create capacity within the system generating greater access and effective efficient use of resource. Provides opportunities for interdisciplinary and cross clinical programme nurse education to generate a commonality of practice within the themes of rapid access, timely assessment , intervention, diagnosis, treatment plan and discharge.

Active blended learning for clinical skills acquisition: innovation to meet professional expectations

The standards for pre-registration midwifery education state that the practice-theory ratio of the programme should be no less than 50% practice and no less than 40% theory, adopting a variety of learning and teaching strategies, including simulation. Simulation for skills teaching has been found to bridge gaps between theory and practice, and to positively affect how prepared and confident the student midwife feels to apply knowledge and skills in the practice setting. With changes in regulation under consultation, and an ever more complex clinical environment, it is timely to revisit learning, teaching and assessment strategies in pre-registration education to ensure that they are fit for purpose. The University of Northampton's approach to learning and teaching, termed active blended learning, is a student-centred approach to support the development of subject knowledge and understanding, independent learning, and digital fluency. This involved the modification of a traditional, four-stage, step-by-step approach to teaching clinical skills, by introducing video-assisted technology to prepare students for a summative assessment using simulation. It is anticipated that this innovative approach to the teaching of clinical skills will enhance the ‘toolkit’ of learning, teaching, and assessment strategies appropriate to contemporary midwifery preregistration education.

A survey of paediatric caries management teaching within dental therapy programmes in the UK.

Objective To assess didactic and clinical skills teaching of conventional and alternative treatment techniques for the management of dental caries in paediatric dentistry in dental therapy schools across the UK.Method A structured online questionnaire was developed using SurveyMonkey. The survey link was emailed to all teaching leads for all 22 dental therapy schools throughout the UK. The survey was open online for three months.Results Data were obtained for 20 schools. Regarding didactic and skills teaching of conventional techniques, the majority of schools taught complete caries removal and plastic restoration. Additionally, most taught both pulpal therapy and pre-formed metal crown placement for the primary dentition. In relation to alternative techniques, favoured teaching options related to no or minimal caries removal with prevention or some form of sealant restoration, including for the primary dentition use of the Hall Technique.Conclusions Both conventional and alternative treatment techniques for the management of dental caries within paediatric dentistry appear to be taught within dental therapy programmes in the UK.

Clinical teaching skills for midwives

Sixty-eight hospital-admitted patients with a first episode of Clostridium difficile infection (CDI) were included and followed up during 1 year. Faeces samples were collected at 1, 2, 6 and 12 months after inclusion and analyzed for the presence of C. difficile toxin B, genes for toxin A, toxin B, binary toxin and TcdC deletion by PCR. All strains were also PCR-ribotyped and the MICs of the isolates were determined against eight antimicrobial agents. In 68 patients initially included, antibiotics, clinical signs and co-morbidities were analyzed and 56 were evaluable for recurrences. The mean number of different antibiotics given during 3 months prior to inclusion was 2.6 (range 0–6). Six patients had not received any antibiotics and three of them had diagnosed inflammatory bowel disease. Thirty-two patients (57%) had either a microbiological or clinical recurrence, 16 of whom had clinical recurrences that were confirmed microbiologically (13, 23%) or unconfirmed by culture (3, 5%). Twenty-nine patients were positive in at least one of the follow-up tests, 16 had the same ribotype in follow-up tests, i.e. relapse, and 13 a different ribotype, i.e., reinfection. Most common ribotypes were 078/126, 020, 023, 026, 014/077, 001 and 005. No strain of ribotype 027 was found. Strains ribotype 078/126 and 023 were positive for binary toxin and were the strains most prone to cause recurrence. All strains were sensitive to vancomycin and metronidazole. Patients with recurrences were significantly older (p = 0.02) and all patients had a high burden of comorbidities, which could explain the high fatality rate, 26 (38%) patients died during the 1-year follow-up.

Milestone-Based Tool for Learner Evaluation of Faculty Clinical Teaching.

Traditional normative Likert-type evaluations of faculty teaching have several drawbacks, including lack of granular feedback, potential for inflation, and the halo effect. To provide more meaningful data to faculty on their teaching skills and encourage educator self-reflection and skill development, we designed and implemented a milestone-based faculty clinical teaching evaluation tool. The evaluation tool contains 10 questions that assess clinical teaching skills with descriptive milestone behavior anchors. Nine of these items are based on the Stanford Faculty Development Clinical Teaching Model and annual Accreditation Council for Graduate Medical Education (ACGME) resident survey questions; the tenth was developed to address professionalism at our institution. The tool was developed with input from residency program leaders, residents, and the faculty development committee and piloted with graduate medical education learners before implementation. More than 7,200 faculty evaluations by learners and 550 faculty self-evaluations have been collected. Learners found the form easy to use and preferred it to previous Likert-based evaluations. Over the 2 years that faculty self-evaluations have been collected, their scores have been similar to the learner evaluation scores. The feedback provided faculty with more meaningful data on teaching skills and opportunities for reflection and skill improvement and was used in constructing faculty teaching skills programs at the institutional level. This innovation provides an opportunity to give faculty members more meaningful teaching evaluations and feedback. It should be easy for other institutions and programs to implement. It leverages a familiar milestone construct and incorporates important ACGME annual resident survey information.

Teaching the pediatric ear exam and diagnosis of Acute Otitis Media: a teaching and assessment model in three groups

BackgroundThe serious consequences of inaccurate diagnosis of acute otitis media have led to a call for greater education to develop proficient pediatric otoscopy skills. Despite the clinical and educational needs, peer-reviewed standardized curricula with validated assessment instruments remain limited. This study evaluated a pediatric otoscopy curriculum incorporated into the Pediatric medical student clerkship with use of outcome measures that included assessment of skills with real patients. The objective was to determine whether students who received the intervention would demonstrate significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure.MethodsDuring their Pediatric clerkship, an intervention group (IG) of 100 medical students received routine instruction and a curriculum intervention. A non-intervention group (NIG) of 30 students received only routine instruction. Outcome measures included written tests and assessment of skills with real patients. A retention group (RG) consisted of 79 students in the IG who completed a written test at the end of medical school. Paired t-tests were used to compare differences in pre-intervention, post-intervention, and retention scores for the IG, NIG, and RG, while analysis of covariance tests were used to compare differences in scores between the IG and NIG.ResultsPre-intervention scores were similar for the IG and NIG for the written test (mean/SD of 12.9/2.9 for IG and 12.9/1.8 for NIG, p = 0.78) and skills checklist (mean/SD of 11.1/4.4 for IG and 10.9/4.0 for NIG, p = 0.88). The IG had significantly higher post-intervention scores than the NIG for the written test (mean/SD of 22.6/1.7 for IG and 13.9/2.5 for NIG, p < 0.001) and skills checklist (mean/SD of 19.2/3.4 for IG and 11.0/3.8 for NIG, p < 0.001). The IG also had significantly higher gain in scores than the NIG for the written test (mean/SD +9.6/2.8 for IG and +1.0/2.3 for NIG, p < 0.001) and skills checklist (mean/SD of +8.1/4.8 for IG and +0.1/4.5 for NIG, p < 0.001). For the RG, there was a significant decrease (p < 0.001) from the post-intervention scores to retention scores (mean/SD of −7.4/2.7) but a significant increase (p < 0.001) from the pre-intervention score to retention score (mean + 2.6/3.3).ConclusionsMedical students who received a formal curriculum intervention demonstrated significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure. However, learning gains diminished over time, emphasizing the need for continued practice opportunities to reinforce students’ skills. Our study provides a formal curriculum to meet identified educational gaps in the important topic of pediatric otoscopy and offers a model for teaching of other clinical skills using rigorous outcome measures including assessment of skills in real patients.