Diagnostic Skills Research Articles

Intelligent diagnosics of vehicles

Problem. Diagnostics or troubleshooting is an integral part of the operation of automotive technology, and as automotive systems become more complex, the need for diagnostic skills increases, so diagnostic methods by the human senses should be considered an integral part of technical diagnostics at all stages of a vehicle life cycle. Methodology. Analytical methods are used to study the methods of diagnosing vehicles with the help of the intellectual abilities of the operator-diagnostician. Results. The paper shows that the intellectual abilities of the operator-diagnostician play an important role in diagnosing vehicles, the advantages and disadvantages of such diagnostics are presented. The list of basic knowledge necessary for the operator-diagnostician is described as well as the type of operational documentation which is necessary to improve the efficiency of intelligent diagnostics. Intelligent diagnostics of vehicles is divided into stages and shows the wide possibilities of diagnosing by the senses and knowledge of the diagnostician. It is shown that a highly qualified diagnostician can significantly reduce the complexity of diagnosis. With qualified training, experienced mechanics determine up to 70-90% of malfunctions and failures of vehicles and units using organoleptic methods and simple tests. Originality. The stages of intelligent diagnostics of vehicles are singled out and the wide possibilities of diagnosing by the human senses and knowledge of diagnostics at these stages are shown. Practical value. The results of this work are intended for wide use, for example, for drivers, maintenance services, developers of operational and technical documentation, developers involved in the improvement of technical diagnostic tools, machine learning, etc.

Right heart catherisation – a virtual reality

Abstract Introduction Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors. Method We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed. The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system. We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis. Results The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion. Conclusion A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals

Testing the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce diagnostic error in trauma triage: a study protocol for a randomized pilot trial

BackgroundNon-compliance with clinical practice guidelines in trauma remains common, in part because physicians make diagnostic errors when triaging injured patients. Deliberate practice, purposeful participation in a training task under the oversight of a coach, effectively changes behavior in procedural domains of medicine but has rarely been used to improve diagnostic skill. We plan a pilot parallel randomized trial to test the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce physician diagnostic errors in trauma triage.MethodsWe will randomize a national convenience sample of physicians who work at non-trauma centers (n = 60) in a 1:1 ratio to a deliberate practice intervention or to a passive control. We will use a customized, theory-based serious video game as the basis of our training task, selected based on its behavior change techniques and game mechanics, along with a coaching manual to standardize the fidelity of the intervention delivery. The intervention consists of three 30-min sessions with content experts (coaches), conducted remotely, during which physicians (trainees) play the game and receive feedback on their diagnostic processes. We will assess (a) the fidelity with which the intervention is delivered by reviewing video recordings of the coaching sessions; (b) the acceptability of the intervention through surveys and semi-structured interviews, and (c) the effect of the intervention by comparing the performance of trainees and a control group of physicians on a validated virtual simulation. We hypothesize that trainees will make ≥ 25% fewer diagnostic errors on the simulation than control physicians, a large effect size. We additionally hypothesize that ≥ 90% of trainees will receive their intervention as planned.ConclusionsThe results of the trial will inform the decision to proceed with a future hybrid effectiveness-implementation trial of the intervention. It will also provide a deeper understanding of the challenges of using deliberate practice to modify the diagnostic skill of physicians.Trial registrationClinical trials.gov (NCT05168579); 23 December 2021.

The anatomical variations of the lateral sesamoid bones of the foot: a retrospective radiographic analysis.

Os peroneum and os vesalianum are sesamoid bones that could be found within fibularis longus and brevis tendons, respectively. They are rarely a cause of lateral foot pain and are often identified as incidental radiographic findings. However, in the context of trauma, these sesamoids may be radiographically misinterpreted as fractures. This study aimed to evaluate the prevalence and normal morphological variants of os peroneum and os vesalianum. Standard oblique lateral and/or anteroposterior radiographic views of 624 feet of adolescent and adult patients were retrospectively reviewed to determine the prevalence and anatomical variations of the os peroneum and os vesalianum in relation to age and gender using plain radiography. Os peroneum was found in 22% and os vesalianum was found in 1.6%. Age was found to significantly correlate with the presence of os peroneum with the highest prevalence (30%) detected in the elderly group. Among 137 feet with os peroneum, 54.0% were between 4 and 8 mm, 67.2% were close to the tubercle of cuboid, 32.8% were located at the level of calcaneocuboid joint, 81.8% were solitary, and 18.2% were bi-/multipartite. Among 10 feet with os vesalianum, type I was identified in 40% and type II in 60%. Different anatomical variants of the lateral sesamoid bones of the foot have been described in this study. A thorough knowledge of normal anatomical variants is essential for proper diagnosis and management and can enhance our diagnostic skills in detecting these sesamoids.

Why should speech-language pathologists read graphic novels? A commentary on humanities as a pathway to improving patient-centred care

Like all who work in medical or allied health professions, speech-language pathologists would benefit from supplementing their learning with humanities education, as it can help to improve diagnostic skills and to develop empathy. Graphic novels on illness and disease, conceived of by those in the medical humanities as “graphic medicine,” have an appeal for their brevity and association with humour, and for their ability to express complex thoughts and feelings through a medium that is both visual and literary. As such, they serve as an ideal resource for deepening one’s understanding of how disorders and diseases are experienced by patients and their caregivers and for helping student clinicians, therapists, and researchers recognize their shared humanity with patients and study participants. In this article, I expand on these ideas and, in order to demonstrate the benefit of closely reading graphic novels from a speech-pathology perspective, I offer my own analysis of Tangles: A Story of Alzheimer’s, My Mother, and Me by Sarah Leavitt (2012).

Real-Life Cases in Student-Family Environment as a New Model for Case-Based Learning for Dental Students in Pathology: Students’ Perspective

Background: Case-based learning is a widely accepted technique to promote critical thinking in health care students. This paper focuses on active learning through real life clinical cases as opposed to hypothetical cases in the dental academic curricula. The overall experience of the faculty as well as the students throughout the case assignment has been reported in this study. Objective: This study provides a student’s perspective and insight into an innovative real-life case-based approach in online learning of pathology. Material and Methods: A real-life case of hypertension, diabetes or both was assigned to the Bachelor of Dentistry students in their second academic year of Pathology. The case was then presented by the students, followed by an open discussion involving peers and faculty members. Students’ responses were obtained for the assignment. Results: The response of students towards case assignment was promising and their feedback on each aspect of the assignment has been described. Faculty perception has also been included in order to share feedback about the students’ participation in the assignment from a faculty viewpoint. Conclusion: The present study introduces an innovative teaching method in medical education which can be utilized in the online learning of pre-clinical subjects and even clinical subjects during adverse situations when patient exposure is less. The real-life case-based learning method discussed in this paper offers real potential in developing critical diagnostic skills in students under a realistic clinical environment

Using the theoretical domains framework to explore stakeholder perspectives of a “prescriber-ready pharmacist” to help develop the future workforce

Abstract Introduction The General Pharmaceutical Council’s (GPhC’s) revised standards for the Initial Education and Training of Pharmacists, enable pharmacists to prescribe on registration”.1 This major reform is transforming the education and training of ‘day-one pharmacist prescribers’ allowing them to play a greater role in patient care. Aim To explore stakeholder perspectives on a “prescriber-ready pharmacist” to help inform the initial education and training of the future pharmacy workforce. Methods Structured interviews with a diverse group of stakeholders, and an interview and focus groups with pharmacy students, took place in Autumn 2021. The schedule was developed using the Theoretical Domains Framework (TDF).2. Participants were identified and recruited via email by the investigators, who had legitimate access to their contact details. All were held and recorded on Microsoft Teams, then transcribed and analysed using Framework Method.3 Ethical approval from LJMU, School of Pharmacy, REC (PBS/2021-22/01). Results The study included 50 participants; interviews with six patients, eight community pharmacists (two independent prescribers (IPs)), 10 hospital pharmacists (six IPs), 12 primary care pharmacists (eight IPs), two nurses (one IP), five GPs, and one second year pharmacy student; and two focus groups, with three, final-year pharmacy students. Participants felt person-centred care, communication and consultation skills were very important for ‘day-one pharmacist prescribers’. Professional knowledge and clinical skills e.g., “interpretation of diagnostic tests” [Hospital Pharmacist_04], were cited by hospital and primary care pharmacists. Conversely, professionalism were more likely to be mentioned by community pharmacists, “General knowledge about legalities of prescribing” [Community Pharmacist_07] and understanding their limitations. Many felt the pharmacy degree needed to become more clinical with additional placement opportunities, which would be challenging in terms of time constraints and staff capacity “… have to provide training for a large number of students that [they] haven't had to train in that way before” [Primary Care Pharmacist_05]. Barriers to ‘day one’ pharmacists prescribing included a lack of experience and confidence and pharmacist respondents felt it was important for them to gain the trust of other health care professionals. Barriers specifically for community pharmacy were: a perceived lack of support and commercial pressures, along with logistical barriers including lack of space, equipment, IT issues and pharmacists sitting outside of the ‘parent team’ in hospitals. Discussion/Conclusion Hospital and primary care pharmacists in the study were more likely to mention professional knowledge and skills, for example clinical and diagnostic skills. This may be explained because many were qualified independent prescribers and so have a better understanding of the knowledge and skills to perform the role. The additional challenges faced by community pharmacy presented may be because of a lack of defined roles for independent prescribers working within this setting. A limitation of the study is a lack of stakeholder representation from medics and other health care professionals in secondary care. ‘Prescriber-ready pharmacists’ require appropriate professional knowledge and skills, and provide a person-centred service within their sphere of competence. Stakeholders need assurance that these pharmacists are competent as independent prescribers at the point of registration before, through changes to the undergraduate programme, in particular placement opportunities.

The future of teaching management reasoning: important questions and potential solutions.

Management reasoning is distinct from but inextricably linked to diagnostic reasoning in the iterative process that is clinical reasoning. Complex and situated, management reasoning skills are distinct from diagnostic reasoning skills and must be developed in order to promote cogent clinical decisions. While there is growing interest inteaching management reasoning, key educational questions remain regarding when it should be taught, how it can best be taught in the clinical setting, and how it can be taught in a way that helps mitigate implicit bias. Here, we describe several useful tools to structure teaching of management reasoning across learner levels and educational settings. The management script provides a scaffold for organizing knowledge around management and can serve as a springboard for discussion of uncertainty, thresholds, high-value care, and shared decision-making. The management pause reserves space for management discussions and exploration of a learner's reasoning. Finally, the equity reflection invites learners to examine management decisions from a health equity perspective, promoting the practice of metacognition around implicit bias. These tools are easily deployable, and- when used regularly- foster a learning environment primed for the successful teaching of management reasoning.

Engaging Pathologists in a Peer-to-Peer Learning Collaborative on HER2-Low Breast Cancer

Abstract Introduction/Objective Recent advances in research have shown clinical effectiveness when targeting the lower range of HER2 expression (ie, HER2-low) in patients with metastatic breast cancer. American Society for Clinical Pathology worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative to proactively prepare pathologists for HER2-low. This CME project was supported by an educational grant from AstraZeneca Pharmaceuticals LP and Daiichi Sankyo Inc. Methods/Case Report 38 pathologists participated in the ASCP HER2 Breast Trailblazers. For foundational knowledge, learners completed online modules covering scientific updates on HER2-low. Through small-group, case- based discussions, learners reviewed operational challenges and opportunities to prepare for HER2-low. They applied this knowledge to lead projects at their own institutions focusing on the anticipated changes around HER2-low. Results (if a Case Study enter NA) The learners identified the following challenges and opportunities: Defining HER2-low: Several learners had heard misconceptions around the definition of HER2-low. Recent studies have defined HER2-low as IHC 1+ or IHC 2+ with ISH-negative. Interobserver concordance with IHC 0 vs 1+: Several learners discussed the challenges around interpreting IHC 0 vs 1+. They felt that some pathologists may need guided feedback to improve their diagnostic skills. Use of IHC vs. ISH: Several learners only performed ISH for HER2 testing on all breast cancer samples. If HER2-low emerges as a third category, they would need to return to IHC. Implications for non-metastatic breast cancer: Recent HER2-low studies have focused on patients with metastatic breast cancer. If HER2-low emerges as a third category, it is unclear whether this designation will also be used in patients who have early-stage breast cancer. Leadership As pathologists prepare for HER2-low, they have opportunities to lead projects to assess and improve IHC interobserver concordance, coach others on IHC interpretation, increase operational efficiency, strength communication skills, and build up the team by proactively anticipating challenges around HER2-low. Conclusion HER2-low breast cancer may be emerging as a new category. Through a peer-to-peer learning collaborative, pathologists identified ways to proactively prepare and demonstrate leadership so that cancer centers and laboratories may be ready to embrace a new paradigm of HER2 classification in breast cancer.

Art in Surgery: A Review of Art-based Medical Humanities Curricula in Surgical Residency

Numerous programs integrate arts and humanities methods to advance medical education competencies. Despite the highly visual and technical nature of the field of surgery, the current state of art utilization in surgical training is unclear. The purpose of this review is to gain a comprehensive understanding of how art has been utilized in surgical training, to investigate the purpose of such interventions, and to assess how art interventions may benefit surgeons. A systematic literature review using PRISMA methodology was conducted to identify articles published prior to February 2022 that investigated or described using art in surgical resident training. Qualitative themes were developed upon full review of the literature and categorized based on fundamental aspects of surgical education. The data was summarized by a narrative approach. Six hundred seventy-four unique articles were initially identified, thirteen of which met inclusion criteria. Twelve studies employed drawing or sculpture in surgical residency training; one discussed art observation to foster mindfulness, teambuilding, and empathy. Eight articles utilized art as an evaluation tool, 2 for didactic and archival purposes, one employed exercises in art analysis to improve empathy and physician wellbeing, and 2 described courses in which art making was treated as a foundational skill. No articles discussed use of art for honing diagnostic skills, observation, or patient communication - competencies that have been addressed in other fields. This review highlights the small number of examples in the medical literature about visual arts in surgical training. The existing art-based surgical humanities studies identify opportunities for curricular innovation within surgical training.

Diagnostic argumentation in teacher education: Making the case for justification, disconfirmation, and transparency

Research on diagnosing in teacher education has primarily emphasized the accuracy of diagnostic judgments and has explained it in terms of factors such as diagnostic knowledge. However, approaches to scientific argumentation and information processing suggest differentiating between diagnostic judgment and diagnostic argumentation: When making accurate diagnostic judgments, the underlying reasoning can remain intuitive, whereas diagnostic argumentation requires controlled and explicable reasoning about a diagnostic problem to explain the reasoning in a comprehensible and persuasive manner. We suggest three facets of argumentation for conceptualizing diagnostic argumentation, which are yet to be addressed in teacher education research: justification of a diagnosis with evidence, disconfirmation of differential diagnoses, and transparency regarding the processes of evidence generation. Therefore, we explored whether preservice teachers’ diagnostic argumentation and diagnostic judgment might represent different diagnostic skills. We also explored whether justification, disconfirmation, and transparency should be considered distinct subskills of preservice teachers’ diagnostic argumentation. We reanalyzed data of 118 preservice teachers who learned about students’ learning difficulties with simulated cases. For each student case, the preservice teachers had to indicate a diagnostic judgment and provide a diagnostic argumentation. We found that preservice teachers’ diagnostic argumentation seldom involved all three facets, suggesting a need for more specific training. Moreover, the correlational results suggested that making accurate diagnostic judgments and formulating diagnostic argumentation may represent different diagnostic skills and that justification, disconfirmation, and transparency may be considered distinct subskills of diagnostic argumentation. The introduced concepts of justification, disconfirmation, and transparency may provide a starting point for developing standards in diagnostic argumentation in teacher education.

Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost–consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes

IntroductionCerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12–24...

8576 A Video Tutorial on the Use of a Bell Pepper as a Model for Hysteroscopy Simulation

<h3>Study Objective</h3> In this educational video, we demonstrate the use of a bell pepper as a model for hysteroscopy simulation. <h3>Design</h3> This model is created by using an os-finder to bore a hole into the side of a bell pepper. Hysteroscopic equipment is set up in the traditional fashion with or without fluid. The features of the bell pepper can then be used to practice skills including visualization, tissue sampling of the bell pepper seeds, and septum take-down which are demonstrated in this video. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Obstetrics and gynecology residents in ACGME-accredited programs are required to complete forty hysteroscopies during their training. Hysteroscopy education with simulation has been shown to improve procedural knowledge, performance, and procedure time, as well as increase interest and confidence among OB-GYN trainees. The benefit of using a bell pepper as a DIY educational model is that it is inexpensive, easily accessible and provides haptic feedback while simultaneously being easily replaceable for skill repetition. These DIY models have been shown to be preferred by trainees and education using these models has been shown to improve trainees' procedural skills and confidence. The skills developed using this model include diagnostic skills such as equipment handling and cavity visualization and operative skills including tissue sampling, polypectomy and septum-take down.

Extended reality veterinary medicine case studies for diagnostic veterinary imaging instruction: Assessing student perceptions and examination performance.

Educational technologies in veterinary medicine aim to train veterinarians faster and improve clinical outcomes. COVID-19 pandemic, shifted face-to-face teaching to online, thus, the need to provide effective education remotely was exacerbated. Among recent technology advances for veterinary medical education, extended reality (XR) is a promising teaching tool. This study aimed to develop a case resolution approach for radiographic anatomy studies using XR technology and assess students' achievement of differential diagnostic skills. Learning objectives based on Bloom's taxonomy keywords were used to develop four clinical cases (3 dogs/1 cat) of spinal injuries utilizing CT scans and XR models and presented to 22 third-year veterinary medicine students. Quantitative assessment (ASMT) of 7 questions probing 'memorization', 'understanding and application', 'analysis' and 'evaluation' was given before and after contact with XR technology as well as qualitative feedback via a survey. Mean ASMT scores increased during case resolution (pre 51.6% (±37%)/post 60.1% (± 34%); p < 0.01), but without significant difference between cases (Kruskal-Wallis H=2.18, NS). Learning objectives were examined for six questions (Q1-Q6) across cases (C1-4): Memorization improved sequentially (Q1, 2 8/8), while Understanding and Application (Q3,4) showed the greatest improvement (26.7%-76.9%). Evaluation and Analysis (Q5,6) was somewhat mixed, improving (5/8), no change (3/8) and declining (1/8).Positive student perceptions suggest that case studies' online delivery was well received stimulating learning in diagnostic imaging and anatomy while developing visual-spatial skills that aid understanding cross-sectional images. Therefore, XR technology could be a useful approach to complement radiological instruction in veterinary medicine.

Perforated appendicitis in infancy

Acute appendicitis is the major indication for abdominal surgery in the pediatric population. It represents 1–2% of all patients admitted into pediatric surgical wards. The clinical manifestations are varied and sometimes atypical due to the nature of the differing pathophysiology and the communicative capabilities of the patients based on age and development. We share a case of acute appendicitis that first presented to our emergency department and admitted under general pediatric medicine; later surgically treated and confirmed using histopathology. The patient's health record was reviewed for the following: demographics, visits, imaging modalities, management, outcome, and histopathology. Our 2-month-old patient was admitted under the general pediatric team who treated him at first under the assumption of incomplete Kawasaki disease. A consultation to pediatric surgery for an infected urachus lead to an Ultrasound and CT-scan studies being done. This was followed by exploratory laparotomy and appendectomy due to the need for drainage and further assessment. The findings which were further confirmed by histopathological specimens were suggestive of acute appendicitis with peri-appendiceal abscess Acute appendicitis in infants is a challenging diagnosis, A high level of suspicion and having knowledge of the red flags specific to abdominal pain and appendicitis in infants could significantly aid in improving diagnostic skills. In addition, early imaging using US in addition to CT is paramount in insuring early recognition and optimal outcomes

Enhancing Doctor of Nursing Practice Students' Diagnostic and Clinical Reasoning Skills.

This article describes one school of nursing's successful approach to augmenting Doctor of Nursing Practice students' diagnostic and clinical reasoning skills. Faculty convened a taskforce to evaluate the current clinical tracking system to expand the clinical log and develop a formative assessment tool. The clinical log enhancement allowed faculty to assess students' learning, clinical decision making, and readiness for clinical progression throughout the program. The expansion of the clinical log system resulted in students' heightened understanding of documentation and clinical practice, and also allowed faculty to comprehensively assess students in diagnostic and clinical reasoning. [J Nurs Educ. 2023;62(2):109-111.].

Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments

We study healthcare operations of emergency departments (EDs) by examining the practice styles and skills of ED physicians. Our data include all residents of Montreal, Canada, with an initial ED visit in Montreal during a nine-month period. For each visit, our data record the initial treating hospital, ED physician, ED billed expenditures, and all interactions with the health system within the subsequent 90 days. Physicians in Montreal rotate across shifts between simple and difficult cases, implying a quasi-random assignment of patients to physicians within an ED. We consider three medical conditions that present frequently in the ED and for which mistreatment may have dramatic consequences—angina, appendicitis, and transient ischemic attacks—jointly examining diagnostic and disposition skills. To control for variation in diagnosis, our sample for each condition consists of patients with a broader set of symptoms and signs potentially indicative of the condition. Separately by condition, we regress healthcare usage and cost measures on indicators for physicians to estimate the skill and practice style of each physician. We then evaluate the variation across physicians in their practice style and skills and the correlations between different measures of skill and practice style. We find significant variation across physicians in their practice styles and skills. We also find that physicians with costly practice styles often have worse outcomes in terms of more ED revisits and more hospitalizations. Finally, the practice styles and skills of physicians correlate positively across the three conditions that we consider. This paper was accepted by Jayashankar Swaminathan, operations management. Funding: Gowrisankaran acknowledges funding from the Center for Management Innovations in Healthcare at the University of Arizona. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2022.4544 .

Right heart catherisation – a virtual reality

Abstract Introduction Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors. Method We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed. The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system. We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis. Results The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion. Conclusion A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals

Pre-service teachers’ learning of diagnostic skills in a video-based simulation: Effects of conceptual vs. interconnecting prompts on judgment accuracy and the diagnostic process

Video-based simulations are considered authentic approximations of practice that can support pre-service teachers' acquisition of diagnostic skills. Still, there is insufficient knowledge on the (differential) effectiveness of different types of prompts on learning in such environments. The presented study experimentally compared the effects of two types of prompts on participants’ judgment accuracy and diagnostic processes in a video-based simulation for diagnostic skills in the context of secondary mathematical argumentation skills. The prompts focused learners either on one indicator of argumentation skills (conceptual prompts) or two indicators and their relation (interconnecting prompts). Results indicate that the prompts effectively supported learning in short interventions. While conceptual prompts led to generally higher learning, interconnecting prompts showed a differential effectiveness based on prior knowledge. Besides highlighting a prototypical video-based simulation for diagnostic skills and prompts to support these, results give indications for teaching diagnostic skills and the adaptive use of prompts for simulation-based learning.

Assessment of Clinical Reasoning and Diagnostic Thinking among Dental Students

Introduction This study aimed to investigate dental students' clinical reasoning and diagnostic thinking ability by key feature test and “diagnostic thinking inventory” questionnaire. Methods The present study was a descriptive cross-sectional study. The participants consisted of 61 senior dental students. Clinical reasoning and diagnostic thinking were assessed by key feature tests and the “diagnostic thinking inventory” “DTI” questionnaire, respectively. The “diagnostic thinking inventory” was developed by Bordage et al. in France and consisted of 41 questions on a 6-point Likert scale. The satisfaction of students was assessed through a 10-item questionnaire. Data were analyzed using SPSS 19 with descriptive tests (mean, SD, and percentage), student independent T-test, and Pearson correlation. The significance level was determined at p < 0.05. Results The mean scores of the key feature test were 56.55 ± 7.80. Diagnostic thinking scores of learners were reported in diagnostic thinking 136.47 ± 16.45, flexibility in thinking 72.22 ± 11.15, and structure of memory 64.24 ± 7.84. The difference in students' scores in flexibility in thinking was significantly higher among male students than female students. (p-value = 0.04). The students' satisfaction scores were 3.53 ± 0.52, which showed relative satisfaction. Conclusion The participants' clinical reasoning and diagnostic thinking skills were reported at a low level. This issue emphasizes the need for training to enhance diagnostic thinking and clinical reasoning in dental education. Formative evaluation and reform of the educational programs of this course should be considered.