Didactic Teaching Sessions Research Articles

The Brussels Breast Surgery Fellowship | A Three-Month Experience in Advancing Skills in Breast Surgery.

The Brussels Breast Surgery Fellowship at Brussels University Hospital offers a unique 3-month clinical immersion in reconstructive and aesthetic breast surgery. Under the guidance of fellowship director Prof. Moustapha Hamdi and his esteemed colleagues, the fellow is exposed to a high volume and wide breadth of cases spanning autologous and implant-based breast reconstruction, oncoplastic surgery, breast reduction and mastopexy, implant augmentation, revision breast surgery, and fat grafting. The multidisciplinary team approach, involving close collaboration with breast surgeons, provides valuable experience in oncoplastic planning and execution. In addition to time in the operating theater, the fellow gains knowledge through outpatient clinics, didactic teaching sessions, and clinical research opportunities leveraging the department's extensive prospective database. As the 2023 fellowship awardee, I had the privilege of learning directly from Prof. Dr. Moustapha Hamdi and participating in over 130 cases across the reconstructive and aesthetic spectrum. Unique features of the fellowship included exposure to lymphedema surgery utilizing the Symani robotic system, advanced techniques like the internal bra, volume distribution mastopexies, observation of private aesthetic clinic cases, and optional participation in academic workshops. This fellowship represents an outstanding opportunity to refine one's skills in breast surgery and microsurgery while experiencing the rich culture of Belgium.

General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention.

Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care. Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05. Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001). This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

Impact of Didactic Instruction on the Utilization of Point-of-Care Ultrasound in Family Medicine Residents.

Background and Objectives In 2014, the Council of Academic Family Medicine released recommendations for the education of family medicine residents in point-of-care ultrasound (POCUS) curricula for Family Medicine Residency programs. One barrier to resident education in POCUSis the lack of access to equipment. This pilot study evaluates whether introducing didactic education on POCUSwithin a Family Medicine Residency program, with limited access to equipment, correlated with increased utilization of ultrasound by residents. Methods Sixteen family medicine residents participated in the intervention, consisting of a four-hour didactic ultrasound session. Resident confidence in POCUS was evaluated utilizing a Likert scale. Resident utilization of POCUS in a clinical setting was also evaluated by review and analysis of resident procedure logs in the New Innovations database. Results The resident confidence in all skills increased immediately after the completion of the didactic teaching session. Residents demonstrated improved confidence in needle guidance immediately and six weeks after the session (p < 0.001). A review of resident activity two years after the intervention revealed a 9.6% increase in the proportion of resident ultrasounds performed compared to the academic year before the intervention. Conclusions Access to equipment is an ongoing barrier to Family Medicine Residency programs in providing education on POCUS. The results of this study indicate that introducing the basics of POCUS via a didactic teaching session not only increased resident confidence in basic ultrasound but also correlated with increased utilization of POCUS. This increased utilization occurred despite residents not having access to ultrasound in their home clinics.

Deferred cord clamping and cord milking: Certainty and quality of the evidence in meta-analyses, and systematic reviews of randomized control trials, guidelines, and implementation studies

Deferred11“Deferred” cord clamping is selected to imply a deliberate choice rather than “delayed” cord clamping, which has a potential negative connotation of being later than intended. cord clamping (DCC) saves lives, so why is it not implemented more routinely? Despite neonatal benefits, DCC is under-utilized, particularly in preterm births. Umbilical cord milking (UCM) also improves some outcomes for preterm infants such as decreasing the need for transfusions. At term, DCC and UCM improve hematological indices. ObjectiveThe objective of this chapter is to examine the quality of evidence for both preterm and term DCC (and UCM), clinical practice guidelines and implementation issues. MethodsKey evidence, primarily from network meta-analyses, meta-analyses and systematic reviews on both preterm and term DCC (and UCM) from randomized clinical trials, clinical practice guidelines and implementation studies, are summarized through a lens of the certainty and quality of the evidence. Regarding the certainty of evidence, for network meta-analysis the Confidence in Network Meta-analysis tool was used, and for meta-analyses the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used. Guideline quality was appraised with two tools: Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) and AGREE-Recommendation EXcellence (AGREE-REX). Implementation study quality was evaluated using The Mixed Method Appraisal tool. ResultsIn a network meta-analysis of 56 RCTs of cord management strategies, DCC reduced the odds of mortality in preterm infants by 30% compared to immediate cord clamping (ICC), including in the subgroup of infants born before 33 weeks’, both with a moderate confidence assessment using the Confidence in Network Meta-analysis tool. DCC reduced the odds of any intraventricular hemorrhage (IVH) by 30%, and the odds of red blood cell transfusion by more than 50%, both with high ratings on the Confidence in Network Meta-analysis. Umbilical Cord Milking (UCM) did not reduce mortality compared to ICC. In contrast to the benefits shown in preterm birth with DCC, a systematic review showed that at term, there were no mortality benefits and few benefits at all except for improved hematological indices. A systematic review of clinical practice guidelines demonstrated that all of them endorsed DCC for uncompromised preterm infants, and 11 more cautiously noted that cord milking might be considered when DCC was not feasible. However, only half (49%) of the recommendations in the guidelines on the optimal duration of DCC were supported by high-quality evidence per AGREE-II and AGREE-REX. Fewer than one in 10 statements (8%) cited a mortality benefit with DCC for preterm infants. Regarding the uptake of DCC, a systematic review of 18 studies on facilitators and barriers to implementation found that almost all (12 of the 14 studies) focused on strategies such as protocols, policy, or toolkits; additionally, 8 of 14 studies used didactic teaching sessions. Only 8 of 18 studies scored high on all four domains of the Mixed Method Appraisal tool. ConclusionsCompared to ICC, DCC in preterm infants conferred significant benefits for mortality, IVH and red blood cell transfusion, with confidence ratings of moderate (mortality) or high. Although guidelines worldwide encouraged preterm (and term) DCC, the quality of the clinical practice guidelines had room for improvement; only half of the recommendations on the optimal duration of preterm DCC were supported by high-quality evidence. Most guidelines did not mention a mortality benefit with preterm DCC and lacked details on practical aspects of implementation. Among implementation studies, which have focused mainly on protocols, policies, toolkits or didactic teaching, quality also demonstrated an opportunity for improvement.

The Utility of Simulation-Based Training in Teaching Frontline Providers Modified Sarnat Encephalopathy Examination: A Randomized Controlled Pilot Trial

BackgroundLimited training in targeted neurological examination makes it challenging for frontline providers to identify newborns with perinatal asphyxia eligible for therapeutic hypothermia. This training is important in the era of telemedicine, where the experts can remotely guide further care of these newborns. MethodsThis randomized controlled pilot study was conducted in a South Indian tertiary hospital. Neonatal nurses, who had no previous hands-on experience in MSEE, were trained in modified Sarnat staging by a didactic teaching session using online teaching module. The nurses were then randomized into two groups for hands-on demonstration by the same trainer (low-fidelity mannequin versus a healthy term newly born infant). After the training period, MSEEs of a normal newborn were performed independently by nurses and were video recorded and assessed by three blinded neonatologists with expertise in neonatal neurology. A follow-up examination was performed by the same nurses after three months to assess skill retention. ResultsThe 10 global ratings of the components of the MSEE were comparable among both groups in both initial and follow-up assessments. The overall diagnostic value was comparable between the simulation and traditional groups (93.75%, 94.11%, respectively). Follow-up examination after three months showed better skill retention in the simulation group (84%) compared with the traditional group (66.7%). ConclusionsOnline-based and low-fidelity mannequin training was equally effective as the traditional method of teaching MSEE in term neonates.

STR1DE: a novel near-peer, simulation-based approach to foundation year 1 doctors’ teaching

NHS Trusts must deliver 30 hours of teaching to Foundation Year 1 doctors (FY1s) per year [1]. Our Trust previously delivered weekly hour-long didactic teaching sessions. Feedback was poor, so a new approach was required. Our Trust employs nine FY3 and FY4 junior doctors as Clinical Fellows in Education and Simulation. It was felt that the team, having recently completed FY1 themselves, could develop a useful and enjoyable FY1 teaching program. STR1DE – Simulation, Teaching, and Reflection for FY1 Development and Education – was developed and delivered by the Fellows. STR1DE involves six full teaching days throughout the year. Each day runs four times with a quarter of FY1s attending, to ensure reasonable class sizes. The team felt that simulation would be beneficial in teaching newly-qualified junior doctors. Simulation is an excellent way to help learners put theory into clinical practice [2], and it was felt that using carefully-designed scenarios would ensure FY1s felt the teaching was useful and relevant. Each STR1DE day therefore involves half a day of simulation using the Trusts’ high-fidelity facilities, alongside half a day of teaching including practical skills, small group teaching, and reflective sessions. All scenarios are designed around clinical scenarios which are commonly faced by FY1s in their clinical practice, alongside a variety of human factors. The scenario is observed remotely by other FY1s and the Fellows. The Fellows lead post-scenario debriefings with emphasis on reflection and peer-to-peer discussion and learning. Feedback has been excellent, with 100% of FY1s rating each session as ‘good’ or ‘very good’. The usage of near-peer teachers, the post-simulation debriefings, and the relevance of scenarios to FY1s’ clinical practice have been noted as factors contributing to this success. The benefits of near-peer teaching have been widely discussed in the literature, though often focus on junior doctors teaching medical students [3]. STR1DE demonstrates that teaching (including simulations) developed and delivered by junior doctors for more junior doctors can be relevant, useful, and enjoyable. Full-day teaching sessions seem to be preferable to shorter weekly teaching, allowing FY1s to focus on learning without worrying about work building up back on the wards. This approach also allows the usage of simulation, which would be difficult to deliver in a shorter session. Full-day teaching sessions, delivered by near-peers, with heavy usage of simulation, can be a highly effective way to deliver FY1 core teaching. 1. UK Foundation Programme. UK Foundation Programme Curriculum. London: UKFPO; 2021. 2. Okuda Y, Bryson E, DeMaria S, Jacobson L, Quinones J, Shen B, Levine AI. The Utility of Simulation in Medical Education: What Is the Evidence?. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2009;76(4):330–343. 3. Rees E, Quinn P, Davies B, Fotheringham V. How does peer teaching compare to faculty teaching? A systematic review and meta-analysis. Medical Teacher. 2015;38(8):829–837.

Neuropathology Outreach in Ghana

Abstract Introduction/Objective Ghana has a population of over 31 million people and approximately 15 neurosurgeons but is currently without a dedicated neuropathologist. Here we present a month of neuropathology outreach performed at the Komfo Anokye Teaching Hospital (KATH) in Kumasi and the Korle-Bu Teaching Hospital (KBTH) in Accra. Methods/Case Report In February of 2022, a second-year neuropathology fellow and a board-certified neuropathologist traveled to Ghana to give 40 approximately 1.5 hour neuropathology didactic and interactive teaching sessions. A two-week format of outreach was developed for each site in Ghana and consisted of didactic lectures and interactive sessions covering the WHO 2021 brain tumor classification system, neuroautopsy, neuroinfectious disease, neurodegenerative disease, neuromuscular disease, forensic neuropathology, neurodevelopment, and unknown case conferences. Meanwhile, a pathology trainee worked remotely to organize 12 one-hour virtual general pathology lectures and develop continuing outreach. A survey of 16 questions including 12 multiple choice questions and four short answer questions was used to assess each component and the overall satisfaction of the outreach. Results (if a Case Study enter NA) Eight brains were examined at four neuroautopsy conferences and ten case consultations were performed upon request. Survey results showed no statistical differences amongst the 20 sessions. Comments were positive and included one respondent planning to redesign their PhD research to focus on neurodegenerative disease in Ghana and several others commenting on the utility of molecular updates. Suggestions for improvement included quizzes, including more morphology and IHC in lectures, sending digital slides before future visits, teaching spinal cord removal, and the need for continuing outreach in neuropathology, dermatopathology, cytopathology and gynecologic pathology. Conclusion This experience provides a useful and well-appreciated approach to delivering international neuropathology outreach. Opportunities in neuropathology on an international level range from educational to clinical practice and research.

Effect of human library intervention on mental health literacy: a multigroup pretest\u2013posttest study

BackgroundMental health literacy (MHL) is an evolving concept encompassing knowledge of mental illness, help-seeking options, perceived stigma, and discrimination. This study aimed to test the effectiveness of a human library intervention at enhancing MHL. A human library intervention was adopted to enhance MHL in this study. The human library intervention aims to establish a positive framework and safe space for dialogue between readers and a ‘human book’. It works to promote dialogue, reduce prejudice, and encourage understanding of people who are regarded as disadvantaged or in a minority group.MethodsAn experimental approach with a multigroup pretest–posttest design was adopted. Forty-five participants aged between 18 and 23 years were recruited and randomly assigned to the experimental group (human library intervention), comparison group (didactic teaching session), or control group (no intervention). Adapted vignette-based MHL scale scores were used as the outcome measures. The overall and subscale scores were included in the analysis.ResultsThe human library intervention group showed a significant improvement in overall MHL compared with the other two groups. In a multivariate analysis of the variance in subscale scores, the intervention was shown to significantly reduce stigma and preferred social distance, but had no significant effect on knowledge acquisition.ConclusionsThe human library intervention is effective at enhancing overall MHL and reducing stigma and preferred social distance. Further studies are suggested to further develop the MHL construct, human library interventions, and the MHL scales for consolidating evidence-based practice.

BPSS Award

BPSS Award

The concept-sharing approach: a teaching strategy to promote objective-oriented learning and academic performance in medical students.

Traditionally teachers display the learning outline at the beginning and conclusions at the end of didactic teaching sessions, and students may find it difficult to understand how teaching activities relate to learning objectives and what they should study for assessments. We introduced the "concept-sharing approach" in our neurophysiology course. This approach explicates how the content relates with learning objectives throughout the entirety of each teaching session to help the students assimilate the learning material and direct their learning in an objective-orientated way. In this study, we aimed to examine satisfaction of the concept-sharing approach in medical students and to investigate the relationship between student perception of this teaching strategy and academic performance. The results demonstrated that most participants (74.1%) had a positive impression of this teaching strategy at the end of the course, which was significantly >50.7% at the beginning of the course (P < 0.001). The participants who agreed the concept-sharing approach was useful had significantly higher final assessment (P = 0.014) and end-of-course formative assessment scores (P = 0.001). The findings indicate that after experiencing this new teaching approach, medical students appreciate its utility and that students who engage with this approach are more likely to perform well in assessments. In summary, the concept-sharing approach is a simple teaching strategy which was favored by students and may promote academic performance.

An Integrated Three‐dimensional (3D) Model of the Larynx, Pharynx, and Skull for Anatomy Education

Gross anatomy curriculum for health profession students covers the larynx and pharynx and the important roles they play in the digestive and respiratory systems. However, the precise anatomical locations and boundaries between the pharynx, larynx and upper airway are complex topics for beginning anatomy students to grasp. This is a critically important topic not only for beginning health profession students, but also for more advanced students who are participating in clinical rotations and/or training in head and neck specialties. Traditional teaching methods to demonstrate the anatomy of this region have included didactic teaching sessions, cadaveric dissection, plastinated models, and two-dimensional representations in textbooks and anatomy atlases. In contrast, more recent teaching innovations include anatomical models created by 3D printing which are proving to be cost effective tools that can enhance learning. Current commercially available half-head models that show the upper airways often display distorted or exaggerated features of the anatomy. The rigidity of material and lack of moveable structures limit their utility as effective teaching tools. In addition, their high cost prevents institutions from being able to adequately supply larger classes. We sought to develop an integrated 3D printed model of the larynx, pharynx, and skull with details and features surpassing typical currently available commercial models. We hypothesize that this model will significantly improve students’ satisfaction and understanding of the boundaries and visuospatial relationships of these structures as compared to traditional teaching modalities. Digital files for bone and soft tissue structures from http://lifesciencedb.jp/bp3d/ have been extensively modeled to produce a life-size skull that demonstrates the upper airways. The model can be opened like a book; this allows the highly detailed anatomy of the nasal cavity, pharynx and its subdivisions, oral cavity and larynx to be visualized both in the intact skull and in sagittal section. This cost-effective 3D model provides anatomically accurate features that are not typically seen together in commercially produced half-head models, for example, the pharyngeal recess, epiglottic valleculae, piriform recess, pharyngeal muscles, and muscles of the larynx. An educational package is also being developed to accompany the model; It includes a learner guide, a video tutorial demonstrating proper handling and demonstration, a PowerPoint presentation over the anatomy of the region, and self-assessment questions to gauge individual's understanding of learning objectives. The efficacy of the model and its accompanying teaching package will be tested with student volunteers in an IRB approved study. The benefits of this model include both the enhancement of understanding through active learning as well as increased availability of anatomy education tools to institutions teaching gross anatomy.

A Novel Contraception Counseling and Shared Decision-Making Curriculum for Internal Medicine Residents

IntroductionMany women of reproductive age with complex medical conditions receive primary care through an internal medicine (IM) physician rather than an obstetrician/gynecologist. Long-acting reversible contraception methods are the most effective form of contraception; however, IM residents are not routinely trained in them. Infrequent training in, inadequate knowledge of, and discomfort with contraception counseling limit the counseling performed by IM residents. Shared decision-making (SDM) is a method of patient-centered communication that can improve communication about patient preferences and increase patient satisfaction with and adherence to contraception. We developed a curriculum to teach contraception counseling under the framework of SDM for IM residents.MethodsThe curriculum focused on contraception counseling through the lens of SDM designed for IM and medicine/pediatrics residents (PGY 2-PGY 4). We adapted an existing seven-step model of SDM to fit elements of contraception counseling. The curriculum consisted of a didactic teaching session with integration of an instructional video and structured interactive discussion. The session lasted 60 minutes.ResultsFifty-eight residents participated in the curriculum. On pre- and postcurriculum surveys, residents reported improvement in contraception knowledge (overall mean precurriculum = 57%, postcurriculum = 70%, p < .001) and comfort with contraception counseling (overall mean precurriculum = 3.2, postcurriculum = 3.6, p < .01). Residents expressed strong support for SDM before and after the curriculum.DiscussionBased on the survey results, the curriculum successfully addressed gaps in residents’ comfort with contraception counseling and knowledge of contraception side effects and efficacy.

Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting

BackgroundThere is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists.MethodsThirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected.ResultsAfter the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients.ConclusionStudents had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.

24. IMPROVING RESIDENT EDUCATION IN THE PEDIATRIC INTENSIVE CARE UNIT THROUGH THE IMPLEMENTATION OF A STANDARDIZED CURRICULUM

Background Trainees at our institution have traditionally found the Pediatric Intensive Care Unit (PICU) to be a challenging rotation, with patient acuity and workload that often makes regular didactic teaching difficult. Aim Statement Our goal was to improve the educational experience in the PICU for our residents by increasing the frequency of structured lectures from a baseline of less than half the days to at least half the days of the week over one year. These measures were assessed with anonymous resident surveys. Interventions In collaboration with PICU faculty and fellows, we developed and implemented a brief daily teaching curriculum based on content specifications for pediatric boards. The curriculum is comprised of a series of prompts and associated teaching points. Prompts include visual aids, schematics, and board-style questions. Through process mapping and workflow redesign, we created a 15-minute block in the weekday schedule to allow for dedicated teaching sessions prior to morning rounds. Measures Pre-intervention survey responses were collected from June through July 2019, surveying all residents who had rotated through the PICU in the prior 2 years (n= 32). The survey assessed resident satisfaction with overall educational experience, didactic teaching experience, and the frequency of teaching sessions. Following implementation of the teaching curriculum in August 2019, the same survey was administered to residents after each PICU rotation block. There have been 5 rotation blocks since implementation of the new curriculum (n= 12). Results At baseline, 15% of residents surveyed reported didactic teaching half or more days per week, as compared with 93% of residents after implementation of the new curriculum (Figure 1). The mean resident satisfaction with overall educational experience increased from 3.4 to 4.2 on a 5-point Likert scale, with 5 being extremely satisfied and 1 being extremely dissatisfied. Conclusions and Next Steps We developed and implemented a standardized curriculum that has led to an increase in the frequency of didactic teaching sessions and improvements in resident satisfaction with the overall educational experiences in the PICU. Going forward, it will be important to gather additional feedback from trainees and PICU staff to improve the lecture materials and identify barriers to lectures taking place. It will be helpful to gather more objective data on the frequency of lectures and to look at resident exam scores pre- and post-intervention.

Heterogeneity in urology teaching curricula among Canadian urology residency programs.

Postgraduate education is transitioning to a competency-based curriculum in an effort to standardize the quality of graduating trainees. The learning experiences and opportunities in each institution are likely variable, as no standard exists regarding the teaching curriculum offered through residency. The objective of this study is to examine the various teaching curricula among different Canadian urology residency programs and to identify which teaching modalities are prioritized by program directors. A 10-question anonymous survey was sent electronically to program directors at all 12 urology residency programs across Canada. Questions were designed to quantify the time allotted for teaching and to assess the various teaching session types prioritized by programs to ensure the successful training of their graduates. We assessed each program's perceived value of written exams, oral exams, didactic teaching session, and simulation sessions. Responses were assessed using a Likert-scale and a ranking format. Descriptive statistics were performed. Overall survey response rate from residency program directors was 75% (9/12). Sixty-seven percent of programs designated one day of teaching per week, whereas 33% split resident teaching over two days. Review of chapters directly from Campbell-Walsh Urology textbook were deemed the most valuable teaching session. Practice oral exams were also prioritized, whereas most programs felt that simulation labs contributed the least to residency education. All programs included review of the core urology textbook in their weekly teaching, while only 67% of programs included faculty-led didactic sessions and case presentations. Forty-four percent of programs included resident-led didactic sessions. Practice oral exams and simulation labs were the least commonly included teaching modalities. Although most program directors prioritize the review of chapters in the core urology textbook, we found significant heterogeneity in the teaching sessions prioritized and offered in current urology residency curricula. As we move to standardize the quality of graduating trainees, understanding the impact of variable educational opportunities on residency training may become increasingly important.

The Effects of a Bug-in-Ear Coaching Package on Implementation of Incidental Teaching by Paraprofessionals in a K-12 School

Paraprofessionals play a critical role in the instruction of students with disabilities and yet they often receive inadequate training in using evidence-based teaching strategies. A promising avenue for improving paraprofessional training is distant bug-in-ear coaching (BIE), where a paraprofessional receives in-the-moment coaching on a teaching strategy from a coach at a different location. This study examined a BIE coaching package to support paraprofessionals in using incidental teaching for teaching self-advocacy skills to students with disabilities. The package included an initial individual didactic teaching session followed by distance BIE coaching. A multiple-baseline across participants design was used to assess the impact of the intervention on both the skills of the paraprofessionals and on student acquisition of self-advocacy statements. BIE coaching was associated with increases in both the accuracy and rate of incidental teaching trials and with use of self-advocacy statements by the students with disabilities.

POETIC (Program for Enhanced Training in Cancer): An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa.

Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals because of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. In its initial year, 2018, the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of seven fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants prior to arrival and upon departure; additionally, three participated in semistructured interviews. Five themes emerged from the qualitative data: expectations of POETIC, differences between oncology in the U.S. and in sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care; clinical trials; and collaboration among medical, radiation, and surgical oncologists. From the quantitative data, feedback was primarily around logistical areas for improvement. POETIC was found to be feasible and valuable. The results from the pilot year justify the program's continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future research will report on the expansion of the program and follow-up with former participants. This work presents a novel model for fellowship exchange between lower- and higher-resourced areas. The program is a short-term observership with tumor boards and didactic teaching sessions incorporated. By attracting oncologists who aim to practice in their home countries, it facilitates international collaboration without contributing to the preexisting lack of medical professionals in low- and middle-income countries.

P.105 The “Comprehensive 3D Skull Base Lab”-- enhancing resident education with virtual/augmented reality and 3D printing at Northwestern University

Background: Due to increasingly limited access to cadavers and first-hand operative experience, there is an increasing need for innovative modalities in neurosurgical education. Recent developments in computer modelling, virtual/augmented reality, and video game technology have created new opportunities for novel teaching tools. We set out to develop a library of 3D models of normal anatomy and pathologic states for use in conjunction with an interactive simulated environment and 3D printing for teaching of neurosurgical residents. Methods: Anatomically accurate 3D models were developed using CT/MRI data from multiple patients using open source segmentation and 3D animation software. An interactive simulated environment was then created using a 3D game engine and used in conjunction with a virtual/augmented reality system. 3D models were also used to for 3D printing. Results: 3D models and an interactive simulated environment were used in conjunction with various viewing modalities, including 3D video, 360 video, and virtual reality headsets, as well as 3D printing. These teaching tools were successfully implemented in neurosurgery didactic teaching sessions and in the skull base lab. Additional benefits were seen with patient engagement and marketing. Conclusions: 3D modeling and animation show considerable promise for neurosurgical education, with additional benefits for patient engagement, marketing, and social media.

P137: Methods for teaching managerial skills in the emergency department: a survey of Canadian educators

Introduction: Emergency department (ED) crowding and increased patient load has been shown to have an impact on physician decision making and patient mortality. As the volumes in Canadian EDs increase, so does the need to effectively prepare new learners for the challenges ahead. This study aims to determine which level of training varying teaching techniques should be employed to educate Emergency Medicine (EM) residents about ED management and flow in the age of competency based medical education. Methods: We designed a survey that contained a previously derived list of ED flow and management teaching strategies. We piloted and edited the survey based on feedback from operations and educational experts. A total of 21 teaching techniques were included in the final survey ranging from didactic teaching sessions to experiential techniques such as residents running the department with supervision. Then, we invited members of the Royal College of Physicians and Surgeons of Canada EM specialty committee, the Canadian Association of Emergency Physicians Education Scholarship Section, and the Canadian EM Simulation Educators Collaborative to participate in our survey. We analysed the results using simple descriptive statistics. Results: A total of 21 EM (38% female, 62% male) educators from 11 programs (78% of Royal College Training sites) responded to the survey, representing 7/10 provinces, with a mean years-in-practice of 15.2 years (SD 9.7). All respondents were involved in resident education; 66% had a current formal educational role, such as Program Director. Results showed a universal trend towards teaching flow and management skills later in residency. Participants endorsed 35.93% of teaching strategies for the “Core of discipline” and 39.65% for the “Transition to practice” stages of training. Didactic and observational techniques were occasionally considered acceptable at earlier training stages, whereas experiential teaching techniques were skewed towards the later stages of residency. Conclusion: EM educators from across Canada believe that most teaching techniques for flow are better suited for the later stages of residency training, with didactic techniques more suitable earlier on. This work will inform faculty development on managerial/leadership skills teaching in the ED.

The missing piece of the body? Oral health knowledge and confidence of doctors.

Introduction Many patients present to doctors with oral health conditions and it is, therefore, important that they have the knowledge and skills to give advice and signpost appropriately. Aim To ascertain the baseline knowledge and confidence of doctors in managing oral conditions and to identify topic areas for training.Design A baseline survey was conducted. Two training programmes were then delivered based on the finding of this survey, followed by a post-training survey. Setting North West London training programme for foundation year 1 (FY1) doctors and general medical practitioner (GP) trainees. Intervention The FY1 doctors had a didactic teaching session. The GP trainees had a training session combined with foundation dentists (FDs), comprised of a lecture and small, mixed group work.Main outcomes measured i) post-training confidence in managing oral conditions, answering patients' questions regarding oral health and signposting patients; ii) the most useful and relevant topics of the training for their daily practice.Results The majority of the doctors had previously received no oral health teaching. Furthermore, the majority did not feel confident at managing oral conditions or signposting patients appropriately. Common topic areas were identified where doctors wanted more oral health teaching. Conclusions FY1 and GP trainees lack knowledge and confidence with regard to the management of oral health issues and recognise that there is a need to know about oral health. This work highlights the need for structured training to equip doctors with appropriate oral health knowledge and skills.