Different Levels Of Training Research Articles

“It’s not Magic, It’s Intentional Communication”—Using the Primary Palliative Care Communication Toolkit to Teach Communication to Interdisciplinary Learners at Different Levels of Training (FR453)

•Incorporate literature-based fundamental conceptual frameworks in communication into a workable toolkit for “just in time” use, for the right learner at the right time at the right place.•Develop a personalized skill set for Palliative Care teams to recognize teachable moments in everyday care and disseminate timely and concise teaching pearls in communication using the Toolkit.•Identify techniques to incorporate primary palliative care communication instruction to enhance skill sets in non-palliative care trainees and inter-professional learners. Primary palliative care (PPC) instruction is gaining prominence as benefits of early palliative care (PC) become clear, as patients live longer with serious illness, and as hospital systems look to improve the care of medically frail patients. With the growth of academic PC, the opportunity to engage learners of many disciplines and levels of training has expanded. Effective PC is based on excellent communication, which can be challenging to teach, especially in busy clinical practices. We discuss the interdisciplinary PC faculty skills development in utilizing the flexible and adaptable PPC Communication Toolkit. We demonstrate how our current training curriculum for fellows and other learners of various levels and disciplines incorporate this Toolkit to enable learners to build on their personal frame of reference as they see faculty incorporate these principles and techniques into everyday practice. Attendees will apply and practice these core elements, methodologies and techniques to engage both teachers and learners during the session. We will showcase four ways the Toolkit has been adapted and incorporated into communication training at a large academic institution and VA hospital. During a real-time consult PC faculty apply the “catch and release” method to coach learners on non-PC rotations when a PC consult is requested. PC faculty use the Toolkit to teach advance care planning to Nephrology fellows, to structure goals of care discussions with Internal Medicine residents on a geriatrics rotation, and to coach ICU nurse practitioners. The Primary Palliative Care Communication Toolkit is a creative, consistent, and adaptable way to incorporate communication training into the day-to-day care of patients living with serious illness and into the education of learners of different disciplines and levels of training. Participants will find tools and ideas that are easy and fun to use as they teach the next generation of clinicians to care for seriously ill patients.

Perceived vs. actual distractions in the emergency department

IntroductionThe emergency department (ED) has been shown to be an interrupt-driven workplace fraught with potential for distractions and interruptions that increase the potential for medical error. Accuracy of provider perception of these distractions and interruptions has yet to be investigated. MethodsAn observational two-phase study was conducted over a 9-week period in the highest acuity zone of the ED at an urban, academic medical center with about 90,000 visits/year. Phase I, conducted over the initial 5-weeek period, consisted of observers recording the type and frequency of all overhead pages in the ED. In phase II, conducted over the final 4-week period, direct observation of faculty and residents was done to record all individual interruptions for different levels of training. Actual data was compared to provider perceptions, as determined by survey responses. Results2438 overhead pages were recorded and occurred, on average, 23.2 times per shift. The perceived rate of overhead pages was 43.2 per shift. 333 individual interruptions occurred, on average, 4.26 times per shift. The perceived rate was 53.5 per shift. Attending providers perceived a significantly higher number of individual interruptions compared to all resident providers. ConclusionThe perceived amount and rate of distractions and interruptions are significantly higher than the actual amount and rate of distractions and interruptions. Attending physicians both perceive and experience more distractions and interruptions. Further work should be done to evaluate the power of provider perception, and the potential contribution of inaccurate perception to medical error and provider burnout.

Evaluation of accuracy of medical optical navigation system “Neuroplan” for modeling of neurosurgical interventions

This study is devoted to the accuracy of the optic navigation system “Neuroplan”. To assess the complex error of the system, a plastic model of the skull with 8 radiocontrast target points was developed. Twelve neurosurgeons with different levels of training participated in the study. The design of the study provided for each doctor performance of registration in the “Neuroplan” system at various positions of the model with subsequent hit at the target points. To select the optimal method of registration for different patient positions on the operating table, the registration table for anatomical landmarks (from 3 to 7) and on the surface was used. The analysis of the obtained results showed a high accuracy of the optic navigation system “Neuroplan”: in the side position of the scull model the target error averaged 1.57 [1.11; 2.13] mm, in the face down position – 1.69 [1.26; 2.19] mm, which is comparable with the declared accuracy of foreign analogues. When the experiment was repeated, it was shown that the system has high retest reliability.

Efficiency Evaluating of Project Training Investing as a Method of Private Investors Involvement

At present, practice-oriented training is taking on particular importance. Innovative projects carried out on the basis of the university with the participation of interdisciplinary project teams can be one of the elements of that kind of training. In order to provide the training of specialists that meet the requirements of international standards, it is necessary to develop mechanisms for attracting non-budgetary sources for investment in the field of education. The main direction of development of the education system in a market economy is the implementation of reforms aimed at overcoming the lack of financing of the higher education system. The participation of private investors will allow diversifying sources of financing in the implementation of practice-oriented project training. The possibility of implementing innovative projects with the participation of specialists from different levels of training and different professional competencies contributes to the creative approach development and problem-solving. In the course of work, participants can increase their professional level and expand the range of their competencies. The possibility of bringing a project to the commercialization stage will allow the project team (with the participation of the university) to create new jobs, integrate financial resources from the project implementation to the development of follow-up projects. Practice-oriented project training is the most important factor in social and economic development and the realization of the country's intellectual potential, determining the qualitative characteristics of labor forces and playing an important role in the development of the economy and society.

As contribuições da educação permanente em saúde no processo de trabalho da estratégia saúde da família

Objective: Identify the contributions of permanent health education to the work process of the family health strategy in a city in South Brazil. Methods: The work is part of a MSc study and used a qualitative approach, with the technique of action research. A total of 33 professionals with different levels of training were included. Data were collected with a self‑administered questionnaire about the educational process and were analyzed by thematic analysis. Results: Three categories of information: contributions of the permanent education in the process of working with users; contributions of the educational actions in the process of work with the team; and in relation to the management. Conclusion: Permanent education is associated to the daily life of workers, helping with the construction of care centered on users and contributing with the improvement of the quality of services. In addition, this study contributed with the implementation of a Municipal Policy of Permanent Health Education.

СИСТЕМА ПІДГОТОВКИ ОФІЦЕРСЬКИХ КАДРІВ У РЕСПУБЛІЦІ БІЛОРУСЬ

Analysis of the foreign experience of the organisation and reformation of the armed forces in other countries, with the respective systems of military education being an integral part, reveals the specific national aspect of such activities in each country. In the meantime, there are some general methodological approaches used in military pedagogic practice across different countries of the world to be practicably considered and applied. The article examines the experience of officers’ training for the armed forces of the Republic of Belarus. The article provides information on the existing network of military educational institutions for the officer training of tactical, operational-tactical and operational-strategic level of military command. Requirements for admission to military educational institutions for the officer training of different levels of training has been given. The terms of military specialists’ training on tactical, operational-tactical and operational-strategic level have been defined. The analysis of the content of officer training for different armed services of the armed forces and different levels of military administration has been conducted. We used the system of the general scientific methods of theoretical and empirical research, in particular, the theoretical-methodological analysis of the problem and the relevant scholarly resources, systematization and generalization of the scientific information pertaining to the essence and content of the set objectives, monitoring of the existing system of military specialists training in the Armed Forces of the republic of Belarus, scientific generalisation, the general scientific methods of logical and comparative analysis, systems approach, peer review, analysis and interpretation of the obtained theoretical and empirical data. An analysis of the concept, structure, goals, content and technologies of officers’ training inthe armed forces of the Republic of Belarus shows that the military education system reflects the current stage of development of the armed forces, as well as the national cultural specificity of the country. Education and training of officers is carried out on the basis of national cultural and military traditions, taking into account the mentality of the Belarusian people. The main direction of officers’ training is their fundamental military and professional training in both the military and civilian fields. First of all, the training of the citizen – patriot of his homeland is carried out. The content of the officers’ training is based on two military education levels. Each level of military education ends with a certain level of qualification. It is possible to distinguish the general tendencies of development of the higher Belarusian military school: improvement of the quality of applicants’ selection, individualization of training of cadets and trainees, stabilization of their number at the present level; further informatization of the educational process, introduction of multimedia learning tools. The reform of higher military education in Belarus continues in line with pan-European development. However, it does not embark on the path of simply copying military educational models of other countries, but takes into account the experience, traditions of the military school, national peculiarities of formation and development of national armed forces. Certainly, the positive elements of the experience of the Belarusian army can be used in the training of officers in the Ukrainian Armed Forces under the conditions of gradual transition to the recruitment on a contract basis.

APPLICATION OF GENETIC PROGRAMMING TOOLS AS A MEANS OF SOLVING OPTIMIZATION PROBLEMS

Purpose. The article is devoted to the problem of practical application of genetic programming tools as a means of solving optimization problems and the use of genetic programming in various fields of activity. It is established that the evolution of genetic programming is directly related to the development of the genetic algorithm, it is also determined that with the passage of time a significant improvement in genetic programming has occurred. Since the advent of the genetic algorithm, many modifications and software implementations have appeared. This in turn led to the implementation of the genetic algorithm toolkit in software products, namely: specialized software, applications for mathematical and analytical packages, frameworks and libraries. The article reveals the significant impact of genetic programming in the areas of: quantum computing, electrical circuit design, etc. Not only advantages, but also disadvantages are considered, attention is also paid to methods of eliminating deficiencies by improving optimization methods and applying a genetic algorithm. Results. The analysis of the main directions of the practical use of genetic programming is carried out and tasks that can be effectively solved using this toolkit are outlined. Scientific novelty. It was determined that the improvement of optimization methods and the expansion of the use of genetic algorithms, stimulates the appearance of such software products on the market, simplifies the structure of software tools, designs the interface for working with a specific commercial user community, simplifies the command language, which allows the use of genetic programming tools circle of users with different levels of training.

Finding the Gaps: Perceived and Unperceived Needs in Malignant Hematology Training in Canadian Hematology Residents

BackgroundMalignant Hematology is in a new era of exciting novel treatment regimens and modalities, including CAR-T (Chimeric Antigen Receptor T-cells) and BiTE (Bi-specific T-cell Engaging) antibodies. Current trainees require an ever-increasing knowledge and skillset to deliver high quality care to more complex patients. There is limited evidence on the educational needs of hematology residents with these emerging complexities. Moreover, these educational needs themselves are poorly-defined. As a first step, we sought to perform a detailed needs assessment to identify knowledge gaps in our learners. It is our intention to use this information to aid in developing a curriculum incorporating these novel elements.MethodsEvery year Hematology residents in Canada (Post Graduate Year [PGY] 4 and above) attend the National Hematology Retreat in Toronto, Ontario for a weekend of educational activities, which also serves as preparation for the Royal College of Physicians and Surgeons Hematology certification exam. This past year, residents were invited to participate in a questionnaire to identify perceived and unperceived needs. They were asked to select topics of perceived needs from a pre-selected list. This was followed by a knowledge assessment using case-based questions in leukemia, myeloma, lymphoma, and Blood and Marrow Transplantation [BMT]. The study is approved by the University of Toronto Research Ethics Board. Data were analyzed descriptively as needed. Mean total scores from the case-based questions were compared between post-graduate years using one way ANOVA. All statistical calculations were performed using SPSS version 24.Results35 of 70 Canadian Hematology residents attending the retreat responded to our survey. Among the respondents, seven were PGY-4, nine were PGY-5, and 19 were PGY-6.Of our pre-selected topics list, residents perceived the most common knowledge gaps existed in management of BMT complications, followed by molecular testing (especially genomics), and novel immune and cellular therapies. The top choices differed in the PGY-4 year (BMT complications, novel immune and cellular therapies and emergency AML complications, Figure 1).Among the respondents answering case-based questions, there was a significant difference in mean scores with increasing length of training (PGY-4: 53%, PGY-5: 70%, PGY-6: 79%, p=0.009). There was a knowledge gap in BMT among all levels of residents, which correlated with their perceived knowledge gaps. However, a majority of them correctly answered the questions on molecular testing and novel immune and cellular therapies.ConclusionsNeeds assessments are useful in assessing background knowledge and identifying perceived and unperceived needs of trainees. These can be used towards creating a resource that accounts for learning priorities. Our needs assessment of hematology residents across Canada demonstrated that:•Knowledge gaps exist among residents at different levels of training, particularly in BMT, compared to other areas of Malignant Hematology. Moreover, this was perceived by residents themselves.•Learning priorities of residents may change over the course of their training.•Educational curricula should incorporate recent advances in hematology (molecular testing and novel immune and cellular therapies); however more emphasis should also be placed on BMT in general. DisclosuresNo relevant conflicts of interest to declare.

High Fidelity Microsurgical Simulation: The Thiel Model and Evaluation Instrument.

The Thiel embalmment method has recently been used in a number of medical simulation fields. The authors investigate the use of Thiel vessels as a high fidelity model for microvascular simulation and propose a new checklist-based evaluation instrument for microsurgical training. Thirteen residents and 2 attending microsurgeons performed video recorded microvascular anastomoses on Thiel embalmed arteries that were evaluated using a new evaluation instrument (Microvascular Evaluation Scale) by 4 fellowship trained microsurgeons. The internal validity was assessed using the Cronbach coefficient. The external validity was verified using regression models. The reliability assessment revealed an excellent intra-class correlation of 0.89. When comparing scores obtained by participants from different levels of training, attending surgeons and senior residents (Post Graduate Year [PGY] 4-5) scored significantly better than junior residents (PGY 1-3). The difference between senior residents and attending surgeons was not significant. When considering microsurgical experience, the differences were significant between the advanced group and the minimal and moderate experience groups. The differences between minimal and moderate experience groups were not significant. Based on the data obtained, a score of 8 would translate into a level of microsurgical competence appropriate for clinical microsurgery. Thiel cadaveric vessels are a high fidelity model for microsurgical simulation. Excellent internal and external validity measures were obtained using the Microvascular Evaluation Scale (MVES).

Differences in expectations of passing standards in communication skills for pre-clinical and clinical medical students

ObjectiveCommunication and interpersonal skills (CIS) are essential elements of competency-based education. We examined defensible CIS passing levels for medical students completing basic sciences (second-year students) and clinical training (fourth-year students), using five standard setting methods. MethodsA 14-item CIS scale was used. Data from second-year (n = 190) and fourth-year (n = 170) students were analyzed using descriptive statistics and generalizability studies. Fifteen judges defined borderline CIS performance. Cut scores and fail rates from five standard setting methods (Angoff, Borderline-Group, Borderline-Regression, Contrasting-Groups, and Normative methods) were examined. ResultsCIS performance was similar during second-year (Mean = 74%, SD = 6%) and fourth-year (Mean = 72%, SD = 5%) students. Judges using the Angoff method expected greater competence at the fourth-year level, as reflected in the Angoff cut scores (second-year = 53% with 0% fail, fourth-year = 66% with 10% fail). Cut scores from the remaining methods did not differentiate between training levels. We found evidence of case specificity. ConclusionPerformance on CIS may be case specific. Passing standards for communication skills may require employing approaches such as the Angoff method that are sensitive to expectations of learner performance for different levels of training, competencies, and milestone levels. Practice implicationsInstitutions that want to encourage continued growth in CIS should apply appropriate standard setting methods.

Focused Cardiac Ultrasound by Nurses in Rural Vietnam

Multiple studies investigating the use of focused cardiac ultrasound (FCU) in lower and middle-income countries and in medically underserved areas of the United States have demonstrated utility in echocardiographic screening algorithms performed by a variety of operators at different levels of training. No study to date has employed previously untrained nurses in a medically underserved setting to identify older adults with cardiac disorders. The aim of this study was to assess the accuracy of nurse-performed FCU to screen adult subjects at a village health center in Vietnam. Vietnamese nurses (N=8) underwent structured training conducted by sonographers and physicians during an outreach event sponsored by the American Society of Echocardiography Education and Research Foundation. The nurses were trained to detect abnormalities from a single echocardiographic view (parasternal long-axis) with a laptop-sized device and underwent pre- and posttraining testing. Following training, cardiac ultrasound examinations were performed on subjects >50years of age at a village health center. First, the nurses performed focused cardiac ultrasound using two-dimensional and color Doppler imaging in the parasternal long-axis view using the M7 device and recorded their assessments. Two-dimensional color and spectral Doppler echocardiography was thereafter performed using the same machine by a sonographer (n=5) or a Vietnamese echocardiography-trained cardiologist (n=1). Interviews and electrocardiography were performed at the time of FCU. Each nurse improved from pre- to posttraining (average improvement in correct answers, 21%; range, 2%-31%). During the scanning phase, nurses' sensitivity, specificity, and accuracy for identifying subjects with any abnormality were 51.5% (85 of 165), 78.1% (82 of 105) and 61.9%, respectively. There were 60 subjects with significant findings (22.2%); all of these subjects had significant abnormalities visible on parasternal long-axis images. Overall sensitivity, specificity, and accuracy for identifying subjects with major abnormalities were 83.3% (50 of 60), 78.1% (164 of 210), and 78.6%, respectively. Nurse-performed FCU demonstrated much higher sensitivity with lower specificity than electrocardiography alone. The combination of nurse-performed FCU plus ECG identified all of the significant findings on echocardiography and increased accuracy to 91.5%. Nurses with no prior echocardiographic experience and with limited training can identify patients with significant cardiac abnormalities using FCU with acceptable accuracy. Screening strategies involving FCU may play a role in improving access to health care and triage in underserved areas.

Naturopathic medical student empathy and burnout: A preliminary study

BackgroundMany studies have demonstrated empathy decline in medical students over the course of training. Burnout negatively affects academic or professional performance and has been negatively correlated with empathy. Neither empathy nor burnout has been previously studied in naturopathic medical students. ObjectiveThe aims of this cross-sectional study were to (1) compare empathy at different levels of training, (2) describe the prevalence of burnout, and (3) identify correlations between empathy and burnout, in naturopathic medical students. MethodsThis cross-sectional study used the Interpersonal Reactivity Index and Maslach Burnout Inventory to measure empathy and burnout, respectively, in an online survey of current naturopathic medical students at one institution. Results1) There was no significant difference in empathy between any cohorts or between those in internship versus those not in internship. 2) Among burnout outcomes, 42% of participants met criteria for emotional exhaustion, 19% for depersonalization, and 64% for low sense of personal accomplishment. 3) Cognitive empathy was positively correlated with affective empathy and a higher sense of personal accomplishment and negatively correlated with emotional exhaustion and depersonalization. ConclusionsWhile a longitudinal study would provide more definitive evidence, this study suggests that empathy in naturopathic medical students is relatively stable over the course of training. It also demonstrates that burnout is prevalent in this population and has an inverse relationship with empathy. Interventions to prevent burnout and increase empathy are discussed.

Therapeutic Patient Education training for nursing students: A case study.

Many educational institutions offer professionals continuing education in therapeutic patient education (TPE). Some also provide it for students in initial training. 1) Describe the methods of implementing the training in two nurse training institutes (IFSI); 2) Determine the conditions conducive to the development of competencies for students in initial training. Nineteen semi-structured interviews were conducted with trainers, external speakers, students in training, and registered nurses. A questionnaire sent to trainers and external speakers was used to supplement the information gathered. All stakeholders had different levels of training and had experience in TPE. Multiprofessionality in teaching was favored. Several pedagogical activities were proposed to make up for the lack of experience of the students and the shortage of internships, among them role-playing, exchanges of practices, and creation of tools. The training was evaluated in terms of satisfaction and acquisition. The training courses implemented largely follow the quality criteria described in the literature. This type of training could be replicated with other students in initial training, or even interprofessional training. The effects of this training should be assessed.

Does the META score evaluating osteoporotic and metastatic vertebral fractures have enough agreement to be used by orthopaedic surgeons with different levels of training?

Differentiating osteoporotic vertebral fractures (OVF) from metastatic vertebral fractures (MVF) is difficult. A magnetic resonance imaging (MRI)-based score (META score) aiming to differentiate OVF and MVF was recently published; however, an independent agreement assessment is required before the score is used. We performed such independent agreement evaluation, including raters with different levels of training. Sixty-four patients with confirmed OVF or MVF were evaluated by six raters (three spine surgeons and three orthopaedic residents) using the META score. We used the intra-class correlation coefficient (ICC) to evaluate inter- and intra-observer agreement and the kappa statistic (κ) to determine the agreement for individual score criteria. We calculated the area under the receiver-operating characteristic curve (AUC) to establish the score accuracy. The inter-observer agreement was poor [ICC = 0.22 (0.12-0.33)]; spine surgeons [ICC = 0.75 (0.66-0.83)] had better agreement than that of residents [ICC = 0.06 (- 0.07 to 0.23)]. The intra-observer agreement was poor [ICC = 0.15 (- 0.04 to 0.30)]; both spine surgeons [ICC = 0.21 (0.05-0.41)] and residents exhibited poor agreement [ICC = - 0.06 (- 0.40 to 0.20)]. The agreement for each specific criterion varied from κ = 0.24 to κ = 0.38. The AUC was 0.57 (0.64 for spine surgeons and 0.51 for residents, p < 0.01). The inter-observer agreement using the META score was adequate for spine surgeons but not for residents; the intra-observer agreement was poor. These results do not support the standard use of the META score to differentiate OVF and MVF. These slides can be retrieved under Electronic Supplementary Material.

Impact of good practices of handling training on beef cattle welfare and stockpeople attitudes and behaviors

The aims of this study were to evaluate the potential impacts of training in good practices of cattle handling on stockpeople's attitudes and behavior, and on cattle welfare, in Brazilian beef farms. Additionally, we aimed to investigate whether the quality of cattle handling deteriorates as the working day progresses. The study was conducted on 24 commercial beef cattle farms (located in Northeastern Pará State, Brazil), which were classified into three groups with different levels of training: Regularly trained (TRAINED-R, n = 9), Occasionally trained (TRAINED-O, n = 9) and Never trained (NON-TRAINED, n = 6). A total of 150 stockpeople working on these farms were categorized according to the level of training received: i) Trained (TS, n = 43), those who attended formal handling skills training; ii) Non-trained, but had close contact with a trained stockperson (CTS, n = 62), and iii) Non-trained, and had no contact with a trained stockperson (NT, n = 45). On each farm, indicators of quality of handling (including animal and stockpeople behavior, and stockpeople attitudes) were measured on one workday, during the vaccination handling procedures of approximately 236 ± 65 (mean ± SD) heads of cattle per farm. We observed that NON-TRAINED farms had the poorest quality of handling, as well as more undesirable animal behaviors during handling (P < 0.05), when compared with the other farm categories (TRAINED-R, TRAINED-O). Stockpeople attitudes and behaviors varied according to their degree of training in good practices of beef cattle handling (P < 0.05). People who participated in a formal training course (TS) had the highest positive and the lowest negative behavior and attitude scores, compared with people in the other groups (CTS and NT). We observed an effect of the progression of the workday (P < 0.05) only on NON-TRAINED farms, where handling became worse over time. Our results support the hypothesis that training stockpeople in good cattle handling practices leads to better attitudes and behavior toward cattle. Thus, training stockpeople can be an effective and practical strategy to promote positive human-animal interactions on beef cattle farms, improving the quality of life of both animals and workers.

THE IMPROVEMENT OF PROFESSIONAL TRAINING ORGANIZATION OF THE X-RAY SCREENING SYSTEMS OPERATORS BY USING THE EYE MOVEMENTS REGISTRATION SYSTEM AND METHODS OF CLUSTER AND DISCRIMINANT ANALYSIS

The X-ray screening systems operators’ professional training is based on the CBT (computer-based training) principle, which has algorithms of adaptive training. These algorithms in existing computer simulators include feedback mechanisms on the basis of trainability exponents – such as the frequency of detecting dangerous objects, the frequency of false alarms and detection time. Further enhancement of the operators’ simulator training effectiveness is associated with the integration of psychophysiological mechanisms providing monitoring of their functional state. Based on the analysis of the particularities of x-ray screening systems operators’ professional training associated with the formation of competences in dangerous objects visual search, the most perspective method is the Eye tracking technology. Domestic and foreign studies of the eye movements characteristics while solving professional tasks in training process are actively developed in various areas. There are no studies of visual search peculiarities in domestic practice in contrast to exterior studies. This research is aimed at considering the usage of Eye tracking technology in the training of x-ray screening systems operators. As the result of the experimental research with the use of mobile eye-tracker Sensomotoric Instruments Eye Tracking Glasses 2.0 the statistical data of eye movement parameters of two groups of subjects with different levels of training have been received. The application of cluster and discriminant analyses methods allowed to identify General classes of these parameters, as well as to obtain the discriminants functions for each group under examination. The theoretical significance of the peculiarities of the operators’ eye movement studies is to identify the patterns of prohibited items visual search. The practical importance of implementation of Eye tracking technology and statistical analysis methods is to increase the reliability of assessment the level of formed competence of x-ray screening systems’ operators in visual search, as well as to develop the potential system of operators’ state monitoring and assessing their visual fatigue.

Validating the ‘laryngeal handshake’: a prospective observational study

Palpation of the airway structures results in misidentification of the cricothyroid membrane (CTM) in a high proportion of patients.1 The ‘laryngeal handshake’ is advocated by the Difficult Airway Society (DAS) as the method of identifying the CTM in the event of cricothyroidotomy.2,3 This is not yet validated in the literature. We sought to investigate the accuracy of this technique in a female population. We recruited 45 female patients attending for routine gynaecological surgery. Five clinicians at different levels of training performed nine individual patient assessments each. In a simulated ‘cannot intubate and cannot oxygenate’ scenario, the CTM was identified using the laryngeal handshake technique (Group L) with the patient in the head extended position under general anaesthesia. We measured and analysed the distance to actual CTM using ultrasound, the time to identification, and perceived difficulty using a visual analogue scale (VAS). We compared these data to conventional palpation technique by the same physicians in a group of 45 controls (Group P). Successful identification of the CTM occurred in 28/45 patients in Group L vs 15/45 in Group P (P<0.01). Distance to the CTM (P<0.01) and VAS (P<0.01) were significantly reduced in Group L. Mean time to CTM identification was longer in Group L at 31 (SD 5.6) sec, compared to Group P which took 18 (SD 5.5) sec (P<0.01). 39/45 of Group L assessments were deemed to be within the midline vs. 28/45 in Group P (P<0.01). The laryngeal handshake method of palpation is an easily learned technique that provides a more robust tactile appreciation of the underlying cartilaginous structures vs conventional palpation. A high degree of reliability in accurately determining the midline using this method allows greater confidence in utilising the vertical incision currently recommended by DAS if no membrane can be identified. 1.Campbell M, Shanahan H, Ash S, Royds J, Husarova V, McCaul C. BMC Anesthesiol 2014; 2214: 1082.Levitan RM. Cricothyrotomy|Airway Cam—airway management education and training. Available from http://www.airwaycam.com/cricothyrotomy (accessed 30 October 2017)3.Frerk C, Mitchell VS, McNarry AF, et al. Br J Anaesth 2015; 115: 827–48

The effect of residency training on arthroscopic knot tying and knot stability: which knot is best tied by Orthopaedic surgery residents?

BackgroundThe aim of this study is to evaluate which of three arthroscopic knots are most reliably taught to and executed by residents at varying levels of training.MethodsThree arthroscopic knots, the Samsung Medical Center (SMC), the Weston, and the surgeon’s knot, were taught to 16 orthopaedic surgery residents. Each knot was tied in triplicate at two sessions 1 week apart. The knots were then biomechanically tested for strength. Corresponding knots tied by a sports medicine fellow served as the respective controls.ResultsComparing all knots regardless of year of training, the SMC knot failed at significantly higher loads (237.2 ± 66.6 N) than the surgeon’s knot (203.7 ± 45.3 N, p = 0.049) and the Weston knot (193.5 ± 56.1 N, p = 0.013). No significant differences in knot strength were found when comparing knots tied by residents at different levels of training and when comparing residents to the sports medicine fellow. There was no difference in conditioning elongation between surgeon’s (p = 0.343), Weston (p = 0.486), or SMC knots (p = 0.200) tied by post-graduate year one and five residents.ConclusionsWe report the first study that evaluates the loop strength of an arthroscopically tied knot performed by orthopaedic surgery residents in various levels of training. In our cohort, the SMC knot required a higher load to failure, when compared to the Surgeon’s and Weston knot, after a simple arthroscopic knot tying curriculum. Based on these findings, he SMC knot should be considered as a part of future orthopaedic surgery resident arthroscopic training programs.

Accuracy in Screw Selection in a Cadaveric, Small-Bone Fracture Model.

Using a cadaveric model simulating clinical situations experienced during open reduction and internal fixation of proximal phalangeal fractures, the aim of this study was to evaluate the relationship between level of training and the rates of short, long, and ideal screw length selection based on depth gauge use without fluoroscopy assistance. A dorsal approach to the proximal phalanx was performed on the index, middle, and ring fingers of 4 cadaveric specimens, and 3 drill holes were placed in each phalanx. Volunteers at different levels of training then measured the drill holes with a depth gauge and selected appropriate screw sizes. The rates of short, long, and ideal screw selection were compared between groups based on level of training. Ideal screws were defined as a screw that reached the volar cortex but did not protrude more than 1 mm beyond it. Eighteen participants including 3 hand fellowship-trained attending physicians participated for a total of 648 selected screws. The overall rate of ideal screw selection was lower than expected at 49.2%. There was not a statistically significant relationship between rate of ideal screw selection and higher levels of training. Attending surgeons were less likely to place short screws and screws protruding 2 mm or more beyond the volar cortex CONCLUSIONS: Overall, the rate of ideal screw selection was lower than expected. The most experienced surgeons were less likely to place short and excessively long screws. Based on the low rate of ideal screws, the authors recommend against overreliance on depth gauging alone when placing screws during surgery. The low-rate ideal screw length selection highlights the potential for future research and development of more accurate technologies to be used in screw selection.

Identifying developmental features in students’ clinical reasoning to inform teaching*

Background: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the “whole – case” format and the “serial cue” approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them.Methods: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this.Results: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it.Conclusions: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the “serial cue” approach of teaching clinical reasoning.