Faculty Supervision Research Articles

Evaluation of Scientific Rigor of Postgraduate Thesis at a tertiary care teaching hospital in Puducherry

Background: Since 2011, postgraduate training on research methods has been organised every year at the study setting and recently it is updated periodically. The objectives were to find out the scientific rigor of MD/MS thesis, and to find out the effectiveness of postgraduate training program on scientific rigor of MD/MS theses. Materials and Methods: It was an education evaluation based on secondary data, where 78 MD/MS thesis records of postgraduates, submitted to the University during the academic year 2017 and 2018 were reviewed. The Kirkpatrick level III framework of the evaluation was used. Thesis records were reviewed by trained postgraduate under the supervision of faculty from the Department of Community Medicine. The Epicollect-5 mobile application was used to enter the data and analysis was done using SPSS software package (version 24). Results: Most (90%) of the reviewed studies were hospital-based cross-sectional. Over the period of one year, there was an improvement in practices such as mentioning of the objectives as per SMART criteria (90% to 97.4%), reporting the details of sample size calculation (67.5% to 76.3%), data entry (62.5% to 68.4%) and data analysis (80% to 82%), and citing the references without errors (22.6% to 47.4%). Conclusions: Most of the studies were hospital-based cross-sectional studies. Over the period of one year, there was an improvement in some aspects of scientific rigor of MD/MS thesis however; there is scope for further improvement in the postgraduate training program. Keywords – Evaluation, Kirkpatrick, Postgraduate, Scientific rigor, Thesis.

Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders.

The custom-fabricated total contact cast is commonly used in the treatment of diabetic foot disorders. This resource-consuming treatment option has been associated with iatrogenic morbidity as well as the need for urgent cast removal and inspection of the underlying limb when potential problems arise. Over a 10-year period, 381 diabetic patients had 2265 total contact cast applications by certified orthopaedic technologists, in a university orthopaedic practice, under the supervision of university faculty. Patients were stratified by glycemic control based on hemoglobin A1c levels, and obesity based on body mass index (BMI). Complications were grouped as (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change or removal. At least 1 complication was observed in 159 of 381 patients. The odds of experiencing a cast-related event for patients with a BMI greater than 30 kg/m2 was 1.55 times greater than patients with a BMI less than 25 kg/m2. As compared to patients with good glycemic control, the odds of experiencing a cast-associated complication was 1.27 times greater in patients with moderate glycemic control and 1.48 times greater in patients with poor glycemic control. The total contact cast is commonly used in the treatment of diabetic foot morbidity. Treatment-associated morbidity may well be greater than previously appreciated. Complications are more likely in patients who have poor glycemic control and are morbidly obese. This information will hopefully stimulate interest in developing commercially available nonrigid alternatives that retain the attributes of the resource-consuming rigid device, with the potential advantage of avoiding the associated morbidity.Levels of Evidence: Level IV, retrospective chart review.

Development of Ecosystem and Learning Spaces in Effective Implementation of PBL in Vishwaniketan Campus

Vishwaniketan iMEET is an engineering institute where Project Based Learning philosophy has been accepted and different PBL models are designed for various learning objectives. Institute has developed its unique framework for supporting PBL practice, which is named as PBL Ecosystem. This paper shortly describes each PBL practice followed at the institute with more emphasis on describing the Frame work of a PBL Eco-System developed for effective implementation of the Project Based Learning approach. This Eco-system is in place since the last one year and an institute's management was interested to know the effectiveness of this PBL-Eco system to influence student’s learning. Thus, this paper also discuss in brief outcome of survey conducted to check effectiveness of Eco-system for one of the important PBL practice Value Addition PBL (VAPBL). Faculty experience and student’s survey outcomes suggested that for effective implementation of the VAPBL, PBL-ecosystem has played crucial role. Result suggested that continuous support and collaboration with industry trainers helped to students for successful implementation of technology for which ecosystem supports. The survey also suggested that there is a need of improvement in lab infrastructure and faculty supervision.

Implementation and evaluation of a comprehensive proficiency-based curriculum in an advanced, minimally invasive procedure: amulti-institutional Canadian experience.

A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was previously developed and shown to be more educationally effective than conventional surgery training. To implement and evaluate this proficiency-based curriculum in 2 academic general surgery residency programs in Canada. Two academic, general surgery residency programs at university hospitals in Ontario, Canada. An 8-week, proficiency-based curriculum consisted of a didactic component (lectures, small group sessions, assigned readings) and a simulation-based component (proficiency-based training in laparoscopic enteroenterostomy and a simulated operating room crisis scenario). It was offered to postgraduate years 2-5 general surgery residents in 2 academic programs in Canada. Pre- and postcurriculum procedure-specific knowledge and psychomotor skills were assessed using a 25-item knowledge test and a procedure-specific assessment scale. Postcurriculum nontechnical skills were assessed using the Nontechnical Skills for Surgeons scale. Participants' perceptions about the curriculum were assessed using a questionnaire. Direct costs for curriculum implementation were recorded. Twenty-five residents participated in the curriculum across 2 programs. Completion of the curriculum resulted in significant improvement in technical skills (45 [37.5-65] versus 88 [85-93]; P< .01) and demonstration of "acceptable" situational awareness (3 [3-4]), decision-making (3[3-4]), teamwork and communication (3 [2-4]), and leadership (3 [3-4]) skills. There was no improvement in procedure-specific knowledge (48 [40-64] versus 58 [48-60]; P = .39). Participants perceived all components of the curriculum as educationally valuable, and 96% agreed and/or strongly agreed that this curriculum should continue to be a part of academic curriculum. The average cost of curriculum implementation was $613.05 Canadian dollars per participant. Lack of faculty supervision was the main barrier to implementation with only 65% of participants agreeing and/or strongly agreeing that quantity of faculty supervision was optimal. A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was successfully implemented and evaluated at 2 academic general surgery residency programs in Canada. Adequate faculty preceptor resources are essential for widespread implementation.

Utilizing a novel resident education initiative to provide reproductive endocrinology and infertility care for underinsured women

Few reports exist in the literature describing infertility evaluations or care in patients covered by Medicaid, but disparities in access are well documented. The objective of this study was to describe the health care received by a cohort of underinsured women with infertility after implementation of a novel quality improvement project designed to increase access to reproductive endocrinology and infertility (REI) specialists. Retrospective observational study. We created a system for provision of infertility consultations from the REI division at an academic tertiary care institution. The Obstetrics and Gynecology (OB/Gyn) resident clinic at our institution provides care for primarily African American underinsured women. Patients are screened in by Ob/Gyn residents staffing routine gyn clinic when a patient presents with infertility. As part of their REI curriculum, Ob/Gyn residents reviewed patient charts in virtual visits under supervision of REI faculty. Patients were then provided diagnostic guidance, management recommendations and access to cost-saving research programs. Patients receive their individualized recommendations and associated costs to make informed healthcare decisions. Patient charts are maintained on a shared electronic medical record list for ongoing management. Charts from the first year of the service were reviewed for demographic and clinical information. This project was reviewed by the University of Pennsylvania Institutional Review Board and determined to be exempt as a Quality Improvement project. Twenty-eight consultations were performed for underinsured women in the first year of service. Of these patients, 22 patients (78%) had Medicaid insurance. Two patients (7%) were seen in the REI office after initial consultation. Nine (22%) completed bloodwork and 10 patients (35%) underwent pelvic ultrasounds. Six evaluations of fallopian tube patency were completed via either imaging (hysterosalpingogram) or surgery (chromopertubation). Eight patients (28%) initiated ovulation induction. Five patients (17%) achieved pregnancy. Pelvic ultrasounds and blood work were fully covered by all insurance. Though our resident clinic remains unable to provide standard infertility treatments like IUI and IVF to our Medicaid patients, patients were still take advantage of the robust REI division at our institution. Academic institutions may be able to connect uninsured and underinsured patients with advice and diagnostics by utilizing resident educational opportunities to offset a portion of financial barriers.

Mitigating “Educational Groundhog Day” – The Role of Learner Handoffs Within Clinical Rotations: A Survey of Pediatric Educational Leaders

BackgroundMedical students decry frequent changes in faculty supervision, leading to the experience of “educational groundhog day.” The discontinuity in supervision, cursory relationships, and uncoordinated feedback impede students’ skill acquisition and delay entrustment decisions. Whereas patient handoff bundles are common, little is known about similarly structured approaches to learner handoffs (LHs). ObjectiveTo describe current LH procedures and practices within pediatric clerkships and subinternships and to gauge interest in a future LH bundle. MethodsNine items included in the 2016 Council on Medical Student Education in Pediatrics annual member survey were analyzed using mixed-methods. ResultsThe response rates were 66% (101 of 152) and 40% (165 of 411) for institutions and individuals, respectively. After limiting data to complete responses to programs with traditional block rotations, 54% of individual respondents (76 of 141) identified as inpatient faculty and about a quarter endorsed providing LHs. Inpatient faculty most commonly supervise medical students for 5 to 7 days. Most endorsed needing 1 to 3 days to determine a student's baseline performance and 5 days or more to make entrustment decisions. Three-quarters of inpatient faculty endorsed interest in LHs, while fewer than 16% of course directors currently provide LH expectations. Four themes emerged: instrument features, stakeholder buy-in, impact, and utility. ConclusionsTypical inpatient faculty service days approximate the time required for making entrustment decisions about clinical students. While most inpatient faculty desire a LH bundle for use within a clinical rotation, few institutions and faculty currently use LHs. LHs could accelerate entrustment decisions by allowing coordinated feedback that might hasten learner clinical-skill development.

Teaching and learning FNA biopsy: An update for the modern audience

Teaching and learning FNA biopsy: An update for the modern audience

An Interprofessional Geriatric Experiential Learning Experience: Its Impact on Physical and Occupational Therapist Students

Introduction. Accreditation standards for physical therapist (PT) education require the inclusion of interprofessional education (IPE) in order to prepare health care professionals to work in collaborative environments. Additional guidelines document the need to educate PT students in the care of older adults; however, a gap in readiness for entry-level practice exists. Therefore, there were three purposes of this study that were to 1) examine the impact of an IPE experiential learning project on PT and occupational therapist (OT) students' knowledge and attitudes toward each other's professions, 2) examine students' comfort, value, and ability to work with another profession, and 3) assess the project's impact on PT and OT students' attitudes toward older adults. Methods. Physical therapist and OT student groups, under the supervision of faculty, evaluated a community dwelling older adult over 3 visits and developed a comprehensive wellness program, which was provided by the students on visit 4. Students completed 2 surveys: the Interprofessional Socialization and Valuing Scale (ISVS) and Kogan's Attitude Towards Old People Scale (KAOP), prior to and at the conclusion of the project. Results. The Wilcoxon’s signed rank test showed significant increases after the completion of the IPE project in the total ISVS (P &lt; .001) median scale scores for all students and on the subscales regarding the ability (P &lt; .001), value (P &lt; .001), and comfort (P &lt; .001) in working with others. Significant increases were observed for all students on the total KAOP scale scores (P &lt; .001) and the positive subscale scores (P &lt; .001); significant decreases were observed in the negative subscale scores (P &lt; .001). Discussion and Conclusion. This study demonstrates a successful IPE experiential learning project used to enhance PT and OT students' abilities, values, and comfort with collaborative practice and enhancement of PT and OT student groups' attitudes toward older adults.

A Review of Forensic Fellowship Training: Similar Challenges, Diverse Approaches.

As the specialty of forensic psychiatry and the numbers of justice involved individuals with mental illness continue to grow, forensic education is receiving more attention. To add to this discussion, the authors reviewed current training practices in forensic psychiatry fellowship programs. As part of a project funded by the state legislature looking at psychiatry and psychology training, with special focus on state hospital partnerships, the authors interviewed and surveyed forensic psychiatry fellowship program directors and conducted site visits to select programs. Given the mandate, special attention was given to programs with state hospital and psychology training affiliations. The literature and fellowship directors identified several key features and challenges for forensic training programs. Forensic fellowships focused primarily on evaluations and consultations but differed in their offerings related to training in treatment, scholarship, and particular types of evaluations. Common concerns included maintaining adequate funding, variety of training experiences, adequate faculty time, and adequate institutional support. Directors described cultivating institutional support by demonstrating mutual benefit as particularly important for securing resources. Forensic fellowships operational during the 2016-2017 academic year offered a range of forensic training activities, but experienced common challenges such as inadequate funding and faculty supervision. Empirical studies are needed to evaluate the relationship between programmatic offerings, the noted challenges, and acquired competencies.

Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective.

To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran. We communicated with responders using a predetermined questionnaire regarding the national orthopedic training program requirements in each respondent's home country. Specific items of interest included the following: the structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book, whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision, and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by reviewing each country's publicly accessible residency training documents that are available on the web and visiting the official website of the main orthopedic association of each country. The syllabi consist of three elements: clinical knowledge, clinical skills, and professional skills. The skill of today's trainees predicts the quality of future orthopedic surgeons. The European Board of Orthopedics and Traumatology (EBOT) exam throughout the European Union countries should function as the European board examination in orthopedics. We must standardize many educational procedures worldwide in the same way we standardized patient safety. Considering the world's cultural and political diversity, the world is nearly unified in regards to orthopedics. The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety. To achieve this goal, we must access and evaluate more information on the residency programs in different countries and their needs by questioning them regarding what they need and what we can do for them to make a difference.

Cooperative Learning: Experiences of Implementing to an Undergraduate Health Sciences Program

Background: Retinoscopy is one of the important clinical skills an undergraduate optometry student should learn. It requires time, dedication, practice and support to attain an acceptable level of proficiency. We report the process of implementing Cooperative Learning (CL) for Retinoscopy skill training in an Optometry program, focusing the preparation, implementation and our experiences. Methods: Year-2 Optometry students were divided into heterogeneous groups to facilitate formal cooperative learning. Students worked together as cooperative units, regulated their own learning and contributed to the success of the group under faculty supervision. Results: Participants positively responded to the supportive learning environment. Faculty felt the implementation and weekly skills training sessions were less cumbersome though the initial planning and preparation was more. Conclusion: Students and faculty appreciated the promotive learning environment that CL offered to maximize learning Retinoscopy and develop social and communication skills. Keywords: COOPERATIVE LEARNING, GROUP WORK, OPTOMETRY, UNDERGRADUATE STUDENTS

The Role of Manual Dexterity and Cognitive Functioning in Enhancing Resident Operative Autonomy

Autonomy, both operative and nonoperative, is one of the most critical aspects of successful surgical training. Both surgeon and resident share the responsibility of achieving this goal. We hypothesize that operative autonomy is distinct and depends, for the most part, on the resident's manual dexterity, knowledge of, and preparation for the procedure. Over a period of 4 academic years, between July 2014 and June 2018, a total of 958 Global Rating Scale of Operative Performance evaluations were completed by 32 general and subspecialty faculty surgeons for 35 residents. Elective procedures were evaluated, including 165 (17.2%) by postgraduate year (PGY)1 residents, 253 (26.4%) by PGY2, 199 (20.8%) by PGY3, 147 (15.3%) by PGY4, and 194 (20.3%) by PGY5. The procedures evaluated were: 261 (27.2%) hernia repairs; 178 (18.6%) cholecystectomies; 102 (10.6%) colorectal and anal procedures; 73 (7.6%) vascular procedures; 56 (5.8%) thyroid and parathyroidectomies; 39 (4.1%) foregut (esophagus and stomach) procedures; 38 (4%) skin, soft tissue, and breast; 92 (10%) hepatopancreatic; 20 (2.1%) pediatric procedures; and 99 (10.3%) other procedures including amputations, cardiothoracic, and solid organs procedures. Each resident was scored from 1 to 5 (1 lowest, 5 highest) in each of the following categories of Global Rating Scale of Operative Performance: respect for tissue (RT), time and motion (T&M), instrument handling (IH), knowledge of the instrument (KI), flow of operation (FO) and resident's preparation for the procedure (RP). Resident operative autonomy (ROA) was assessed using the Zwisch scale, a 4-point scale describing faculty supervision behaviors associated with different degrees of resident autonomy (1: Show and Tell, 2: Active Help, 3: Passive Help, and 4: Supervision Only). Correlation and ordinal regression analyses were conducted to examine the relationship between ROA and manual dexterity (RT, T&M, IH, and FO), and cognitive functioning (knowledge of instruments and resident preparation). Results indicated a positive correlation between ROA and RT (r = 0.528, p < 0.001), T&M (r = 0.630, p < 0.001), IH (r = 0.597, p < 0.001), KI (r = 0.490, p < 0.001), FO (r = 0.637, p < 0.001), and RP (r = 0.525, p < 0.001). Additionally, there was a weak inverse correlation between ROA and the number of years the surgeon had been in practice (r = -0.127, p = 0.001). The significant predictors of resident autonomy found by the ordinal logistic regression include time and motion (p < 0.001), flow of operation (p < 0.001), and resident's preparation for the procedure (p < 0.001). Resident operative autonomy is a product of shared responsibility between the faculty and resident. However, residents' inherent and/or acquired skills and preparation for the operative procedures play a critical role. Residents should be advised to use available resources such as simulation to augment their skills preoperatively and to enhance their autonomy in the operating room.

Promoting Health Equity Through Purposeful Design and Professionalization of Resident Global Health Electives in Obstetrics and Gynecology

To design an Obstetrics and Gynecology (OBGYN) residency elective in global health that meets ACGME standards and simultaneously promotes health equity. A 4-week elective was established for US residents in a high-volume African district hospital that served as a site for OBGYN rotations for the national internship training program. Clear clinical, operative, and teaching requirements were delineated for US OBGYN residents. Resident formal didactic outputs were incorporated into the intern OBGYN curriculum. The program was evaluated through assessment of resident experience and contribution to local training, as well as assessment of intern competency in OBGYN. Scottish Livingstone Hospital, a public district hospital in Molepolole, Botswana. Second- to fourth-year OBGYN residents from US training programs, working with Batswana medical interns under on-site faculty supervision. From May 2016 to June 2018, 18 residents from 9 US OBGYN residency programs participated in the elective. Under supervision, US residents performed 116 major and 77 minor gynecologic surgeries, and teach-assisted Batswana interns and medical officers in 76 cesarean deliveries. Residents led or contributed significantly to 25 didactic education sessions as part of the formal intern OBGYN curriculum. During this period, 24 Batswana interns rotated through the hospital's department of OBGYN, and all 24 trainees met required OBGYN competencies prior to completing their internship. Matching US resident demand for global health experiences to equitable global health programming while maintaining ACGME training guidelines poses a challenge to OBGYN residency training programs. This elective provides a model OBGYN global health elective that addresses host-identified needs, broadens residents' skills, and meets standards for postgraduate OBGYN training. Purposeful global health electives for US residents embedded in longitudinal programs provide an opportunity for residents to contribute to broader global health efforts that promote health equity.

A qualitative data analysis: family victim advocates in child advocacy centers

ABSTRACTFamily victim advocates in child advocacy centers provide a valuable resource to children and parents involved in child abuse investigations. This work requires that family victim advocates be knowledgeable in such areas as child development, crisis intervention, community resources, family relationships, child welfare and criminal justice systems. Because family victim advocates provide essential services to parents and caregivers, the role requires ongoing training and education to remain current on the ever-changing complexities of working with not only the children and families but also the criminal and child protection systems responsible for investigating these cases. The current study reports the findings from a nationwide survey of family victim advocates employed in child advocacy centers related to their motivation for doing the work as well as their perceptions of their training and potential training needs. A group of doctoral students comprised the research team and worked collaboratively under the supervision of university faculty to conduct the qualitative data analysis. The findings describe the characteristics and motivations of family victim advocates working in child advocacy centers and emphasize the need for more advanced trainings that focus on skill-building and strengths-based practices utilized to support children and parents in child abuse cases.

A human cadaveric model for effective instruction of lateral canthotomy and cantholysis

ABSTRACTPurpose: To evaluate a human cadaveric model in improving knowledge and comfort of ophthalmology residents performing a lateral canthotomy/cantholysis.Methods: A prospective study was conducted in ophthalmology residents, who participated in a workshop including an interactive lecture followed by hands-on training on a human cadaver. The lecture consisted of the indications and techniques of lateral canthotomy/cantholysis, along with video-demonstration of proper technique. Residents practiced the procedure on cadavers under faculty supervision. Knowledge and comfort level of conducting the procedure was assessed pre- and post-workshop.Results: Post-workshop, the residents showed a significant improvement in general knowledge regarding the technique of the procedure. Pre-workshop, the average knowledge score was 9 points out of 18 and this improved post-workshop to 12 points out of 18 (p < 0.0001). Residents showed a significant improvement in comfort levels performing the procedure. Using a Likert scale, the average comfort level of performing the procedure rose from 2.5 (Fair) prior to the workshop to 4 (Very Good) post-workshop (p = <0.01). All participants reported an average score of 4.91 (1 = Strongly Disagree, 5 = Strongly Agree) that the human model workshop was clinically applicable to their training and would impact the quality and safety of patient care.Conclusion: The study demonstrated an increase in knowledge and comfort in performing lateral canthotomy and cantholysis using a cadaver model. With the time-sensitive nature of orbital compartment syndrome, it is imperative that physicians are comfortable in performing this procedure to prevent permanent vision loss.

Impact of a Student-Run Clinic in a Non-Profit Substance Abuse Rehabilitation Facility for Women [32B

INTRODUCTION: Substance abuse is a growing problem among women, and is frequently accompanied by multiple gynecologic concerns. Residential substance abuse rehabilitation facilities offer an opportunity to address those concerns. The purpose of this report is to examine the impact of an all-volunteer, medical student-run clinic with faculty supervision within a non-profit, inner-city women's residential substance abuse rehabilitation facility. METHODS: 625 clients were admitted, regardless of financial status, to a 70-bed residential substance abuse rehabilitation facility between 2016 and mid-2018. Data including Pap smears, Human Papillomavirus (HPV) infection, and sexually transmitted infection testing were analyzed. RESULTS: From January 2016 through August 2018, 175/625 (28.0%) clients accepted Pap testing. 52/175 (29.7%) had an abnormal result, defined as Trichomonas infection, HPV infection, or premalignant or malignant lesion. 240/625 (38.4%) clients accepted Gonorrhea/Chlamydia testing, and 6 were identified as having Gonorrhea or Chlamydia. In 2018 alone, Pap testing identified 7/44 (15.9%) clients as having premalignant or malignant lesions, including one case of squamous cell carcinoma. 9/24 (37.5%) had a high-risk HPV strain. 7/44 (15.9%) had Trichomonas. Clients also received counseling regarding personal health awareness and reduction of high-risk behaviors. CONCLUSION: The use of a student-run clinic to provide gynecologic services within a residential substance abuse rehabilitation facility has a major impact and is cost-efficient. Many clients have no other opportunity to obtain instruction on health awareness and high-risk behavior, as well as diagnosis and treatment of abnormal Pap smears and STIs. This model allows non-profit facilities to provide an otherwise unaffordable level of care.

Facilitating conditions for farmer learning behaviour in the student-to-farmer university outreach

ABSTRACTPurpose: This study elucidates on how faculty supervision support to students during farm placements and other facilitating conditions influence farmer learning in the student-centred university outreach.Methodology/Design/Approach: Cross-sectional data were collected from a sample of 283 farmers who had previously hosted students of Gulu University in the student-to-farmer university outreach. Structural equation modelling was used to analyse how faculty supervision support to students in combination with other facilitating conditions affect the formation of intentions for learning and actual farmer learning behaviour.Findings: Faculty supervision support in the student-to-farmer outreach was found to significantly influence formation of intentions for learning (β = 0.380; t = 5.263; P < .01) and actual farmer learning behaviour (β = 0.182; t = 2.081; P < .05).Practical implications: Faculty supervision support to students is critical to fostering lasting learning relationships in university outreach. Thus, it needs to be a part of the transformation agenda of the higher education sector for improved community linkages and innovation.Theoretical implications: Empirical data obtained from the context of student-centred university outreach is used to extend the model of facilitating conditions.Originality/Value: The study addresses how faculty supervision support together with farmers’ perception of student attitudes and the value of the learning content influence farmers’ learning behaviour during university outreach.

Clinical procedural skills assessment during internship in ophthalmology

Introduction:Directly observed procedural skills (DOPS) is a unique method for assessment since it tests the trainee’s ability to apply his knowledge and skills in performing a particular procedure and provides an assessment of the practical work performed by the trainee on a ‘real’ patient under supervision of an experienced faculty. The study aims to make use of DOPS rating for assessment and further improvement in procedural skills in interns in Ophthalmology rotational posting. Methods: A prospective study was planned and 15 interns on 2 weeks’ rotational posting in the department of Ophthalmology were included by purposive sampling over a duration of 2 months. Four clinical procedural skills were identified and in the second week of posting, the interns were assessed by three DOPS encounters at an interval of 2 days for each clinical skill. The DOPS ratings were analyzed quantitatively using R-statistical software by repeated measure ANOVA and Banfuroni test. Results: A total of 180 DOPS were undertaken for 15 interns in 4 core areas of ophthalmic examination. The mean overall DOPS rating for DOPS-1 was 3.70±0.82, DOPS-2, 3.83±1.82 and DOPS-3, 4.93±1.65; the difference in DOPS rating between the first and second encounter was not statistically significant (p=0.497), between the second and the third and between the first and the third were statistically significant (p=0.000 in both cases) using Banfuroni test. The overall difference was also statistically significant (p=0.000) using repeated measure ANOVA. Both the assessor and intern satisfaction increased significantly from the first to the third DOPS, but not statistically significant between the first and the second and between the second and the third DOPS. Conclusions: We found significant improvement in interns’ clinical skills through repeated DOPS and the method was well accepted by both the students and the faculty. Internship period can be well utilized for improving clinical skills and novel performance assessment methods like DOPS might prove to be highly beneficial in ensuring adequacy of learning during internship and also to assess their readiness for accepting professional responsibilities in future.

Wet Lab-Based Cataract Surgery Training Curriculum for the PGY 2/PGY 3 Ophthalmology Resident.

Studies have shown that structured cataract surgery training curricula are beneficial for resident surgeons-in-training, yet nearly one-third of US training programs do not have one, and public dissemination of said curricula are lacking. We created a microsurgical simulation center and accompanying structured training curriculum. Weekly lectures focused on the steps of cataract surgery, variations on technique, and complications. Each didactic was followed by a 1.5- to 2-hour time block with faculty supervision in the wet lab. Finally, to demonstrate proficiency, residents submitted a recorded video illustrating their competency within 1 week of the lecture. We reviewed videos and provided written feedback via a standardized form. Curriculum effectiveness was evaluated through formative feedback on the course itself and complication rates for resident-performed cataract surgery before and after implementation of the curriculum. The course was implemented in 4 consecutive academic years, allowing time for nine junior residents to participate in the course at least once before operating as a senior. The incidence of posterior capsule tears for senior residents decreased from 3.07% in the 4 years preceding curriculum implementation to 1.13% for the senior residents who completed the course at least once as juniors (p = .0571). Supervised wet lab sessions and submitted videos allowed faculty to identify surgically struggling residents early. Implementation of a cataract surgery training curriculum for junior ophthalmology residents provides a safe and effective environment to practice surgical techniques. Such a curriculum may decrease the complication rates of beginner surgeons.

Use of the Bougie Endotracheal Tube Introducer in Unstable Cervical Spine Airway Management?

To the Editor Holmes et al1 provide a succinct, up-to-date account of airway management techniques in patients with an unstable cervical spine at a busy trauma center. Their results are notable for high first-attempt success rates with both video laryngoscopy (VL) and smaller cohorts of awake fiberoptic bronchoscopy–guided intubation or a combined hybrid technique. Success rates were lower with an asleep fiberoptic bronchoscopy technique and a very small group with traditional direct laryngoscopy. We have increasingly incorporated use of the bougie endotracheal tube introducer in patients undergoing VL or direct laryngoscopy with a cervical collar in place and concern or risk for cervical spine instability. Advantages for increased first-pass success and decreased neck motion have been well described.2,3 One of the authors is currently training flight nurses and emergency paramedic colleagues with a VL-guided + bougie technique for all prehospital intubations with very high first-pass success. Use of the bougie as an aide is not described in the current article, and we were curious whether those data were available and, if so, whether there was any detectable impact on success rates or change in use over time. First attempt on the majority of intubations was either by an anesthesiology resident or certified registered nurse anesthetist under direct faculty supervision. Because all major level 1 trauma academic training institutions balance the need for the education of junior residents, we acknowledge the need to have the most proficient intubator perform the initial attempt in patients at particularly high risk to maximize success. We also wished to know whether the authors were able to detect any signal from the experience of the resident trainee or intubator and first-pass success for the various techniques. Descriptions of current standard clinical techniques from experienced trauma centers are useful for the anesthesiology community, and we commend Holmes et al1 for their addition to the topic. Christopher T. Stephens, MDJohanna B. De Haan, MDSam D. Gumbert, MDEvan G. Pivalizza, MBChB, FFASAUTHealth McGovern Medical SchoolHouston, Texas[email protected]