Formal Teaching Sessions Research Articles

An audit cycle of consent form completion to improve training and service standards in a regional hand centre

An audit cycle of consent form completion to improve training and service standards in a regional hand centre

Are psychiatrists trained to be leaders in mental health? A survey of early career psychiatrists.

The aim of this study was to investigate how early career psychiatrists in 2014 valued the leadership skill education in their training to become psychiatrists. All psychiatrists who gained Fellowship since 2009 after training in New Zealand or Australia were invited to take part in a survey. Respondents considered themselves not adequately prepared for the leadership, management and administrative tasks and roles they have as psychiatrists, with preparedness for management tasks scoring the lowest. They valued as most useful to have opportunity to practice with a leadership role, to be able to observe 'leaders at work', to have a supervisor with special interests and skills in leadership and management and to have a formal teaching program on leadership and management. They advised teaching to be given throughout the entire 5 years of the training program by experienced leaders. Leadership skills training in the education of psychiatrists should contain both practical experience with leadership and management roles and formal teaching sessions on leadership and management skills development. Suggestions for improvement of the leadership and management skills education in the training of psychiatrists have been formulated.

Difficult Conversations: A National Course for Neurosurgery Residents in Physician-Patient Communication

To describe the design, content, implementation, and evaluation of a national curriculum for teaching practical skills in empathic communication to residents in neurosurgery. Based on needs assessed through a national survey of neurosurgery program directors, videotaped scenarios using standardized patients illustrating good and bad communication skills were developed. Presurveys and postsurveys were conducted querying participants on their level of competence and the specific behaviors they would attempt to change following participation. A subgroup of residents was evaluated before and after the training based on videotaped role-play exercises. A pilot study was conducted at the authors' institution and later implemented at National Neurosurgery Boot Camps. A total of 14 Duke graduate medical education neurosurgery residents agreed to participate in the pilot study. From across the country, 93 residents (representing 59 institutions) participated in the communication training as part of the Neurosurgery Boot camps, 11 of whom volunteered to participate in a role-playing session before and after the formal teaching session. Most of the neurosurgery program directors responding to the survey indicated that an interactive online communication-training module would be of value (77%). A total of 93 residents participated in communication training as part of the Neurosurgery Boot Camps. Approximately half of the residents reported having no formal physician-patient communication training. Presurvey and postsurvey results showed significant improvement in several of the communication scenarios. Those who participated in role-play showed significant improvement in "asking open-ended questions," "listening," "fire warning shot," "allowing patient to absorb," and "explaining in clear language." Neurosurgeons frequently participate in difficult conversations. Both residents and faculty note that exposure to this content is suboptimal. A hybrid approach to teaching communication skills is well received and enhances graduate medical education training of surgical subspecialists.

Implementation of an Intensive Care Unit Delirium Protocol: An Interdisciplinary Quality Improvement Project.

Delirium is a commonly observed problem for adult patients in the intensive care unit (ICU) that is associated with increased mortality, increased hospital length of stay, and long-term disability of ICU survivors. This makes prevention and prompt treatment of delirium imperative goals for critical-care providers. Bedside critical-care nurses are uniquely poised to champion efforts to prevent, detect, and treat delirium but oftentimes are not aware of the most recent evidence-based guidelines or the potential long-term implications for the ICU survivor. Nurses have reported higher levels of confidence in detecting delirium, increased knowledge of delirium, and enhancement of patient care skills after receiving formal didactic educational training. The objectives of this quality improvement project were to develop, implement, and evaluate a nursing education program for critical-care nurses that presented a protocol for the prevention and management of delirium in adult ICU patient populations, as well as improve nurses' familiarity, comfort, and compliance with using a standardized evaluation method for delirium and intervention care bundle. A didactic training program for bedside critical-care nurses was developed and implemented. Upon completion of the educational sessions, a daily bedside delirium screening and care bundle protocol were implemented for all patients in ICUs throughout the facility. Bedside critical-care nurses were invited to participate in the formal teaching sessions. This included nursing staff from each of the 3 ICUs in this facility, as well as supplemental "float pool" staff. Pre-educational and posteducational nursing attitudes and self-perceived confidence levels regarding delirium care were measured using a 5-point Likert scale. Pre-educational and posteducational nursing knowledge was measured using raw scores obtained from a 15-item multiple choice test. Following the implementation of the delirium screening and care bundle protocol, nursing staff compliance with screening and care bundle items was measured, as well as overall incidence of positive delirium screenings among all screenings completed. A sample of 49 nurses participated in the formal educational teaching sessions. All 5 nursing attitude and perceived confidence statements measured before and after the educational sessions showed a significant increase in positive perceptions overall (P < .0001). Overall mean posteducation knowledge test raw scores showed a significant improvement from pre-educational scores (70% ± 12.8% vs 95% ± 6.9%; P < .0001). Once-daily ICU delirium screenings and care bundle interventions were initiated for all ICU patients; overall compliance during the measurement period was 56.3% (598 of 1061 possible delirium screenings and protocols completed). Of all daily patient screenings performed, 20.4% resulted positive for ICU delirium. All patients who received the care bundle interventions received the interventions uniformly, regardless of clinical delirium status. This quality improvement project demonstrates that a formal didactic training program for ICU nurses can result in increased awareness and knowledge of ICU delirium and adequately prepare them for how to properly screen and treat patients. Although overall compliance with implementing daily ICU delirium screenings and care bundle interventions was relatively low, those patients who did receive screening and interventions demonstrated that the incidence of positive delirium screenings at this facility is low compared with reported figures. In addition, patients who did receive the appropriate care bundle interventions did so in a uniform manner, regardless of the presence or absence of clinical delirium.

Determination of University Students’ Misconceptions about Light Using Concept Maps

The concept map has evolved, in recent years, as an important teaching and learning tool. It engages students in active learning and assists instructors with their delivery. Thus, we believe that it has the power to be relevant and effective to reflect the design of a poly-functional teaching tool. We argue in favor of renewing didactic tools used in education, in general, and in teaching GO (geometric optics) in particular. The main purpose of this study, however, is to show that the concept mapping is a very effective way in terms of revealing the misconceptions of students, studying GO, during their university year. 52 freshman students (first year) majoring in life science and nature (LSN) were asked to draw a conceptual map about propagation of light; a two-stage experiment: before and after formal teaching sessions. The findings of the qualitative analysis of the students’ maps are in line with the results of other research; students have many misconceptions about light and traditional strategy used for teaching GO is not effective for conceptual change. Also, The approach of scoring tasks, as only one survey is not recommended.

Inclusion of Otolaryngology in Medical Student Education: A National Survey

Objectives: Otolaryngology-related conditions make up 25% of primary care complaints; however, US medical schools do not routinely require otolaryngology instruction, potentially negatively impacting knowledge, attitudes, and medical student career choices. This survey was intended to (1) determine the extent of clinical and pre-clinical otolaryngology education at Accreditation Council for Graduate Medical Education institutions, and (2) focus future educational efforts. Methods: A prospective online survey was sent from the Education Steering Committee of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) to all Accreditation Council for Graduate Medical Education (ACGME) otolaryngology training programs. Results: Forty percent (42/105) of program directors responded. They reported that medical students could graduate without any clinical instruction in otolaryngology in 85% (34/40) or any formal otolaryngology instruction in 59% (24/41). An otolaryngology rotation was required in only 5% (2/41) of programs. Increased exposure to otolaryngology was noted in 44% (18/41) while decreased exposure was seen in only 22% (9/41). Otolaryngologists provided formal teaching sessions for less than 8 hours over 4 years of medical school in 90% (26/29) of programs. When asked about instruction in specific topic areas, respondents did not know if topics were covered in 19-37% (8-15/42), regardless of topic. Conclusions: Otolaryngology-provided education is extremely limited in ACGME medical student education despite its importance in patient care. We suggest that the lack of otolaryngology integration in the medical student curriculum should be the focus of future educational efforts, including a national medical student curriculum.

Endoscopic approaches to enteral feeding and nutrition core curriculum

Endoscopic approaches to enteral feeding and nutrition core curriculum

Survey of core medical trainees in the United Kingdom 2013 – inconsistencies in training experience and competing with service demands

There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.

Surgical residents' perceptions of patient safety climate in Dutch teaching hospitals

Explicit attention to patient safety during surgical training is needed to improve patient safety. A positive safety climate is associated with greater patient safety and is a requisite for safety teaching at the workplace. The Safety Climate Survey (SCS) measures perceptions of safety climate. This study aims to take a first step in validating the SCS for use among surgical residents in the Netherlands and to highlight opportunities for safety climate improvement through changes in surgical training in the Netherlands. It therefore assesses (1) if the SCS can be used to assess surgical residents' perceptions of the safety climate in Dutch teaching hospitals; and (2) how, according to SCS results, these residents perceive the safety climate in Dutch teaching hospitals. In a cross-sectional study conducted in February 2011, a Dutch translation of the SCS was administered to all general surgical residents in the Netherlands. Face validity and internal consistency were assessed, as were overall mean, means per item and significant differences in means between different groups of respondents. In total, 306 of 390 (78%) residents completed the questionnaire. The SCS showed good face validity and internal consistency (Cronbach's alpha = 0.87). Residents reported an overall mean of 3.95 (standard deviation 0.51) out of a maximum score of 5.00, and 52% reported an overall mean of 4.00 or higher. Women and residents working in university hospitals gave significantly lower scores. Significant differences were also found among hospitals and among regions. Majority of the items scored less than 4.00. The SCS is potentially useful to measure surgical residents' perceptions of the patient safety climate in Dutch teaching hospitals. There is considerable room for improvement of the patient safety climate. Surgical training should include better feedback, formal patient safety teaching sessions at the workplace and specific attention to patient safety during the introduction in a new hospital, and supervisors should encourage surgical residents to report any patient safety concern they may have.

PTU-013 The Impact of Education on Fluid Prescribing amongst Junior Doctors: Abstract PTU-013 Table 1

Introduction Gastroenterology patients frequently require intravenous fluids but inappropriate prescription is associated with poorer outcomes (1). Educational initiatives can improve fluid prescription (2) and this study examines knowledge of electrolyte requirements and post-operative fluid prescription amongst final year medical students and junior doctors, ten years on from the paper by Lobo et al (3). Methods 56 junior doctors and final year medical students in a large UK teaching hospital answered a questionnaire on fluid prescribing practise before attending a formal teaching session on the topic where they also received a pocket handbook on Trust prescribing guidelines. Six months later they were asked to repeat the questionnaire. There were 36 respondents after the teaching session. Results Prior to the teaching 25% did not feel confident with fluid prescribing and 34% felt they had unsatisfactory or poor teaching at medical school. 18% stated that fluid balance charts were not checked regularly. Only 10% of respondents were aware of the sodium content of normal saline and 9% would prescribe two or more litres of normal saline per day in a post-operative patient. After the teaching session 94% felt confident with fluid prescribing and 64% knew the sodium content of normal saline. 5% would prescribe two or more litres of normal saline per day in a post-operative patient. Conclusion Knowledge of electrolyte requirements and fluid prescribing is still inadequate, but a teaching session with a handout significantly improved knowledge and confidence in prescribing. The six months of experience gained in this time may be a confounding factor, but as the questionnaires indicated lack of fluid chart review with seniors or other relevant teaching sessions, their main source of knowledge was postulated to be from our teaching. More attention should be given to this subject in medical schools and guidance should be given at Trust inductions. Disclosure of Interest None Declared References Walsh SR et al. Perioperative fluid management: prospective audit. Int J Clin Pract. 2008 Mar; 62(3):492–7. Epub 2007 May 30. De Silva AN et al. Improving peri-operative fluid management in a large teaching hospital: pragmatic studies on the effects of changing practise. Proceedings of the Nutrition Society 2010; 69: 499–507. Lobo DN et al. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clinical Nutrition 2001; 20(2):125–30.

CORR Insights®: Validity and Reliability of the Paprosky Acetabular Defect Classification

In the article, “Validity and Reliability of the Paprosky Acetabular Defect Classification,” Yu et al. determined the validity, teachability and reliability of a classification system we described for categorizing acetabular defects in revision THA. When we first presented this classification system in the early 1990s, few classified and standardized the reporting on acetabular defects in the literature. Due to limited advancements in imaging at the time, we attempted to create a classification system based on an AP radiograph for wide use by the orthopaedic community. Our classification system was broadly adopted due to the paucity of other classification systems and the ease of using a simple AP radiograph. Although our classification system is still taught in the classroom, it has yet to be validated in the literature. The purpose of the study by Yu et al. was to establish whether the preoperative Paprosky classification, determined by the blinded observers, correlated with intraoperative findings; and whether the reliability of the classification system improved with formal teaching. As observed when we described the classification system in 1994, the severity of the defect as graded radiographically correlates with intraoperative findings. In particular, we emphasized that our classification system was useful in predicting the integrity of major anatomic landmarks, including the teardrop, ischial bone loss, the ilioischial line (Kohler’s line), and the degree of superior migration of the cup. The authors properly presented the key components of our classification system in Table 2. The observers in this article accurately determined the integrity of these major structures using an AP pelvis radiograph, with more severe disruption of the teardrop, the ilioischial line, and superior bone loss correlating with more severe intraoperative bone loss (p < 0.05). The observers in group 1 who underwent formal teaching sessions each 2 week period prior to grading the radiographs, significantly improved their reliability between the first and third grading sessions. The interobserver reliability increased from moderate to good between session 1 and 3. Similarly, the observers who underwent one teaching session improved their reliability from moderate to good. These results suggest that our system is teachable. One criticism is that the intraoperative findings could have been skewed based on the degree of iatrogenic bone loss that occurred during cup removal. Even if this occurred, the classification system was found to be reliable, valid, and teachable, just as we had hoped when we created it nearly 20 years ago. We appreciate the work of Yu et al. in validating our classification system and we hope it has, and will continue helping orthopaedic surgeons accurately report and manage acetabular defects in revision THA.

Graduate orthodontic education in Turkey: the residents' perspective

The aim of the present study was to explore residents' perceptions of their educational and clinical treatment experiences including the number of clinical cases undertaken, patient completion rates, techniques utilised and the scientific component of Turkish graduate orthodontic programmes. Residents recorded in the list of Turkish Orthodontic Society were sent an e-mail to participate in a survey containing 46 multiple-choice questions and ten one-line answers. An e-mail with a personalised online link was sent to a total of 227 residents throughout the Turkey. Data were categorised, and basic statistics including chi-square comparative analyses were performed. A total of 136 (response rate of 59.91%) residents completed the survey. The majority of residents (58.08%) were either 'very satisfied' or 'satisfied' with their programme. Respondents said they have just the right amount of formal didactic teaching sessions or dedicated and protected academic time. Most residents (69.11%) indicated their programme offers training in numerous philosophies; whilst 97.79% said they have sufficient clinically based training and 42.64% said they have sufficient research-based training. Overall, residents in the Turkey are satisfied with their orthodontic programme. They receive comprehensive training with the opportunity to start and complete a significant number of their patients. The survey findings suggest that orthodontic programmes in Turkey are deficient in providing care to underserviced populations and disabled patients. Programmes could improve the opportunity for residents to treat patients requiring interdisciplinary treatment.

Deficiencies in Concussion Education in Canadian Medical Schools

Recent reports raise concern that physician knowledge of the identification and management of concussion may be deficient. There is little information known about the adequacy of concussion education provided to physicians or medical students. The present study assesses the concussion curriculum offered at medical schools in Canada. We asked all 17 Canadian medical schools to complete a questionnaire on their concussion curriculum, including the following: year of medical school offered; format/setting; and estimated teaching hours. The responses were organized into three categories: (1) concussion-specific education; (2) head injury education incorporating a concussion component; and (3) no concussion education. Replies were received from 14 (82%) of the 17 medical schools in Canada. Of the 14 responding schools, four (29%) provided concussion-specific education, six (43%) offered head injury education that incorporated a concussion component, and four (29%) reported no concussion teaching in their curriculum. We found deficiencies in the concussion education curriculum provided in the majority of Canadian medical schools. To address this issue, we recommend that all medical schools should, at a minimum, include a one-hour formal concussion-specific teaching session in an early year of their curriculum to be followed by clinical exposure to concussed patients in the later years of medical school. Future studies will be necessary to evaluate if these recommended curricular enhancements are effective in remedying the reported gaps in physicians' concussion knowledge and whether the improved curriculum translates into better care for patients suffering concussion.

One-dimensional learning: detrimental to the Situational Judgement Test?

Medical students acquire knowledge, apply theory, and develop skills during their undergraduate training. At medical school, formal teaching sessions tend to focus on the communication between doctor and patient, often with only passing reference to more complex everyday scenarios in which doctors find themselves. There are many situations and diverse interactions demanding effective communication in which the future clinician may be undertrained. These could be with, but are not limited to, members of …

Simulation-guided cardiac auscultation improves medical students’ clinical skills: the Pavia pilot experience

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs.

A Survey of Digital Rectal Examination Training in Canadian Medical Schools

The digital rectal examination (DRE) is important for the diagnosis of a variety of gastrointestinal, urological and gynecological disorders. However, it appears that Canadian medical students may not be adequately taught nor provided the opportunity to practice their skills often enough. The present study was an analysis of the current practices in DRE teaching and evaluation in undergraduate medicine programs across Canada. Clinical skills coordinators from the 14 English-speaking medical schools in Canada were invited to participate in the survey and to respond to questions regarding DRE teaching at their respective schools. Thirteen of the 14 schools (93%) responded to the survey. The DRE is taught in various ways: 69% of schools use anatomical rectal models, 62% use video tutorials and 62% involve physician instruction. Most schools (85%) offer one formal teaching session before clerkship. Generally, there is no formal DRE teaching session during clerkship. Preclerkship students in 62% of the schools perform <=1 DRE during their training, and clinical skills coordinators in 85% of the schools expected that clerkship students perform <=2. The training is evaluated in a variety of ways, with most schools (77%) only requiring mandatory attendance. Although a variety of techniques are used to teach and evaluate DRE training in Canadian medical schools, students are performing very few DREs before graduation. Medical schools should objectively evaluate proficiency to give meaningful feedback and improve competence in their students as well as provide more opportunities for students to obtain the necessary experience performing DREs during their clinical training.

Helping the general physician to improve outcomes after PEG insertion: how we changed our practice

During their careers, most general physicians are involved in the decision-making process for patients that potentially require percutaneous endoscopic gastrostomy (PEG) insertion. However, poor patient selection and less than favourable outcomes are frequently observed in this group. With the aim of identifying and addressing the underlying issues, the PEG service at University Hospital Llandough was radically changed over an eight-year period. The development of a nurse-led pre-assessment service and design of a specific referral form was successful in reducing the number of PEG referrals and consequently the 30-day mortality rate. Furthermore, the educational and training needs of general physicians of all grades regarding the issues surrounding PEG placement were identified and addressed at formal teaching sessions. A combination of these factors has positively impacted on our service, with more appropriate patient selection and a reduced 30-day mortality rate.

Intensive Care Medicine Trainees’ Perception of Professionalism: A Qualitative Study

The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows' views on professionalism is available. A nationwide qualitative study was performed. The moderator asked participants to clarify the terms professionalism and professional behaviour, and to explore the questions "How do you learn the mentioned aspects?" and "What ways of learning do you find useful or superfluous?". Qualitative data analysis software (MAXQDA2007) facilitated analysis using an inductive coding approach. Thirty-five fellows across eight groups participated. The themes most frequently addressed were communication, keeping distance and boundaries, medical knowledge and expertise, respect, teamwork, leadership and organisation and management. Medical knowledge, expertise and technical skills seem to become more tacit when training progresses. Topics can be categorised into themes of workplace-based learning, by gathering practical experience, by following examples and receiving feedback on action, including learning from own and others' mistakes. Formal teaching courses (e.g. communication) and scheduled sessions addressing professionalism aspects were also valued. The emerging themes considered most relevant for intensivists were adequate communication skills and keeping boundaries with patients and relatives. Professionalism is mainly learned 'on the job' from role models in the intensive care unit. Formal teaching courses and sessions addressing professionalism aspects were nevertheless valued, and learning from own and others' mistakes was considered especially useful. Self-reflection as a starting point for learning professionalism was stressed.

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

Resources to help solve drug calculation problems

This article is the third in a series of articles discussing drug calculations and discusses the resources, in terms of knowledge and skills, that are required to support the use of methods for solving calculation problems (Wright, 2009). The main resources discussed are clinical practice, numeracy knowledge (including number patterns), proportions and factors, and clinical tools such as syringes. These resources can be used as part of formal teaching sessions, or can be developed and practised by individual nurses to improve knowledge and confidence in solving drug calculations. The most important resource for developing drug calculation skills is regular exposure to drug calculations in clinical practice. Any drug calculation teaching and assessing, therefore must have clinical practice as the starting point, with numeracy knowledge not extracted and taught separately, but developed as a resource from within practice, for the purpose of supporting practice.