Formal Training Curriculum Research Articles

Learning and Giving Compassionate Care to Patients: Perspectives of the ICU Nurses.

Compassion forms the basis for nursing practice and is an essential component of patient-centered care. It is vital, essential and of great significance to relieve patient's suffering and have a positive impact on the quality of care provided by a nurse. In the context of Tanzania, knowledge on learning and giving compassionate nursing care to patients remained unresearched. To explore nurse's perspectives on how they learn and give compassionate nursing care to patients in ICUs in Tanzania. A qualitative descriptive study design using in-depth interviews was conducted amongst eleven (11) ICU nurses of two hospitals in Dodoma region. Audio-recording and notetaking were used to collect data. Data from the audio records were transcribed verbatim and subjected to inductive thematic analysis using manifest codding approach with a semantic focus. We report this paper according to COREQ checklist. Three themes emerged from data that summarised the nurses' perspectives on learning and giving compassionate care to patients in ICUs. These themes included (i) Sources and learning of compassionate nursing care (ii) Practicing compassionate nursing care and (iii) impact of compassionate nursing care. Overall, nurses in this setting expressed compassion to as a combination of empathy, ethical view, duty to care and readiness to go extra mile to address patients needs defined their unique view of compassion. Emphasis of compassionate nursing care in formal training curricula, role modelling on compassion in clinical settings and motivation of nurses in critical care settings may facilitate provision of compassionate nursing care amongst patients in ICUs. The findings of the present study underscore the nurse's perspectives on compassionate nursing care and what motivates and prevents them to provide compassionate care to patients. No Patient or Public Contribution.

A review of minimal access surgery provision and training within the United Kingdom

When combined with healthcare pressures, the exponential growth of robotic-assisted surgery (RAS) has impacted UK-based training outcomes, including the learning curve to competency. Aim: To ascertain the current provision of RAS and investigate differences in access to minimal access surgical (MAS) facilities and training across the UK. A two-armed electronic survey was conducted. The first arm questioned clinical leads regarding robotic practice and future training provisions. The second investigated trainee and trainers’ perceptions of MAS training and facilities. 64% (52/81) of responding trusts utilise a robotic system. The majority (68% [55/81]) have plans to expand or acquire a system within 3 years. 171 responses from 112 UK and Republic of Ireland hospitals were collected for Arm 2. Laparoscopic categories queried whether trainees had access to a formal curriculum, training days and sim-boxes. Most consultants (51.9%) and trainees (51.6%) reported that there was no formal local training curriculum for robotic surgery. Combined responses demonstrated 42.1% (n = 195/463) said “yes”, 39.5% (n = 183) “no” and 18.4% (n = 85) “don’t know”. For combined robotic categories (simulation, training days and operative lists) 28.3% (n = 134/473) responded “yes”, 51.6% (n = 244) said “no” and 20.1% (n = 95) said “don’t know”. This study provides insight into the current provision of robotic-assisted surgery at UK trusts and highlights the need to facilitate regular clinical training and equitable access to MAS simulation within a formal curriculum. This may aid regulation of training in parallel with the expansion of robotic practice and avoid a significant skill acquisition gap and risks to patient safety.

Developing surgical and anesthesia resident patient safety competencies through systems-based event analysis. Guide to curricular development and evaluation of longer-term resident perceptions

Previous studies have demonstrated that residents participating in patient safety event investigations become more engaged in future patient safety activities. Currently, there is a gap in resident participation in patient safety event analyses. The objective was to develop and implement a sustainable, faculty-led curriculum for resident participation in patient safety event investigations and to evaluate resident perceptions of the training at least one year following completion of the training. One hundred sixty-five residents from three specialties participated in a formal RCA2 training curriculum from 2013 to 2019. In November 2019, the same residents were asked to complete a survey which examined their perception of the training including the tools and techniques such as event mapping, cause-and-effect diagramming, and developing action plans for solving problems and unsafe conditions. The survey response rate was 36 % (60/165). Sixty-three percent (38/60) of the residents responding to the survey believed that RCA2 training should be provided to all residents. Former residents rated the RCA2 training tools and skills favorably, 3.6 median score (3.5–3.7, 95 % C.I.). Forty-eight percent of responding residents (29/60) believed that the previous RCA2 training improved the way they identify and solve problems. The curriculum and faculty development program provides an effective intervention to address the current, identified gaps in patient safety in graduate medical education.

Operative dictations in surgical trainees: an underutilized educational resource?

Accurate operative notes are imperative to patient care and are used for communication, billing, quality assurance, and medical-legal conflicts. However, operative note quality often varies and many lack critical details. Unfortunately, no standardized training exists in operative dictations for surgical trainees. This pilot study sought to determine resident ability to dictate a comprehensive operative note and to determine a need for a formal operative dictation curriculum. Thirty-eight surgical residents between post-graduate years (PGY) one to four participated in a ventral hernia repair simulation. One senior (PGY3/4) resident coached two junior residents (PGY1/2). Residents completed an informal needs assessment regarding operative dictations. Post-simulation, residents completed an operative dictation. Notes were graded using a modified validated rubric. Thirty-five residents completed the needs assessment, and 38 residents submitted an operative note. Eighty-two percent of this group have completed ≤ 25 operative dictations in training and 77% have received minimal feedback on operative dictations. Out of 33 total points, mean overall score was 18.9 ± 5.4 (Junior resident: 17.9 ± 5.4; Senior resident: 20.9 ± 4.8) Total mean scores did not significantly differ between junior and senior residents (p = 0.10). Senior and junior residents scored similarly on the procedural details component (p = 0.29). Senior residents scored higher on relevant patient history and operative note headers (p = 0.04). Standard surgical training may not provide enough teaching and feedback to residents on operative note dictations. A formal residency training curriculum may bolster trainee ability to learn the components of an effective operative note.

The importance of robotic surgery training in HPB fellowship: a survey of the 2022 AHPBA fellows

BackgroundThe 2022 incoming fellows’ expectations for their robotics training, as well as their perceptions of the utility of the surgical robot, are not well defined. MethodsCross-sectional survey of 24 AHPBA fellows in 2022, analyzed with descriptive statistics and Spearman's rho. ResultsOf 33 current AHPBA fellows, 22 completed the survey (66.7%). Study participants had limited-to-moderate experience with robotics prior to fellowship (mean 2.5 ± SD 1.1; range 1–4). Most participants agreed that robotics influenced their fellowship choice (mean 4.14 ± SD 0.87; range 1–5), would make then more marketable (mean 4.77 ± SD 0.52; range 1–5) and improve job prospects (mean 4.68 ± SD 0.87; range 1–5). Of the study participants, 55% responded that robotics training is “essential” in fellowship, while 64% responded that it is “essential” for their careers. Fellows were only slightly satisfied with overall robotics training within their respective programs (mean 3.44 ± SD 1.17; range 1–5) The majority (73.7%) expect that robotics will comprise <25% of their training. Notably, the majority (75%) have no formal robotics training curriculum. DiscussionThis survey identifies potential gaps where robotics training could be improved for future incoming AHPBA fellows.

A Multi-Institutional Needs Assessment in the Development of a Robotic Surgery Curriculum: Perceptions From Resident and Faculty Surgeons

The growing adoption of robotic-assisted surgery mandates residents must acquire robotic skills. No standardized curriculum for robotic surgery exists. Therefore, programs have developed their own curricula, which are often unstructured and based on resource availability. With this strategy programs may not adhere to scholarly approaches in curriculum development. We aimed to obtain a multi-institutional needs assessment to address training needs and identify integral components of a formalized robotic surgery curriculum. A 10-question survey was distributed to general surgery residents. A separate 7-question survey was sent to robotic faculty surgeons at 3 institutions. Survey questions queried demographics, opinions regarding robotic training, proficiency definitions, and identification of procedures and instructional strategies for a curriculum. Mann- Whitney U test and Fisher's exact test were performed to compare responses amongst residents and faculty. Spearman's correlation was used to identify relationships between experience or post-graduate year (PGY) with response selection. Both residents and faculty believed robotic training should start in the PGY1 (55.1% vs 52%; p = 0.58). Faculty recognized robotic training to be more important compared to residents (84% vs 58.1%; p < 0.05). Both groups considered a minimum of 21 to 40 robotic cases to be sufficient exposure during training (p = 0.30). Cholecystectomy (82.4% vs 72%; p = 0.261), ventral hernia repair (89.2% vs 88%; p = 1.0), inguinal hernia repair (91.9% vs 92%; p = 1.0), and right colectomy (83.8% vs 80%; p = 0.7) were considered to be the most appropriate robotic procedures during training. Both groups concurred that bedside (91.9% vs 100%; p = 0.33) and console skills training (97.3% vs 100%; p = 1.0), small group simulation (94.6% vs 72% p = 0.005), and independent practice (87.8% vs 92% p = 0.73), were instructional strategies vital to a curriculum. Faculty considered online didactic modules (96% vs 59.5%; p < 0.05) to be more important, whereas residents favored small group experiences for fundamental skills (94.6% vs. 72%; p < 0.05) and procedure-based simulation (96% vs 64%; p < 0.05). Our targeted needs assessment identified requisite components of a robotics curriculum, which are feasible and accepted by both residents and faculty. Medical educators can use this as a resource to develop a formal robotics training curriculum.

The role of the Neuropsychologist across the stages of recovery from acquired brain injury: a summary from the pediatric rehabilitation Neuropsychology collaborative

ABSTRACT Neuropsychologists working in a pediatric neurorehabilitation setting provide care for children and adolescents with acquired brain injuries (ABI) and play a vital role on the interdisciplinary treatment team. This role draws on influences from the field of clinical neuropsychology and its pediatric subspecialty, as well as rehabilitation psychology. This combination of specialties is uniquely suited for working with ABI across the continuum of recovery. ABI recovery often involves a changing picture that spans across stages of recovery (e.g., disorders of consciousness, confusional state, acute cognitive impairment), where each stage presents with distinctive characteristics that warrant a specific evidence-based approach. Assessment and intervention are used reciprocally to inform diagnostics, treatment, and academic planning, and to support patient and family adjustment. Neuropsychologists work with the interdisciplinary teams to collect and integrate data related to brain injury recovery and use this data for treatment planning and clinical decision making. These approaches must often be adapted and adjusted in real time as patients recover, demanding a dynamic expertise that is currently not supported through formal training curriculum or practice guidelines. This paper outlines the roles and responsibilities of pediatric rehabilitation neuropsychologists across the stages of ABI recovery with the goal of increasing awareness in order to continue to develop and formalize this role.

The attitudes, experiences, and self-competencies of pediatric endocrinology fellows and attending physicians regarding diabetes technology: the Turkey experience.

Unlike in Western countries, the use of diabetes technologies has been limited in Turkey, or at least until the last few years. This low adoption frequency may be attributed to the lack of experience of pediatric diabetes teams in working with new technologies. The aim of this study is to evaluate the attitudes, experiences and self-efficacies of pediatric endocrinology fellows and attending physicians in terms of use of continuous subcutaneous insulin infusion (CSII) therapy and continuous glucose monitoring (CGM) systems. The questionnaire used in this study consisted of 63 questions including 10 questions evaluating the demographic characteristics and experience of the participants, 33 Likert-type questions related to self-competency, 17 yes/no questions and 3 open-ended questions which evaluated attitudes towards our study area. This questionnaire was e-mailed to pediatric endocrinology fellows and attending physicians working in Turkey. A total of 24 fellows and 28 attending physicians working in the field of pediatric endocrinology participated in the survey. Of the respondents, 61% reported that there was no formal training curriculum regarding diabetes technology at their institutions. The mean scores obtained from the Likert scale questions measuring self-competency in using CSII and CGM were 3.8 and 3.3 out of 5, respectively. Of the respondents, 55% judged themselves to be under-skilled in interpreting pump reports while 39% of the respondents reported themselves as being under-skilled in interpreting CGM reports. While it is true that training programs for using diabetes technology have been established by the National Pediatric Endocrinology Association in Turkey, the development of a specific curriculum for institutions that provide pediatric endocrinology fellowship training in this framework will increase the self-confidence of pediatric endocrinologists in this matter and this will ultimately contribute to the improvement of the metabolic control of children with diabetes.

Assessment of Obstetric and Gynecology Residents: An Assessment of Attitudes before and after Initiation of a Robotic Training Curriculum

Study Objective Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. Design This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. Setting N/A. Patients or Participants Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. Interventions A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. Measurements and Main Results After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Conclusion Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation. Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. N/A. Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation.

Open Science in Kenya: Where Are We?

According to the United Nations Educational, Scientific, and Cultural Organization (UNESCO), Open Science is the movement to make scientific research and data accessible to all. It has great potential for advancing science. At its core, it includes (but is not limited to) open access, open data, and open research. Some of the associated advantages are promoting collaboration, sharing and reproducibility in research, and preventing the reinvention of the wheel, thus saving resources. As research becomes more globalized and its output grows exponentially, especially in data, the need for open scientific research practices is more evident — the future of modern science. This has resulted in a concerted global interest in open science uptake. Even so, barriers still exist. The formal training curriculum in most, if not all, universities in Kenya does not equip students with the knowledge and tools to subsequently practice open science in their research. Therefore, to work openly and collaboratively, there is a need for awareness and training in the use of open science tools. These have been neglected, especially in most developing countries, and remain barriers to the cause. Moreover, there is scanty research on the state of affairs regarding the practice and/or adoption of open science. Thus, we developed, through the OpenScienceKE framework, a model to narrow the gap. A sensitize-train-hack-collaborate model was applied in Nairobi, the economic and administrative capital of Kenya. Using the model, we sensitized through seminars, trained on the use of tools through workshops, applied the skills learned in training through hackathons to collaboratively answer the question on the state of open science in Kenya. While the former parts of the model had 20–50 participants, the latter part mainly involved participants with a bioinformatics background, leveraging their advanced computational skills. This model resulted in an open resource that researchers can use to publish as open access cost-effectively. Moreover, we observed a growing interest in open science practices in Kenya through literature search and data mining and that lack of awareness and skills may still hinder the adoption and practice of open science. Furthermore, at the time of the analyses, we surprisingly found that out of the 20,069 papers downloaded from BioRXiv, only 18 had Kenyan authors, a majority of which are international (16) collaborations. This may suggest poor uptake of the use of preprints among Kenyan researchers. The findings in this study highlight the state of open science in Kenya and challenges facing its adoption and practice while bringing forth possible areas for primary consideration in the campaign toward open science. It also proposes a model (sensitize-train-hack-collaborate model) that may be adopted by researchers, funders and other proponents of open science to address some of the challenges faced in promoting its adoption in Kenya.

Current status of robotic surgery in colorectal residency training programs.

Robotic surgery (RS) has been increasingly incorporated into colorectal surgery (CRS) training. The degree to which RS has been integrated into CRS residency training is not well described. A web-based survey was sent to all 2019 accredited CRS residency programs within the United States and Canada. Program directors (PDs) were queried on how robotic surgery had been integrated into their program, specifics on RS curriculum and opinions on RS training during general surgery residency. We compared survey responses by program type (university-based, university-affiliated programs, or independent programs) and by geographic region. In addition, a chi-square test was used to evaluate differences in survey responses with respect to robotic curriculum components. Of 66 programs, 42 (64%) responded to the survey. Of the responding programs, 35 (83%) were university-based or university-affiliated, while 7 (17%) were independent. Most programs were in the Midwest (33%). Forty-one (98%) reported having a surgical robot in use at their institution, with 95% reporting active participation of CRS residents in RS. While 74% of programs have a formal RS training curriculum for CRS residents, there was considerable variability in the curriculum elements employed by each institution, and the differences in proportions of these elements were significant (χ2 99.8, p < 0.001). The median operative approach to abdominopelvic cases was estimated to be 33% robotic, 40% laparoscopic and 20% open. There were no significant differences in the survey responses between university/university-affiliated and independent programs (p > 0.05) or among the different regions (p > 0.05). This study demonstrated that almost all CRS residencies have integrated RS and have trainees operating at the robotic console. Most programs have a robotics curriculum and there are expanding indications for RS within CRS. This expansion calls for discussion on implementation of training standards such as curricular requisites, baseline competency assessments, and definitions of minimum case requirements to ensure adequate training.

The effectiveness of a formal curriculum in teaching mass casualty management.

To improve knowledge, skills, and confidence in mass casualty management through design and im-plementation of a formal educational curriculum. Observational study using a mixed-methods formal educational training curriculum. Rural Emergency Medical Services (EMS) system in Pennsylvania. Subjects/participants: Convenience sample of 141 licensed EMS providers. Formal educational curriculum using a computerized mass casualty scenario, lectures, hands-on skill stations, post-intervention participant satisfaction survey, knowledge retention at three- and six-month post curriculum. The formal curriculum resulted in an improvement in scene size-up, incident command system (ICS) set-up, and medical management of 12 percent, 27 percent, and 26 percent, respectively. Average scores on the written component evaluating mass casualty incident (MCI) management and knowledge of test patient triage were 84 percent and 74 percent, respectively. Knowledge recall at three- and six-month post-training was highly retained as test scores were generally unchanged from the time of the educational session. Course and instructor evaluations by participants reflected a high degree of satisfaction (scoring five on a five-point Likert scale). The formal curriculum was effective in improving the knowledge, skills, and confidence of mass casualty management. Although traditional educational methods tend to show decreases in long-term knowledge retention, the mixed active learning strategies used in this curriculum resulted in high level retention since short and long-term test scores were similar and unchanged over time. Additionally, this curriculum was perceived by participants as highly satisfactory toward their knowledge and skill development.

Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe.

1) To investigate the current practice in point-of-care ultrasound use in PICUs across Europe; 2) to understand the barriers for point-of-care ultrasound implementation in the clinical practice; 3) to identify existing point-of-care ultrasound training programs; and 4) to assess training needs. Cross-sectional electronic survey. Medical directors of European PICUs. The response rate was 42.3%; 142 of the 336 invited PICU medical directors from 26 European countries completed the survey. The clinicians in almost all the PICUs across Europe were reported to use point-of-care ultrasound in some form. A significant variation in the clinical practice according to the patient characteristics and presence of a fellowship training program was observed. PICUs with cardiosurgical patients reported using point-of-care ultrasound significantly more often than others. Ultrasound-guided vascular access was the most common point-of-care ultrasound indication, except in PICUs providing joint care for neonates and children. Units with a fellowship training program reported an increased use of point-of-care ultrasound for hemodynamic evaluation, during resuscitation and a positive impact on collaboration with imaging specialties. Although no barrier was deemed substantial to impede point-of-care ultrasound implementation, a number of potential hindrances to its implementation were reported-such as lack of formal training curriculum, collaborative learning opportunities, and quality assurance processes. Bedside informal teaching in point-of-care ultrasound was reported the most common method to acquire point-of-care ultrasound skills. Point-of-care ultrasound is being used extensively across heterogeneously organized PICU settings in Europe. However, there remains a significant variation in the clinical practice across the units. Clear needs for improved point-of-care ultrasound training programs and clinical governance structure were identified. Evidence-based point-of-care ultrasound guidelines, structured training programs dedicated to neonatal and pediatric intensive care settings, and educational research in point-of-care ultrasound use may help in strengthening clinical governance, making clinical practice uniform and enhancing quality assurance.

Training Medical Student Facilitators of Peer-Assisted Study Sessions Using an Objective Standardized Teaching Exercise.

IntroductionPeer-assisted study sessions (P.A.S.S.) are medical student–facilitated small-group sessions that aim to improve students’ knowledge and performance in preclinical courses. Peer teaching has been shown to have a positive impact on academic performance of both learners and peer teachers. For peer teaching to be more effective, there is a need for training of peer teachers. We developed a facilitator training workshop to help to improve medical students’ confidence in serving as P.A.S.S. facilitators.MethodsParticipants were first-year medical students who were approved to become P.A.S.S. facilitators. We recruited facilitators to attend a training workshop and provided them with a training manual to use during the training session and as a resource after the session. We recruited five standardized students to participate in an objective standardized teaching exercise (OSTE). We asked facilitators to complete pre/post surveys before and after the workshop to indicate their level of confidence in facilitating the sessions and provide feedback on the workshop.ResultsNine P.A.S.S. facilitators participated in the training session. Analysis of pre- and postworkshop survey data showed a statistically significant increase in student confidence (p ≤ .02).DiscussionDeveloping and implementing a formalized P.A.S.S. facilitator training manual and workshop with an OSTE helped improve students’ confidence in facilitating an organized, effective, and interactive peer teaching session. Students’ positive feedback on the OSTE suggests that OSTEs can be useful tools to help peer teachers learn skills to cope with challenging situations with students.

Capacity building in female pelvic medicine and reconstructive surgery: Global Health Partnership beyond fistula care in Ethiopia.

Obstetric fistula is a devastating childbirth injury that leaves women incontinent, stigmatized and often isolated from their families and communities. In Ethiopia, although much attention has focused on treating and preventing obstetric fistula, other more prevalent childbirth-related pelvic floor disorders, such as pelvic organ prolapse, non-fistula-related incontinence and post-fistula residual incontinence, remain largely unattended. The lack of international and local attention to addressing devastating pelvic floor disorders is concerning for women in low- and middle-income countries. The objective of this article is to highlight the need for a more comprehsive approach to pelvic floor care and to share our experience in addressing it. Here, we share our experience launching one of the first formal training programs in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) in Ethiopia. This fellowship program provides quality care while strengthening the health system in its local context. This program has positioned Ethiopia to be a regional leader by providing comprehensive training of surgeons and allied health professionals, building appropriate health system and research infrastructure, and developing a formal FPMRS training curriculum. We hope that sharing this experience will serve as a template for others championing comprehensive pelvic floor care for women in low- and middle-income countries.

Microsurgery Training Resource Variation among US Integrated Plastic Surgery Residency Programs.

Given emerging focus on competency-based surgical training and work-hour limitations, surgical skills laboratories play an increasingly important role in resident education. This study was designed to investigate educational opportunities in microsurgery across integrated residency programs. Senior residents (PGY 4-6) at integrated plastic surgery programs were surveyed during the 2016 to 2017 academic year to determine each program's access to: training microscopes and anastomosis models, video-based skills assessment, pre-requisite skills exams, flap courses, or a formal microsurgical training curriculum. Programs were stratified based on large size (>18 residents) and presence of microsurgery fellows. Chi-squared analysis was performed with p < 0.05 to assess statistical significance. Survey responses were collected from 32 of 60 eligible programs (53% response rate). Sixty-nine percent provide access to one to two training microscopes, 25% provide three or more, and 6% provide none. Sixty-nine percent of programs train anastomosis with nonliving prosthetics, 66% with living biologics, and 50% with nonliving biologics. Large program size or having microsurgical fellows was not associated with increased access to training microscopes or specific anastomosis models. Programs without microsurgery fellows reported more often that a formal microsurgery curriculum would be helpful (90 vs. 58% of programs with fellows, p = 0.0003). Respondents who indicated that creating a formal curriculum would not be helpful elaborated that their program already has a formal curriculum or a high volume of microsurgery cases. This study demonstrates the current variation in microsurgery training at integrated plastic surgery residency programs. A formal microsurgical training curriculum is commonly viewed as being helpful, particularly at programs without microsurgery fellows.

Solid, Cystic, and Tubular: Novice Ultrasound Skills Training Using a Versatile, Affordable Practice Model

In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model. Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate. The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI. The model was tested in a cohort of 50 medical students and general surgery residents. The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents. This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence.

Who Is Performing Hip Arthroscopy?: An Analysis of the American Board of Orthopaedic Surgery Part-II Database.

Hip arthroscopy utilization has increased dramatically over the last decade. However, the lack of a formal training curriculum raises concern that inconsistent technical performance may be an issue for early-career hip arthroscopists. The purpose of the present study was to investigate hip arthroscopy utilization by early-career orthopaedic surgeons while focusing on fellowship training status to better guide future development of a hip arthroscopy training curriculum. The American Board of Orthopaedic Surgery (ABOS) Part-II database was used to identify candidates who had performed ≥1 hip arthroscopy procedures between 2006 and 2015. Procedures were categorized using Common Procedural Terminology (CPT) codes, and candidates were categorized by fellowship training experience. Trends in hip arthroscopy utilization were evaluated using univariate and regression analyses while stratifying by fellowship training experience. Overall, 9.2% (643) of 6,987 ABOS candidates had performed ≥1 hip arthroscopy procedures. Over the study period, both the proportion of candidates performing hip arthroscopy and the proportion of hip arthroscopy procedures performed (relative to all procedures performed, of any type) increased (p < 0.001). Candidates performing hip arthroscopy most frequently reported sports medicine fellowship training (74.5%; 479 of 643). Also, among the candidates who performed hip arthroscopy, the proportion who had sports medicine fellowship training increased over the study period (p = 0.001). The majority of candidates performing hip arthroscopy (67.2%; 432 of 643) performed ≤5 hip arthroscopy procedures, while a small number of high-volume hip arthroscopists (6.5%; 42 of 643) performed 34.6% (1,403 of 4,054) of all hip arthroscopy procedures. The increase in hip arthroscopy utilization in this cohort appears to have been driven primarily by the increased number of candidates performing hip arthroscopy and less by an increasing number of hip arthroscopy procedures being performed by individual candidates. The majority of candidates performing hip arthroscopy were sports-medicine-fellowship trained. This information is valuable for both trainees and educators interested in improving education and defining a curriculum for future hip arthroscopy training.

A pilot survey on an understanding of point of care bedside ultrasound (POCUS) among medical doctors in internal medicine: Exposure, perceptions, interest and barriers to training

Introduction: Clinical bedside point-of-care ultrasonography (POCUS) is an important adjunct to history and physical examination. The objective of this pilot survey is to assess the level of exposure, perceptions, interest levels and possible barriers toward training of POCUS in internal medicine. Methods: In October 2015, all medical doctors who were working in the Singapore General Hospital Internal Medicine Department were invited to complete a hard-copy printed 27-question Likert-scale survey. Results: A total of 124 medical doctors participated in the survey (response rate 82.1%). The proportions of participants who have heard, witnessed, and performed POCUS were 65.6% ( N = 82), 71.2% ( N = 89) and 41.6% ( N = 52), respectively. POCUS was rated highly on usefulness in the practice of internal medicine ( M = 8.74; SD = 1.34). The top three POCUS skills that doctors would like to acquire would be (1) procedural guidance POCUS (70.8%); (2) point-of-care cardiac ultrasound (69%) and (3) lung ultrasound 58.4% (based on percentage ranked first through third). The sample mean of interest in undergoing further training in POCUS is 8.91 (SD = 1.27) (0 = not interested, 10 = very interested). The top three barriers identified were (1) lack of an ultrasound machine ( M = 7.98 SD = 2.28); (2) cost of an ultrasound machine ( M = 7.79 SD = 2.19) and (3) lack of a formal training curriculum ( M = 7.25 SD = 2.08) (0 = not a barrier at all, 10 = severe barrier). Conclusions: There is a high level of exposure and interest in POCUS. Doctors perceived bedside POCUS as very useful in the practice of internal medicine. A lack of machine and formal curriculum impedes development of a training program. This pilot survey may serve as a basic needs assessment to an implementation of an internal medicine POCUS training curriculum.

Adolescent health care education and training: insights from Israel.

There is a growing need for health care professionals to extend their knowledge in adolescent health care. Formal training curricula in adolescent medicine have been established in the United States, Canada, and Australia, yet many other countries have developed shorter training programs to enable interested physicians to further pursue knowledge and practical experience in delivering improved quality health care for adolescents. The Israeli experience in building an infrastructure that allows students and physicians to learn about adolescent medicine and to train in the field is described. It includes a series of lectures and seminars for medical students during medical school and at the clinical rotations in pediatric wards; the development of hospital-based and community-based multidisciplinary adolescent health services where residents can practice adolescent health care; a 3-year diploma course in adolescent medicine for specialists in pediatrics and family medicine; mini courses in adolescent medicine for pediatricians and family practitioners working in community settings; and a simulated patient-based program regarding communication with adolescents, aimed for all professional levels - medical students, residents, and specialists. This infrastructure has been developed to create a leading group of physicians, who are able to operate adolescent clinics and to teach adolescent medicine. Recently, a formal fellowship program in adolescent medicine has been approved by the Scientific Council of the Israel Medical Association. The Israeli experience described here could be applied in countries, where formal training programs in adolescent health care are not yet established.