Hands-on Practice Sessions Research Articles

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

Impact of Training Frequency on Nurses' Pediatric Resuscitation Skills.

The ideal time frame for frequency of resuscitation skills training has yet to be determined. Results obtained from this performance improvement project using hands-on practice sessions suggest that 6 months may be an adequate time frame for retention of resuscitation skills. Professional development educators may want to consider 6-month retraining intervals for low-volume/high-risk skills such as cardiopulmonary resuscitation to optimize nurses' proficiency in these life-saving competencies.

Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

BackgroundA growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach.AimTo implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures.SettingThe study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns.Program descriptionThis was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention.ResultsThirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099.ConclusionsA single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

A training course on laboratory animal science: an initiative to implement the Three Rs of animal research in India.

There is a current need for a change in the attitudes of researchers toward the care and use of experimental animals in India. This could be achieved through improvements in the provision of training, to further the integration of the Three Rs concept into scientific research and into the regulations of the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA). A survey was performed after participants undertook the Federation of European Laboratory Animal Science Associations (FELASA) Category C-based course on Laboratory Animal Science (in 2013 and 2015). It revealed that the participants subsequently employed, in their future research, the practical and theoretical Three Rs approaches that they had learned. This is of great importance in terms of animal welfare, and also serves to benefit their research outcomes extensively. All the lectures, hands-on practical sessions and supplementary elements of the courses, which also involved the handling of small animals and procedures with live animals, were well appreciated by the participants. Insight into developments in practical handling and welfare procedures, norms, directives, and ethical use of laboratory animals in research, was also provided, through the comparison of results from the 2013 and 2015 post-course surveys.

Molecular dynamics characterization of the conformational landscape of small peptides: A series of hands-on collaborative practical sessions for undergraduate students.

Molecular modelling and simulations are nowadays an integral part of research in areas ranging from physics to chemistry to structural biology, as well as pharmaceutical drug design. This popularity is due to the development of high-performance hardware and of accurate and efficient molecular mechanics algorithms by the scientific community. These improvements are also benefitting scientific education. Molecular simulations, their underlying theory, and their applications are particularly difficult to grasp for undergraduate students. Having hands-on experience with the methods contributes to a better understanding and solidification of the concepts taught during the lectures. To this end, we have created a computer practical class, which has been running for the past five years, composed of several sessions where students characterize the conformational landscape of small peptides using molecular dynamics simulations in order to gain insights on their binding to protein receptors. In this report, we detail the ingredients and recipe necessary to establish and carry out this practical, as well as some of the questions posed to the students and their expected results. Further, we cite some examples of the students' written reports, provide statistics, and share their feedbacks on the structure and execution of the sessions. These sessions were implemented alongside a theoretical molecular modelling course but have also been used successfully as a standalone tutorial during specialized workshops. The availability of the material on our web page also facilitates this integration and dissemination and lends strength to the thesis of open-source science and education.

Bystander cardiopulmonary resuscitation training experience and self-efficacy of age and gender group: a nationwide community survey

BackgroundWe hypothesized that recent hands-on practice for cardiopulmonary resuscitation (CPR) would be strongly associated with a higher likelihood of self-efficacy in bystander CPR among laypersons according to age and gender group. MethodsWe used the National Korean Community Health Survey database of 228921 representatively sampled responders from 253 counties in 2012. Laypersons who had previous CPR training were eligible. Exposure variables were having had CPR training with hands-on practice session with a manikin (Practical-CPR-Training) and CPR training within the last 2 years (Recent-CPR-Training). Primary outcome was self-efficacy in bystander CPR. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects of CPR training across different age and gender groups. ResultsOf 62425 eligible respondents who have had CPR training, 20213 (32.4%) had Practical-CPR-Training. Adjusted odds ratios (AORs) for self-efficacy were 4.08 (3.78-4.41) in Practical-CPR-Training, 2.61 (2.50-2.73) in male, 1.26 (1.16-1.36) in good self-rated health, 1.19 (1.10-1.29) in high school graduate, 1.19 (1.01-1.39) in persons living with stroke patients in household, and 1.17 (1.10-1.24) in Recent-CPR-Training. In interaction models, Practical-CPR-Training showed higher self-efficacy in all age and gender groups, whereas Recent-CPR-Training was not associated with better self-efficacy in elderly group, male (AOR, 0.90 [0.69-1.18]) and female (AOR, 0.94 [0.72-1.23]). ConclusionSelf-efficacy in bystander CPR was higher in person with recent CPR training with hands-on practice with a manikin.

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation

Problem: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment. Intervention: All 133 final-year students completed a 2-week anesthesia rotation, which began with a half-day session consisting of a lecture and hands-on practice session during which they learned 9 basic transthoracic echocardiography views using 4 basic ultrasound probe positions. Context: Each student was required to perform a transthoracic echocardiography-examine under supervision of 1 patient/week for 2 weeks, and their results were compared against that of the supervisor's. Most patients were elective cardiac surgery patients. One long question on transthoracic echocardiography was included in their end-of-year surgery examination paper. Students provided feedback on their experience. Outcome: Most students learned the basic transthoracic echocardiography views fairly efficiently and had variable, though generally favorable, success rates in identifying obvious cardiac anomalies, including use of color Doppler. A few common mistakes were identified but were easily correctable. Logistics for mobilizing enough bedside supervision were challenging. Students reported positive feedback on the teaching initiative. Lessons Learned: We were able to execute a successful short training course on transthoracic echocardiography during the final-year medical degree anesthesia rotation. Our initiative may set an example for other clinical departments to design similar courses pertinent to their specialties and syllabuses.

Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department.

To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings.

Scan When You Can: Using Open Ultrasound Practice Sessions as a Venue to Encourage Interprofessional Education

Recently many medical schools have introduced ultrasound education, with several institutions adopting formal teaching of ultrasound into their anatomy curricula. Additionally, medical schools nationwide have begun to incorporate various forms of interprofessional education (IPE) into their programs to prepare medical students for the teamwork necessary to serve as physicians. The Anatomy course at Mayo Medical School incorporated several IPE sessions with physical therapy students. Since the course is integrated with radiology, ultrasound imaging was recently added to complement static images and visualize living anatomy. Due to the success of prior IPE endeavors in anatomy, a new elective experience for hands‐on ultrasound practice sessions was offered to both medical and physical therapy students. The aim of this study was to assess student perception of elective ultrasound practice sessions as an opportunity for interprofessional peer‐learning. Practice sessions were scheduled once a week for 4 hours and a trained teaching assistant was available during the sessions. Students were encouraged to discuss different techniques and anatomical knowledge based on their respective experiences. A sign‐in sheet was kept to monitor how many students from both groups attended. Students were asked to fill out a survey at the end of 4 weeks to assess perceptions of the interprofessional experience. Preliminary results indicate that students appreciated the diversity of an interprofessional approach to learning ultrasound skills and enjoyed teaching each other anatomy through ultrasound.

Evaluating the Effect of a Community-Based Lay Health Advisor Training Curriculum to Address Immigrant Children's Caries Disparities

Previous programs had not designed the culturally adequate Lay Health Advisor (LHA) oral health training curriculum for medically underserved population. We evaluated the effects of LHA training curriculum for addressing immigrant children's caries disparities in their access to dental care. We used a pre/post-test study design. Immigrant women were recruited from churches, schools, and immigrant centers in an urban area. Four training classes were held. Each training cycle lasted 15 consecutive weeks, consisting of 1 weekly 2-h training session for 12 weeks followed by a 3-week practicum. The curriculum included training in caries-related knowledge, oral hygiene demonstrations, teaching techniques, communication skills, and hands-on practice sessions. Thirty-seven LHA trainees completed the course and passed the post-training exam. The data were collected using self-report questionnaires. The level of oral health knowledge, self-efficacy and attitudes toward oral hygiene were significantly increased after LHA training. There was a significant and over twofold increase in trainees' oral hygiene behaviors. An increase of >20% in LHA and their children's dental checkup was observed following training. After training, LHAs were more likely to have 3+ times of brushing teeth [Odds Ratio (OR) = 13.14], brushing teeth 3+ minutes (OR = 3.47), modified bass method use (OR = 30.60), dental flossing (OR = 4.56), fluoride toothpaste use (OR = 5.63) and child's dental visit (OR = 3.57). The cross-cultural training curriculum designed for immigrant women serving as LHAs was effective in improvement of oral hygiene behaviors and access to dental care.

Introducing First Aid Skills to Pre-Clerkship Medical Students While Reinforcing Basic Science Concepts

The benefit of exposing medical students throughout their medical training to emergency medicine concepts, including basic first aid knowledge, has been established [1]. The American College of Emergency Physicians (2008) called for introduction and integration of basic first aid skills throughout the 4 years of medical school [2]. Teaching clinical skills to preclinical students has the benefit of enhancing learning by providing meaningful clinical relevance to basic science learning, is motivating for learning, and is beneficial for reviewing and reinforcing basic science concepts [3]. It is often assumed that entering medical students have knowledge and skills to provide essential medical care; however, many are unfamiliar with even very basic first aid skills. A 2-hour workshop to teach first aid procedures was developed and presented to 25 volunteer first (M1) and second year (M2) students at Rutgers Robert Wood Johnson Medical School (RWJMS). The workshop covered procedures for wound care, hemorrhage control, and treatment of burns. Relevant basic science content (musculoskeletal anatomy and physiology, microbiology of tetanus and skin infections, and antibiotic pharmacology) was presented, followed by demonstrations and hands-on practice sessions. The practice sessions included procedures for applying direct pressure to a wound, dressing a wound, and wrapping burns with sterile gauze. Workshop evaluations via pre and post-surveys measured knowledge acquisition, comfort in providing first aid, and overall effectiveness of the session. Evaluation results were very positive. The mean score (12 questions) of first aid knowledge increased from 38.3 % to 81.7 % (p<0.001). On a Likert scale measuring student comfort in providing care to a bleeding patient (1=very uncomfortable to 5=very comfortable), scores increased from 2.68 to 4.36 (p<0.001); comfort for providing burn care increased from 2.28 to 4.48 (p<0.001). On additional posttest Likert scale questions (1=strongly disagree to 5=strongly agree), students also responded very positively to the integration of basic science content (4.72), hands-on practice sessions (4.58), usefulness of information (4.76), and interest level and quality of presentation (4.76). There were no significant differences between M1 and M2 students; at least one semester of medical school basic science material is recommended. Based on this initial success, another workshop about limb injuries and cervical spine injury care is being developed as another optional student experience, and will include both basic science correlations and hands-on practice sessions.

Evaluation of Hypertrophic Pyloric Stenosis by Pediatric Emergency Physician Sonography

The objective was to evaluate the accuracy of pediatric emergency physician (EP) sonography for infants with suspected hypertrophic pyloric stenosis (HPS). This was a prospective observational pilot study in an urban academic pediatric emergency department (PED). Patients were selected if the treating physician ordered an ultrasound (US) in the department of radiology for the evaluation of suspected HPS. Sixty-seven patients were enrolled from August 2009 through April 2012. When identifying the pylorus, pediatric EPs correctly identified all 10 positive cases, with a sensitivity of 100% (95% confidence interval [CI] = 62% to 100%) and specificity of 100% (95% CI = 92% to 100%). There was no statistical difference between the measurements obtained by pediatric EPs and radiology staff for pyloric muscle width or length (p = 0.5 and p = 0.79, respectively). Trained pediatric EPs can accurately assess the pylorus with US in the evaluation of HPS with good specificity.

Simulation‐based local anaesthesia teaching enhances learning outcomes

The aim of this study was to evaluate the efficacy of simulation-based local anaesthesia teaching strategies compared to the traditional classroom lecture format on the acquisition of knowledge by students. Two groups of 10 students each were included in our study. Each of the dental students was enrolled in their third year of the programme. None of the students had ever received instructions in local anaesthesia. Group I received a 45-min instructional module that was delivered in the classroom in the traditional PowerPoint lecture format. Group II received a 45-min instructional module in the simulation laboratory as a short tutorial that was followed by an integrated practical demonstration and a hands-on practice session using local anaesthesia simulation phantoms. An identical 15-question multiple-choice test was used to test student knowledge acquisition at the end of the given session. There was a statistically significant difference between the two groups, as the participants in group II had higher score results than those of group I. In contrast to the traditional classroom lecture format, simulation-based local anaesthesia teaching is an effective tool to enhance the acquisition of theoretical knowledge by students.

Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurements

To assess whether a standardization exercise prior to commencing a fetal growth study involving multiple sonographers can reduce interobserver variation. In preparation for an international study assessing fetal growth, nine experienced sonographers from eight countries participated in a standardization exercise consisting of theoretical and practical sessions. Each performed a set of seven standard fetal measurements on pregnant volunteers at 20-37 weeks' gestation, and these were repeated by the lead sonographer; all measurements were taken in a blinded fashion. After this the sonographers had hands-on practice and feedback sessions on other volunteers. This process was repeated three times. Measurement differences between sonographers and the lead sonographer, expressed as a gestational-age-specific Z-score, between the first and third scans were compared using the Wilcoxon signed ranks test, and variance was assessed using Pitman's test. Interobserver agreement was also assessed using the intraclass correlation coefficient (ICC), and all images were scored for quality in a blinded fashion. At baseline the level of agreement and image scoring were high. A significant reduction in the differences between sonographers and the lead sonographer were seen for fetal biometry overall (head circumference, abdominal circumference and femur length) between the first and third scans (median Z-scores, 0.46 and 0.24; P = 0.005), and a reduction in the variance was also observed (P < 0.001). The ICCs for measurement pairs for every fetal measurement showed a clear trend of increasing ICC (better agreement) with consecutive training scan sessions, although no improvement in image scores was seen. Even for experienced sonographers, a standardization exercise before starting a study of fetal biometry can improve consistency of measurements. This could be of relevance for studies assessing fetal growth in multicenter sites.

The Second African Federation of Neurological Surgeons Course in the East, Central, and Southern Africa Region Held in Dar es Salaam, Tanzania, January 2011

The second International African Federation of Neurological Surgeons course was organized on January 24 to 28, 2011, at the Seacliff Hotel and Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. President Jakaya Mrisho Kikwete graced the official opening with high ranking government officials in attendance. The targeted participants were young neurosurgeons in the East, Central, and South African region. More than 80 surgeons, residents, and neurosurgical nurses came from Tanzania, Kenya, Uganda, Rwanda, Ethiopia, Zambia, and Zimbabwe. The objectives of the course were to teach and train young local surgeons in the essential-relevant for the region-and current techniques and management principles of brain and spinal diseases, acquire new skills through hands-on practical sessions, and share experiences. The course consisted of didactic sessions, practical aspects on spine internal fixation, cadaver dissections, and live microscopic and endoscopic surgery. Experienced faculty from different states of the United States, Spain, Turkey, India, Egypt, and Ethiopia facilitated the course. The objectives of the course were met with a favorable evaluation report. The collaboration and experience gained will be reinvested in organizing similar courses in the region.

Medical Student Identification of Knee Effusion by Ultrasound

Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.

Virtual Rheumatology

Arthrocentesis is an important skill for medical practitioners at all levels of training. Previous studies have indicated a low comfort level and performance of arthrocentesis among primary care physicians that could be improved with hands-on training. The objective of this study was to improve comfort with knee and shoulder arthrocentesis at all levels of medical training, including medical students, internal medicine residents, and rheumatology subspecialty residents, and in arthrocentesis of the elbow, wrist, and ankle for advanced subspecialty residents in rheumatology through the use of a formal workshop using simulators. Fourth-year medical students and internal medicine residents were recruited from the University of South Florida. The rheumatology advanced subspecialty residents were participants from University of South Florida and from the American College of Rheumatology national meetings in 2008 and 2009. A 1-hour PowerPoint lecture followed by a hands-on practice session using Sawbones models (shoulder and knee for all groups, and elbow, wrist, and ankle additionally for the advanced subspecialty residents). A preworkshop self-assessment survey allowed the participant to rate his/her comfort level with arthrocentesis on a scale of 1 to 5. A survey with identical questions was completed immediately after the workshop. A follow-up survey was distributed by e-mail 3 to 6 months after the workshop. One hundred forty-one medical students, 75 internal medicine residents, and 39 rheumatology subspecialty residents participated from January 2008 until January 2010. Mean comfort level in knee and shoulder arthrocentesis improved from preworkshop comfort level for all joints and among all participants. In addition, rheumatology subspecialty resident mean comfort level improved for ankle from 2.37 to 3.65, elbow from 2.56 to 3.80, and wrist from 2.31 to 3.77 (P < 0.0001). Our study involved a very large number of participants encompassing different levels of training and is the largest number of advanced subspecialty rheumatology residents studied with regard to joint injection training. We have confirmed that a formal joint injection workshop using simulators is an effective method of improving comfort level in arthrocentesis among participants from all levels of medical training. Future studies should evaluate the effect of such training on actual clinical use and competence.

Reflections on teaching database management systems to undergraduate students

Database management courses are an essential part of computer science curricula in educational institutions. Courses are normally well-designed, however, in order for students to better understand the theoretical concepts, hands-on practical sessions are also necessary. Such practice will help students to meet the challenges of job market and working in the industry. This paper suggests that group projects be used as a tool to make the teaching and learning of the subject area, more effective. In the paper, we first discuss the design of a course module and describe a pedagogical approach that was adopted to teach a database management systems (DBMS) course at a university in Pakistan and then analyse students’ feedback comments to gauge the effectiveness of the teaching strategy. Our design proposes a detailed 16-week plan for the teaching of the subject. The current study also provides guidelines for the teaching staff intending to take on the responsibilities of delivering DBMS and similar courses.

The role of instrumental vaginal delivery in low resource settings

This commentary discusses instrumental vaginal delivery (IVD) and the issues experienced with that practice in low resource settings. It states that IVD is a key element of essential obstetric care and the improvement of maternal and neonatal outcomes will require the scaling up of IVD use with the provision of equipment and trained operators to areas where they are currently unavailable.

Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

BackgroundLittle is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings.MethodsA naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD), foot complications in diabetes, smoking cessation and venous leg ulcers). Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review). Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation). Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation) and follow-up telephone interviews (n = 152 pre, 121 post). Interviews were conducted with 83/95 (87%) CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation.ResultsWhile statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%), diabetes foot care (83%) and venous leg ulcers (60%). Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time, workload pressure and staff resistance.ConclusionImplementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse settings yet many indicators remained unchanged. Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare.