Hands-on Sessions Research Articles

S0535 Education of Trainees and Endoscopy Technicians in Electrosurgical Unit Operations in the Endoscopy Unit

INTRODUCTION: Knowledge gaps in electrosurgical unit (ESU) operations among surgeons, which impact operator and patient safety, are well-documented. However, similar data in gastroenterology are lacking despite ubiquitous use of this device in the endoscopy unit. Our goal was to assess the baseline knowledge of the ESU among primarily GI trainees and endoscopy technicians. METHODS: A longitudinal pilot study was designed to assess the knowledge of trainees and endoscopy technicians at an academic institution. Participation was voluntary. A multiple-choice examination was formulated to test pre-defined learning objectives (Figure 1). Demographics and work experience data were collected (Figure 2). We administered a pre-test (baseline knowledge) followed by a lecture (Session 1). One week later, we held a hands-on demonstration with an assessment of ESU functional operations (Session 2) and a repeat exam. Knowledge was reassessed after 3 months via an online exam. The data was collected and analyzed.Figure 1.: Educational objectives were defined and established for the purpose of assessing knowledge regarding principles, operations, and applications of the ESU in the endoscopy suite. The multiple-choice exam was designed to address Objectives 1-15. Objective 16 was assessed only during Session 2, the hands-on demonstration of the ESU, where participants were expected to perform basic tasks on the ESU under observation.Figure 2.: Demographic data and education background of all participants were collected via survey at the beginning of Session 1, except for 1 GI fellow who only participated in Session 2, after which demographic data was collected.RESULTS: Twelve trainees (11 GI fellows, 1 surgical resident) and 7 endoscopy technicians participated; background details are presented in Figure 2. Before Session 1, the mean reported comfort levels with the principles of ESU (on a scale 1–5) were 2.3 vs. 3.9, and 2.3 vs. 3.7 with physical ESU operations, among trainees vs. technicians, respectively. On the pre-test, the mean score was 57% among 11 GI fellows (confidence of 20–40%), 42% in 1 surgical resident (confidence of 20–40%), and 53% among 7 technicians (confidence of 67–87%). After Session 2, 5 GI fellows scored a mean of 79% (confidence of 55–75%). At 3 months, 8 GI fellows scored a mean of 73% (confidence of 56%) vs. 67% among 3 technicians (confidence of 78%). Practical questions on the exam were answered 61%, 85%, and 76% correctly, in series, on each of the exams. See Figure 3 for detailed data.Figure 3.: Primary results of the study. The graph demonstrates trends of exam scores across sequential components of the study, delineated by participant type. All available exam scores were included regardless if the participant was present for Session 1, Session 2, or both sessions. A table of individual exam score results are juxtaposed with self-reported information regarding comfort level and perception of how one scored after taking the exam. The last table provides results regarding trends in overall exam scores categorized by practical vs. theoretical. The subcategory "practice-critical" reflects practical knowledge that could have implications on immediate adverse effects or outcomes during an endoscopic case.CONCLUSION: Baseline ESU knowledge and self-confidence were deemed suboptimal in all participants. Lecture and a hands-on session provided immediate benefit, but knowledge retention may regress. Overall, participants scored higher at 3 months compared to baseline. Consistent participation was challenging to achieve in this design. Integrating a standardized or formalized curriculum for trainees and staff can improve confidence and practical knowledge of the ESU and achieve adequate cross-training, thereby positively impacting performance and patient safety. This study revealed challenges and limitations to be addressed in more robust future studies.

Human corpse model for video-assisted thoracoscopic lobectomy simulation and training.

Minimally invasive surgery simulation is an integral part of surgical education and skills acquisition. Our goal was to present a new video-assisted thoracic surgery simulation model based on the human corpse as an alternative to animal models. Selective cannulation of the cadaver heart was used to fill the pulmonary vessels with a gel to improve the visibility and tactile feedback of the vessels and to simulate any bleeding complications. During surgical simulation, the tutor fills out a questionnaire designed to evaluate the duration of the procedure, the correct completion of the surgical steps and the occurrence of complications. At the end of the simulation session, in order to compare the simulation to clinical practice, all the participants were asked to answer 5 questions using a scale from 1 to 10. We have performed 2 hands-on sessions using 2 human corpses for each session. Each surgeon performed 1 lobectomy using video-assisted thoracoscopic surgery (VATS) first as the operator and at least 1 lobectomy as an assistant. The median operative time was 83 min in favour of surgeons who had previously performed more than 30 video-assisted lobectomies (P = 0.03). All the surgeons were able to complete all the steps of the procedure; surgeons who had performed fewer than 10 lobectomies required more support by the tutors than the other surgeons. The median total score was 40.5 (interquartile range 39-44.8). We believe that this model includes most of the features necessary to validate a surgical simulator and allows realistic training for performing a VATS lobectomy. This model could be an effective alternative to anaesthetized animals for VATS lobectomy training and simulation.

A curriculum to democratize and standardize flexible endoscopy fundamental knowledge and skills: a critical review of the first 5years of a surgical endoscopy university diploma.

As flexible endoscopy offers many advantages to patients, access to training should be aggressively encouraged. In 2014, the IRCAD-IHU-Strasbourg launched a year-long university diploma using advanced education methods to offer surgeons and gastroenterologists high-quality, personalized training in flexible endoscopy. This paper describes and critically reviews the first 5years of the University Diploma in Surgical Endoscopy (UDSE). The UDSE aims to progressively transmit theoretical knowledge, clinical judgment, and practical skills on basic and advanced flexible endoscopy. The 300-h year-long curriculum is composed of 100h of online lectures with tests, 150h of clinical rotations and 50h of hands-on sessions. The hands-on training is delivered through validated mechanical simulators, virtual reality simulators, and specifically designed ex vivo and in vivo animal models. Participants' demographics, training, and clinical experience were recorded. Trainees' evaluations of each online lecture, hands-on training, and clinical rotations were assessed using a Likert scale from 1 (not satisfactory) to 5 (outstanding). Trainees' skill progression was evaluated using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) proficiency test. Finally, clinical uptake was surveyed. 162 (79.01% males) trainees from 38 countries enrolled and successfully completed the first 5 courses. The vast majority of the trainees were surgeons and 19.14% were gastroenterologist. Sixty-nine (42.59%) participants were residents and 97 (56.79%) had no prior experience in flexible endoscopy. The online lectures, on-site sessions, and clinical rotations were highly appreciated receiving an overall average score of 4.33/5, 4.56/5, 4.43/5, respectively. Trainees' endoscopic skills improved significantly (16.68 vs. 20.53 GAGES scores; p = 0.016). At an average of 18.83months following the course, 31 alumni (77.50% of repliers) started to use a flexible endoscope in their practice. Over its 5-year evolution, the UDSE has proven to be a valid means to ease access to the fundamental knowledge, practical skills, and clinical judgment necessary to achieve proficiency in surgical endoscopy.

Usability and Practicality of a Novel Mobile Attachment for Aural Endoscopy (endoscope-i): Formative Usability Study

Background Our aims were to determine the usability and practicality of the endoscope-i system, a novel mobile attachment for aural endoscopy. This incorporated assessing the ease of use of the endoscope-i for different professionals, and ultimately improving the system by receiving constructive feedback. Objective Our objectives were to assess the ease of the endoscope-i system in conducting an aural examination and to assess its feasibility for integrating its use into clinical practice. We looked to assess its ease, effectiveness, and efficiency; to compare this to current practices with otoscopes; and to determine whether participants perceived the system to be able to produce an image of sufficient quality to make a clinical assessment. Finally, we wanted to assess the usefulness of the current training given for using the system, and we sought to gain feedback for the product from the differing specialists. Methods A formative usability study of the endoscope-i system was conducted with 5 health care professionals. Each session lasted 40 minutes and involved audio/video consent, a hands-on session, a private semistructured interview, and an option to discuss the device with a company representative. Results All participants found the endoscope-i system easy to use. The image quality was perceived to be greater than that achieved by current otoscopes. The ability to record images and view them retrospectively was also seen as a positive. Conclusions This study has not identified any significant issues relating to the design, functionality, or application of the endoscope-i. Participants perceived the system as superior to current options with a directly positive impact on their clinical practice.

Resident perception of standardization and credentialing for high-risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study.

Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre-and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents' perceptions of the course and the procedures. Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledge-based evaluations. Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.

Neurosurgical simulator for training aneurysm microsurgery\u2014a user suitability study involving neurosurgeons and residents

BackgroundDue to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)–based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures.Materials and methodsWe developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4–15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants’ clipping performance and a comparison between groups was done.ResultsThe proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods.ConclusionThe integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.

Untargeted Metabolomics Workshop Report: Quality Control Considerations from Sample Preparation to Data Analysis.

The Proteomics Society, India (PSI), hosted the Metabolomics workshop on experimental and data analysis training for untargeted metabolomics in December 2019. The workshop included six tutorial lectures and hands-on data analysis training sessions presented by seven speakers from across the globe. The tutorials and hands-on data analysis sessions focused on workflows for liquid chromatography-mass spectrometry (LC-MS) based on untargeted metabolomics. We review here three main topics from the workshop, which were uniquely identified as bottlenecks for new researchers: (a) experimental design, (b) quality controls during sample preparation and instrumental analysis, and (c) data quality evaluation using open source tools. Our objective here is to present common challenges faced by novice researchers and present guidelines to address them. We provide resources and good practices for researchers who are at the initial stage of setting up metabolomics workflows in their laboratories.

The performance improvement-score algorithm applied to endoscopic stone. Treatment step 1 protocol

Background Pi-score (Performance Improvement score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. Methods The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during 4 courses in Barcelona and Milan. Collected data were independently analysed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa Statistics was used for comparison analysis. Results 16 Hands-on Training expert tutors and 47 3rd year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task1=0.30 (fair); Task2=0.18 (slight); Task3=0.10 (slight); Task4=0.20, (slight). Concordance between Pi-score results and proctor average scores per-participant was the following: Task1=0.74 (substantial); Task2=0.71 (substantial); Task3=0.46 (moderate); Task4=0.49 (moderate). Conclusions Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.

Exploratory analysis on the usage of Pi-score algorithm over endoscopic stone treatment step 1 protocol.

The Performance Improvement score (Pi-score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during four courses in Barcelona and Milan. Collected data were independently analyzed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa statistics were used for comparison analysis. Sixteen hands-on training expert tutors and 47 3rd-year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task 1=0.30 ("fair"); Task 2=0.18 ("slight"); Task 3=0.10 ("slight"); Task 4=0.20, ("slight"). Concordance between Pi-score results and proctor average scores per-participant was the following: Task 1=0.74 ("substantial"); Task 2=0.71 ("substantial"); Task 3=0.46 ("moderate"); Task 4=0.49 ("moderate"). Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

2015 개정 교육과정의 「과학탐구실험」이 고등학생의 과학 및 일반 핵심역량에 미치는 효과: 교수학습 방법을 중심으로

This study investigated the effect of 「Science Inquiry Experiment」 of 2015 Revised National Curriculum towards high school students’ science and general core competencies. To discern its own effect from that of 「Integrated Science」, researchers focused on the teaching & learning methods within the classes. We utilized pre- and post-test design between the end of 1st and 2nd semesters. Research data were from 489 high school 1st grader students from 5 regions of South Korea, using questionnaires about 5 science and 6 general core competencies. As a result, all the 5 science core competencies and total science competency score were increased significantly, but only 2 general core competencies were increased significantly and total general core competency score did not. In the regression analysis, among teaching & learning methods ‘hands-on’ and ‘others’ showed significant positive effect on science and general core competencies. And significant negative effect were shown in ‘non-lab activity’ for science core competency, and ‘minds-on’ for science and general core competencies. It is probably because those teaching & learning methods were different in the extent of guiding students to actively engage in the classes. Thus, the subject can foster students’ core competencies when introducing enough hands-on sessions. Referring to the teacher survey, researchers suggested that the subjectivity of science teachers should be emphasized and supported to help their practice in the 「Science Inquiry Experiment」classes. And ultimately, to help students foster core competencies which are required in the future society, hands-on experiment centered science subject should remain in the next national curriculums.

Prof. James Tait Goodrich 1946 - 2020+

James Tait Goodrich was born on April 16, 1946 in Portland, Oregon, United States, the son of Richard Goodrich and Gail (Josselyn) Goodrich. Dr. Goodrich served as a Marine officer during the Vietnam War, during which time he decided his next step would be to pursue a medical career. Not only was he an elite surgeon, but over the years he was also a generous mentor and teacher who shared his craft with many young surgeons who wanted to follow in his footsteps. During the Tet Offensive, he spotted a Vietnamese surgeon in a medical tent opening up a soldier’s head. “Cool,” he thought. “I want to do that” (1). Upon return to the USA, Jim married Judy Loudin on December 27, 1970, the love of his life who gave him the confidence and support to pursue his dreams. Dr. Goodrich completed his undergraduate work at the University of California, Irvine and his graduate studies at the School of Arts and Sciences of Columbia University (1972), receiving his Masters and Doctor of Philosophy degrees in 1978 and 1980, respectively. He received his Medical Degree from Columbia University College of Physicians and Surgeons. After an internship at Columbia- Presbyterian Medical Center (1980-1981), he completed his residency training at the Presbyterian Hospital in New York City and the New York Neurological Institute (1981-1986). He also holds the rank of Professor Contralto of Neurological Surgery at the University of Palermo in Palermo, Italy. He was Director of the Division of Pediatric Neurosurgery at the Children’s Hospital of Montefiore Health System and he served as a Professor of Clinical Neurological Surgery, Pediatrics, Plastic and Reconstructive Surgery at the Albert Einstein College of Medicine since 1998 (2). Dr. James T. Goodrich dedicated his life to saving children with complex neurological conditions. He had a particular interest in the treatment of craniofacial abnormalities. He was a pioneer in this field and developed a multi-stage approach for separating craniopagus twins who have their brain and skull conjoined. In 2016, he famously led a team of 40 doctors in a 27-hour procedure to separate the McDonald twins. Throughout his distinguished career, he became known as the world’s leading expert on this lifesaving procedure. He has been consulted on hundreds of cases, and he routinely traveled the world sharing his vast knowledge and expertise with colleagues (3,4). In Brazil, Dr. Goodrich played a very important role in leading the processes to successfully separate craniopagus sets in Ribeirao Preto (2017-2018), and in Brasilia (2019). A classical multistage surgery was performed to separate the Ribeirao Preto conjoined twins, and Dr. Goodrich participated on all the neurosurgical procedures as a great mentor. In the final operation, on October 28, 2019, some members of Montefiore Hospital medical staff (Dr. Oren Tepper, plastic surgeon, Dr. Carlene Broderick, pediatric anesthesiologist and Kamilah A. Dowling, nurse) also worked alongside Jim and the Brazilian team. An extraordinary and humble man, his words after the first surgical step, during an interview for a TV channel, were that in “this particular surgery we were able to do more than we expected because the anatomy was very good and the team had exceptional skills that made the difference”. Dr. Goodrich was a chief supporter of the Latin American Pediatric Neurosurgery Course (LACPN), having participated in all editions since 2004. In these events, he did not hesitate to share his knowledge during the hands-on sessions and, likewise, his wonderful conferences. Prof. Goodrich was officially honored by the Brazilian Society for Pediatric Neurosurgery during the “XII Brazilian Congress of Pediatric Neurosurgery”, in Florianopolis, Brazil. Dr. Goodrich was a gentle and truly caring man. He did not crave the limelight and was beloved by his colleagues and staff. He has authored numerous book chapters and articles on Pediatric Neurosurgery and is known worldwide as a prominent lecturer in this field. Outside his work, he was also known for his passion for historical artifacts, travelling, wine, and surfing. Dr. Goodrich was an incredible human being. In March 30th, 2020, he passed away after complications due to Covid-19 (5). In that day the world has become a little less bright without Jim. Our sympathy and prayers go to his wife Judy, his three sisters, and all those who were close to him

Tu1046 EFFECT OF AN EDUCATIONAL POLYPECTOMY WORKSHOP ON CHOICE OF TOOL UTILIZED BY GENERAL ENDOSCOPIST DURING COLONOSCOPY

Optimal removal of diminutive (<5mm) polyps (DP) has been evaluated in multiple studies. Studies have compared and shown that polyp removal via cold snare polypectomy (CSP) is superior to removal via jumbo biopsy forceps (JBF), especially for DP measuring 4-5mm. Despite this, many general endoscopists still utilize JBF as the standard approach for DP removal. Our study sought to determine if a polypectomy educational session would increase the rate of CSP among general endoscopists. General endoscopists at a tertiary care center underwent an educational session discussing the optimal methods of polyp removal, followed by a hands-on laboratory session. Participants underwent surveys analyzing comfort regarding removal of polyps before and immediately after the session. Changes in polypectomy practice was analyzed by looking at random 2 week intervals of all colonoscopies performed by general endoscopists prior to, immediately after, and 6 months after the educational session was completed. Endoscopy notes were retroactively analyzed to gather data on number of polyps removed, polyp size, method of removal, and patient characteristics. Chi Square analysis was utilized to compare the change in polypectomy method across the three time points. 17 general endoscopists underwent the education session. Surveyed participants experienced a small subjective improvement in comfort using CS for removal of polyps and with removal of flat polyps less than 10mm. 218 colonoscopy patients (54.9% female) were evaluated before (n=97), immediately after (n=83), and 6 months after (n=88) the polypectomy seminar. There was no significant difference between age, BMI, prep quality, and polyp size amongst groups. There was a significant increase in CS compared to JBF use for the removal of ≥ 4mm polyps immediately after the session (p=0.0008 using Bonferroni-adjusted p-value). There was an insignificant decline in the proportion of CS use at 6 months post intervention compared to immediately-after the workshop (p=0.108). When broken down further, the proportion of 4mm polyps removed with a CS rather than JBF significantly increased immediately after the educational session and was sustained at 6 months post intervention (p=0.0004). There was no significant change in rates of CS use for 5mm polyps, although data showed it was used >90% of the time prior to the educational intervention (p=0.1420). An educational session with didactic and hands-on components appears to be an effective way to increase proportion of CS use for DP removal at a tertiary care center, thereby likely improving resection margins. Further studies will evaluate if these results remain sustained and if this session would be of benefit to endoscopists in a community setting.Proportion of cold snare compared to jumbo biopsy forceps utilization in polypectomy for polyps 4-5mm in size.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Do Voluntary Lab-Based Active Learning Sessions Impact Medical Student Knowledge Retention?

Despite recent evidence demonstrating the benefits of case-based and active learning strategies in medical education, many medical schools have reduced or entirely eliminated teaching laboratories in medical microbiology courses. The objective of our investigation was to analyze the impact of a voluntary hands-on microbiology laboratory session on students' knowledge retention and ability to apply the underlying principles to exam questions in our Introduction to Infectious Diseases (IID) course. We compared the performance of students participating in the wet labs with those who did not, analyzing scores on exam questions directly related to the concepts presented in the laboratory session and their overall scores on the IID module exam. The voluntary nature of our microbiology lab session provided a unique opportunity to assess its impact on knowledge retention independent of other factors, such as lecture and exam content, etc. Data were collected for 7 academic years and analyzed in aggregate. Students who attended voluntary lab sessions scored higher on exam questions related to lab exercises than students who did not attend (Mann-Whitney, p = 0.0074). These results support the benefit of reexamining material originally presented during classroom sessions in an active, collaborative learning environment. Course evaluation responses indicted that students valued the opportunity to visually reinforce concepts they had previously read in a textbook or heard in lectures. At a time when many medical schools are reducing or eliminating hands-on lab sessions in microbiology and other basic sciences, our results highlight the benefits of this teaching strategy. The laboratory session provided an opportunity for students to revisit concepts initially presented in the traditional classroom setting and to actively engage in applying these concepts to case-based scenarios. The improved educational outcomes will benefit students in future standardized exams as well as in their professional practice.

ECLS Training and Simulation - Evaluation of the 8th Educational Corner of the EuroELSO Congress 2019 Held in Barcelona.

Introduction: Simulation-based learning and hands-on learning are popular in medicine, particularly in areas where life-saving manoeuvres and team skills are required. Simulations can be provided in different environments: directly in hospitals (in situ), in dedicated facilities (simulation rooms) or, on occasion, at scientific meetings, thus taking advantage of the delegates' motivation. Simulation-based learning in extracorporeal life support is also increasingly relevant due to the inherent features of the often difficult and emergent decision-making, approaches and management involved, as well as to the challenging multidisciplinary teamwork. Aim: Based on these premises and on the constant rise in interest in starting new extracorporeal life support programmes, the EuroELSO organization has, since the beginning of its scientific activities, established an 'ad hoc' space (Educational Corner) for training and hands-on sessions with a limited number of attendees per session during its annual congress. Methods: Experienced trainers deliver repeated dedicated sessions on fundamental aspects of extracorporeal life support management. After several years of sessions, a questionnaire was prepared and delivered to the attendees at the 8th annual congress in Barcelona. Results: More than 90% of the responders indicated that they would recommend the workshop to their colleagues and that they received useful information during the workshops. Over 85% of the responders (85-97%) indicated that the workshops met the set educational goals and objectives and indicated that the simulation sessions would have a positive impact on their daily practice. Conclusion: The Educational Corner during the EuroELSO Congress has achieved great popularity, as shown by the number of attendees participating each year, and presumably improves many technical and behavioural skills among the attendees.

P046: Physicians experience with the Epic electronic health record system: findings from an academic emergency department implementation

Introduction: In June 2019, The Ottawa Hospital launched the Epic EHR system, which transitioned all departments from a primarily paper-based system to an exclusively electronic system using a one-day “big bang” approach. All Emergency Physicians (EP) received online module training, personalization sessions, and at-the-elbow support during the transition. We sought to evaluate EP satisfaction with the implementation process and the system's impact on clinical practice in a tertiary care academic emergency medicine setting. Methods: Email surveys were distributed during the pre-implementation and go-live phases. Questions were developed by the research team and piloted for face validity and clarity. Surveys were sent to staff EPs, residents and fellows. Likert scales were used to evaluate agreement with statements and the modified Maslach Burnout Inventory was used to assess burnout. Pre-post groups were compared using chi-squared tests to assess for significant differences. Future surveys will be distributed in 2020 for continued implementation evaluation. Results: Response rates were 49% (78/160) in the pre and 48% (76/160) in the post period. The majority of respondents were staff (66% pre; 75% post) working 8-15 shifts/month. Prior to launch, 52% of EPs felt the pre-training modules provided sufficient preparation, however only 32% felt this way after go-live (p = 0.02). Providers did not feel there were enough personalization (21% pre vs. 24% post, p = 0.66) or hands-on sessions offered (51% pre vs. 39% post, p = 0.15) and this opinion did not change after go-live. Before Epic, EPs were most concerned with productivity/efficiency, documentation time, and lack of support/training. Although documentation was reported to be easier after go-live by 69% of EPs, reviewing documents, using standardized workups/protocols, patient monitoring/follow-up, efficiency and billing were reported by &gt;50% of EPs to be more difficult. Overall, there was a 22% increase in feeling confident to use Epic (28% pre vs. 50% post, p &lt; 0.01); however, only 38% of providers were satisfied with the system. Notably, 82% of EPs reported experiencing moderate or high burnout in the post implementation period. Conclusion: Despite receiving standard EHR training and support, the majority of clinicians did not feel adequately trained or confident using Epic and reported moderate to high burnout. These findings will inform optimization efforts and they represent key considerations for other EDs planning future implementations.

Contributions from Japan to gastrointestinal endoscopy training and development: Special report.

Contributions from Japan to gastrointestinal endoscopy training and development: Special report.

Scientific method for improvement and student success: Plan-Do-Study-Act.

Are you curious what STEM students find to be barriers to their own success? Do you have anything in your courses or research laboratory environments that you would like to improve? In this hands-on session you will learn how to use the basic principles of improvement science, specifically a branch called Networked Improvement Communities (NIC), to identify ideas that you think might produce the improvement you seek. You will be guided through setting up a Plan-Do-Study-Act (PDSA) cycle to test your change idea on a rapid timescale in your own local environment. The First2 Network (https://first2network.org) is a growing statewide alliance that aims to improve student success and retention in STEM fields, using the NIC framework. First-generation and other underrepresented students are at the center of the work, and current undergraduates involved in First2 will help lead this session. We invite all students at the conference to join in and share their own experiences and perspectives with faculty members during this session. First2 Network, a National Science Foundation INCLUDES Alliance, is supported by NSF award numbers HRD-1834569, 1834575, 1834586, 1834595, and 1834601.

Unique Exposure to Ultrasound in Pre-clinical Undergraduate Medical Education [39A

INTRODUCTION: Purpose: Descriptive case study of pre-clinical ultrasound education at the University of Nevada, Las Vegas School of Medicine. BACKGROUND: Point-of-Care Ultrasound (POCUS) is increasingly valued across medical disciplines. As benefits of ultrasound are recognized, so too is the need to integrate ultrasound into undergraduate medical education (UME). Early exposure contributes to ease of use during clinical rotations. Our objective is to describe integration of POCUS before clinical immersion and how efforts were perceived. METHODS: 58 medical students participated in a hands-on training session before initiation of clerkship duties. A brief didactic introduction for ultrasound techniques began each session. Students were divided into duos and rotated through 6 stations designed to provide training in ultrasound of the abdomen, head/neck, and cardiac. Each station consisted of a clinical scenario, ultrasound machine, standardized patient/model, and instructor. Student feedback was collected via 6-point questionnaire at the end of the session. RESULTS: 58/58 students completed the survey, positively evaluating clinical relevance and student satisfaction. 58/58 students answered “yes” that “the session met the stated learning objectives,” 57/58 answered “yes” that “the learning environment was conducive to my acquiring new skills.” Comments were entered in an optional field with the descriptors “great” and “helpful” trending throughout feedback, indicating high student satisfaction. CONCLUSION: UME is changing, with new challenges to preparing students for clinical years including the incorporation of POCUS. The overwhelmingly positive feedback for our session indicates integrating POCUS as an educational tool with hands-on ultrasound practice can provide engaging and applicable skills for medical students.

Longitudinal Competence Programs for Basic Point-of-Care Ultrasound in Critical Care: A Systematic Review

Competence in point-of-care ultrasound (PoCUS) is widely recommended by several critical care societies. Despite numerous introductory short courses, very few doctors attain PoCUS competence because of the challenges in establishing longitudinal competence programs. To evaluate the methodologic quality of the literature on basic PoCUS competence processes in critical care. A systematic review to identify manuscripts meeting predefined inclusion criteria was performed using three medical databases (PubMed, OVID Embase, and Web of Science); using extra references from original articles, review articles, and expert panel guidelines; and by directly contacting authors for further information if required. The objectives, domains, and inclusion and exclusion criteria of the review were determined during discussions between experienced PoCUS educators. Data extraction and analyses were performed independently by three reviewers. Of the 5,408 abstracts extracted, 42 met the inclusion criteria for longitudinal PoCUS competence. Each study was described along four broad categories: general information, study design, and trainee characteristics; description of introductory course; description of longitudinal competence program; and grading of overall methodologic quality on a 4-point Likert scale. Thirty-nine studies (92.9%) were from a single center. Most studies lacked important details on study methodology such as prior ultrasound experience, pre- and postcourse tests, models for hands-on sessions, ratio of instructors to trainees, competence assessment criteria, number of scans performed by individual trainees, and formative and summative assessments. The studies were rated as follows: poor= 19 (45.2%), average= 15 (35.7%), good= 4 (9.5%), and excellent= 4 (9.5%). Ther is very little high-quality evidence on PoCUS competence. To help frame policy guidelines to improve PoCUS education, there is a need for well-designed longitudinal studies on PoCUS competence. PROSPERO database; No.: CRD42018094033; URL: https://www.crd.york.ac.uk/PROSPERO/.