Mandatory Skills Research Articles

Preclinical Simulation Training of Medical Students Results in Better Procedural Skills Performance in End of the Year Three Objective Structured Clinical Evaluation Assessments

Objectives The Association of American Medical Colleges published guidelines for procedural skills to be included in medical school curricula; however, standardized training and objective assessments of procedural skills are limited. We implemented and evaluated a simulation-based mandatory procedural skills training program for preclinical medical students for nine procedures students were expected to gain proficiency before graduation.

Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings

Objective:To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings.Methods:This qualitative exploratory research was conducted through video recording at The Children’s Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis.Results:Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: (1) Courteous and polite attitude, (2) Marginal nonverbal communication skills, (3) Power game/Ignoring child participation and (4) Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement.Conclusion:Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor’s instrumental behaviour and ignoring the child participation.

Integration of a Low-Cost Introductory Ultrasound Curriculum Into Existing Procedural Skills Education for Preclinical Medical Students.

We evaluated integration of an introductory ultrasound curriculum into our existing mandatory procedural skills program for preclinical medical students. Phantoms consisting of olives, pimento olives, and grapes embedded in opaque gelatin were developed. Four classes encouraged progressive refinement of phantom-scanning and object identification skills. Students improved their ability to identify hidden objects, although each object type achieved a statistically significant improvement in correct identification at different time points. The total phantom cost per student was $0.76. Our results suggest that short repeated experiences scanning simple, low-cost ultrasound phantoms confer basic ultrasound skills.

Examining Residents' Strategic Mindfulness During Self-Regulated Learning of a Simulated Procedural Skill.

Simulation-based training is currently embedded in most health professions education curricula. Without evidence for how trainees think about their simulation-based learning, some training techniques may not support trainees' learning strategies. This study explored how residents think about and self-regulate learning during a lumbar puncture (LP) training session using a simulator. In 2010, 20 of 45 postgraduate year 1 internal medicine residents attended a mandatory procedural skills training boot camp. Independently, residents practiced the entire LP skill on a part-task trainer using a clinical LP tray and proper sterile technique. We interviewed participants regarding how they thought about and monitored their learning processes, and then we conducted a thematic analysis of the interview data. The analysis suggested that participants considered what they could and could not learn from the simulator; they developed their self-confidence by familiarizing themselves with the LP equipment and repeating the LP algorithmic steps. Participants articulated an idiosyncratic model of learning they used to interpret the challenges and successes they experienced. Participants reported focusing on obtaining cerebrospinal fluid and memorizing the "routine" version of the LP procedure. They did not report much thinking about their learning strategies (eg, self-questioning). During simulation-based training, residents described assigning greater weight to achieving procedural outcomes and tended to think that the simulated task provided them with routine, generalizable skills. Over this typical 1-hour session, trainees did not appear to consider their strategic mindfulness (ie, awareness and use of learning strategies).

Qualification of ship doctors: a German approach.

While a steady growth of cruise tourism since the 1970s created an increasing demand for ship doctors medical postgraduate specialty training did not sufficiently reflect the scope of skills and knowledge required from a physician being left to himself at sea. The German Maritime Health Association therefore tasked a working group with analysing the situation and coming up with suggestions for an adequate postgraduate training for ship doctors. The working group consisted of 19 experts with various backgrounds in maritime medicine. A literature review was done on cruise ship epidemiology as well as an assessment of tasks and environmental factors influencing medical care on board of cruise ships. Necessary knowledge and skills were derived and compared with those imparted by standard German medical education. Mandatory knowledge and skills were identified as well as elements of standard medical education contributing to these goals. Those aspects that would or could not be adequately covered by German standard education were catalogued and summarised in a course curriculum. In 2013 after approval by its board of directors the German Maritime Health Association published a qualification and training recommendation addressing colleagues planning to muster as ship doctors.

Why evaluation is important to you, me and everybody

The Health and Care Professionals Council (HCPC) suggest that the use of operational evaluation and monitoring contributes to the creation of correct and current assessment standards ( HCPC, 2009 ). This short article is aimed at anyone who attends training courses including mandatory, induction, CPD, management and clinical skills, and explores the theory of evaluation and its benefit in adding depth and value to all training purposes.

O-069a Videolaryngoscopy As An Intubation Training Tool For Neonatal Trainees – A Randomised Controlled Trial: Abstract O-069a Table 1

<h3>Background and aims</h3> Endotracheal intubation is a mandatory skill for neonatal trainees. However, inexperienced trainees have success rates &lt;50%. We compared intubations supervised by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view. <h3>Methods</h3> RCT (ANZCTR# 12613000159752) at The Royal Women’s Hospital, Melbourne. Eligible intubations were those performed orally, in infants without facial or airway anomalies, in the delivery room or in NICU, by trainees with &lt;6 months experience. Intubations were randomised to videolaryngoscope screen visible to the instructor (intervention) or covered (control). Primary outcome was first attempt intubation success rate confirmed by colorimetric detection of expired CO₂. A sample size of 206 provided 80% power to detect a 20% difference in success rates (50% vs. 70%). <h3>Results</h3> <h3>Conclusions</h3> Intubation success rates of inexperienced doctors were significantly improved, OR 2.81 (95% CI 1.54–5.17), when the instructor was able to share their view on a videolaryngoscope screen.

PO-0753 Videolaryngoscopy As An Intubation Training Tool For Neonatal Trainees – A Randomised Controlled Trial

<h3>Background and aims</h3> Endotracheal intubation is a mandatory skill for neonatal trainees. However, it is difficult to learn and junior trainees have success rates &lt;50%. Videolaryngoscopy allows the instructor to share the same view of the pharynx as the trainee. We compared intubations guided by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view. <h3>Methods</h3> An unblinded randomised, controlled trial (ANZCTR number 12613000159752) at a tertiary neonatal centre commenced March 2013. Eligible intubations were those performed on infants in the delivery room or in the neonatal intensive care unit, by trainees with less than six months of tertiary neonatal experience. Nasal intubations, intubations in infants with facial, oral or airway abnormalities and intubations carried out by more experienced doctors were excluded. Intubations were randomised to the videolaryngoscope screen being visible or covered (control). A sample size of 206 had an 80% power to demonstrate an absolute difference of 20% in the success rate between intervention and control groups. Primary outcome was first attempt intubation success rate confirmed by colorimetric detection of expired carbon dioxide. <h3>Results</h3> 190 intubations have been randomised since March 2013 (80% of all eligible intubations since trial commencement). Median weight at intubation of recruited infants was 1195 g (range 504–4804 g), median corrected gestation 29 weeks post menstrual age (range 24–41). Recruitment will be complete by May 2014 and data analysis by July 2014. <h3>Conclusions</h3> To follow upon completion of the trial.

Mandatory communication skills training for oncologists: enforcement does not substantially impact satisfaction.

Even though there is evidence that both patients and oncology clinicians are affected by the quality of communication and that communication skills can be effectively trained, so-called Communication Skills Trainings (CSTs) remain heterogeneously implemented. A systematic evaluation of the level of satisfaction of oncologists with the Swiss CST before (2000-2005) and after (2006-2012) it became mandatory. Levels of satisfaction with the CST were high, and satisfaction of physicians participating on a voluntary or mandatory basis did not significantly differ for the majority of the items. The evaluation of physicians' satisfaction over the years and after introduction of mandatory training supports recommendations for generalized implementation of CST and mandatory training for medical oncologists.

Mandatory communication training of all employees with patient contact

In 2010 a communication program that included mandatory communication skills training for all employees with patient contact was developed and launched at a large regional hospital in Denmark. ObjectiveWe describe the communication program, the implementation process, and the initial assessment of the process to date. MethodThe cornerstone of the program is a communication course based on the Calgary Cambridge Guide and on the experiences of several efficacy and effectiveness studies conducted at the same hospital. The specific elements of the program are described in steps and a preliminary assessment based on feedback from the departments will be presented. ResultsThe elements of the communication program are as follows: (1) education of trainers; (2) courses for health professionals employed in clinical departments; (3) education of new staff; (4) courses for health professionals in service departments; and (5) maintenance of communication skills.Thus far, 70 of 86 staff have become certified trainers and 17 of 18 departments have been included in the program. Conclusion and practice implicationsEven though the communication program is resource-intensive and competes with several other development projects in the clinical departments, the experiences of the staff and the managers are positive and the program continues as planned.

ATTITUDES AND EXPERIENCE OF TRAINEES IN PALLIATIVE MEDICINE TO ABDOMINAL PARACENTESIS

BackgroundAbdominal paracentesis is widely used as a symptom control measure for malignant ascites. In the UK, ultrasound guided insertion has become standard practice in some specialist palliative care units. This...

Communication Approach in Teaching English as a Foreign Language: In reference to Uttar Pradesh

The present paper is a study of the condition of Englishin Uttar Pradesh as it is considered to be worst of all the states of India. It also suggests ways of teaching English in Uttar Pradesh and Introduction of Communicative Language Teaching can be really vital. English is considered to be a mandatory skill of survival in the present circumstances but irony is that Government is not giving so much consideration to this fact. The paper suggest some remedy for the improvement of standard of English in UP as writer observes many drastic mistakes and problems of undergraduate students personally. The paper is an attempt to draw attention towards those problems and find a solace.

Pericardiocentesis in trauma

Pericardiocentesis (PCC) had been taught as a mandatory skill in the Advanced Trauma Life Support (ATLS®) course as a bridge to definitive surgical therapy for traumatic pericardial tamponade since its inception in 1978. Immediate thoracotomy for penetrating trauma to the heart and chest has resulted in the decreased use of PCC in trauma. PCC is now offered as an optional skill in the ninth edition of the ATLS®. A review of the literature regarding the use and effectiveness of PCC in traumatic pericardial tamponade in the modern era is necessary to better define its current role in trauma care. Scientific publications from 1970 to 2010 involving PCC after trauma were identified. The Preferred Reporting Items for Systematic reviews and Meta-Analyses was used. Human studies describing acute traumatic tamponade were included. Publications involving nontraumatic or chronic pericardial tamponade from effusions caused by inflammatory, infectious, or neoplastic etiology were excluded. Publications were categorized by level of evidence. Of the 135 publications identified, 27 were included, composing of 2,094 trauma patients with suspected cardiac tamponade. The reported use of PCC decreased from 45.9% of patients in the period 1970 to 1979 down to 6.4% of patients in the period between 2000 and 2010 (p < 0.05). Reported rates describing the use of PCC as the sole intervention decreased from 13.7% in the period 1970 to 1979 to 2.1% in the period 2000 to 2010 (p < 0.05). Survival analysis after PCC was possible for 380 patients. Overall survival following PCC was 83.4% (n = 317) and 91.8% (n = 145) when used as the sole intervention. In patients who received PCC then thoracotomy, survival rate was 79.5% (n = 178). Studies on the use of PCC for trauma are limited and biased toward survivors. The reported survival rate is high. There remains a limited role for PCC in nontrauma centers where definitive surgical management is not immediately available and transport time to a higher level of care facility supports the use of temporary decompression by PCC. Systematic review, level III.

ACGME and ABOS Changes for the Orthopaedic Surgery PGY-1 (Intern) Year

The Accreditation Council for Graduate Medical Education (ACGME) and American Board of Orthopaedic Surgery (ABOS) recently mandated major changes to curricular requirements for the PGY-1 (intern) year for categorical orthopaedic surgery residents. Since July 1, 2013, PGY-1 residents are required to have 6 months of orthopaedic surgery rotations, 6 months of nonorthopaedic surgery rotations, and complete a mandatory surgical skills curriculum [1, 2]. The ACGME and ABOS executed these changes in an effort to improve the quality and breadth of education for interns, preparing them for more advanced orthopaedic education. These changes were prompted by shifts in general surgery procedures (from open to laparoscopic), which have reduced the operating room experience of suturing and knot tying for interns, as well as by duty hour requirements that further reduce the operating room experience for interns. Together, these shifts in first-year resident experience have resulted in less surgical training for the orthopaedic surgery intern. The new ABOS requirements, which commence on July 1, 2014, seek to offset those losses [1, 2]. This column describes the changes mandated by the ABOS and ACGME for the orthopaedic intern year, discusses some limitations associated with these changes, and offers program strategies for effective implementation.

Conversational learning among medical students: harnessing the power of web 2.0 through user driven healthcare.

The prevalent system of Undergraduate Medical Education in India by and large thrives on a system of didactic lectures or antiquated textbooks based teaching-learning rather than dynamic patient based interaction. Couple that with minimal motivation and future incentives for students pursuing undergraduate research as well as the lack of formal training, a graduate medical doctor is not equipped with the basic mandatory skill set of appraising available evidence for treating patients in his practice. doi : 10.5214/ans.0972.7531.200201

Postgraduate surgical education and training in Canada and Australia: each may benefit from the other's experiences

Canada and Australia share similar cultural origins and current multicultural societies and demographics but there are differences in climate and sporting pursuits. Surgeons and surgeon teachers similarly share many of the same challenges, but the health care and health-care education systems differ in significant ways. The objective of this review is to detail the different postgraduate surgical training programs with a focus on general surgery and how the programs of each country may benefit from appreciating the experiences of the other. The major differences relate to entry requirements, the role of universities in governance of training, mandatory skills courses in early training, the accreditation process, remuneration for surgical teachers and the impact of private practice. Many of the differences are culturally entrenched in their respective medical systems and unlikely to change substantially. Direct entry into specialty training without an internship per se is now firmly established in Canada just as delayed entry after internship is mandated by the Australian Medical Board. Both recognize the importance of establishing goals and objectives, modular curricular and the emerging role of online educational resources and how these may impact on assessments. The Royal Australasian College of Surgeons is unlikely to cede much responsibility to the universities but alternative academic models are emerging. Private health care in the two countries differs, but there are increasing opportunities for training in the private sector in Australia. In spite of the differences, both provide excellent health care and surgical training opportunities in an environment with significant fiscal, technological and societal challenges.

Robotic implantation of deep brain stimulation leads, assisted by intra-operative, flat-panel CT

There are two mandatory skills in deep brain stimulation (DBS) neurosurgery: accuracy and control. Frame-based robotic registration was performed. Prior to insertion into the skull, the guide tube's position was checked with flat-panel computed tomography (fpCT). After registration against the pre-operative plan, we measured and corrected the robotic arm's position so that the guide tube with the micro-electrode would follow the planned trajectory exactly. We then used fpCT again to check the DBS lead's final position. The combination of intra-operative fpCT with robotised surgery provides an appropriate, user-friendly solution to the key technical challenges in DBS lead implantation.

Back to basics in the management of suspected sepsis: investigate then treat

Sepsis is the leading cause of direct maternal deaths in the UK. The 2011 Confidential Enquiries into Maternal Deaths Report recommends early recognition and aggressive antibiotic treatment as key measures...

Are nursing students’ clinical skills competency and self-confidence levels improved via video iPods? A randomized controlled pilot study

Background: Mobile technologies allow students the opportunity to enhance learning while away from the traditional classroom setting. However, educational outcome research is lacking in the use of mobile health (m-health) applications in healthcare professional practice development. Objectives: The aim of this pilot study was to discover whether male and female urinary catheter insertion videos delivered via iPods increases students’ skills competency and self-confidence levels. Methods: A prospective replicated study including second year, semester two, undergraduate nursing student participants (NSP) (N=16) was conducted: nine control participants (no video iPods) and seven intervention participants (video iPods). Nursing students attending a mandatory skills class in a learning resource center (LRC) in a School of Nursing located in Northern California were asked to participate in the study. NSP completed a questionnaire regarding previous clinical exposure to urinary catheterizations and levels of competency and confidence in performing the skills prior to taking a required skills course. Directly following the completion of the questionnaire, the participants’ viewed a professional video and a clinical faculty demonstrating the skills. Thereafter the NSP were provided practice time with evaluative feedback. At the completion of the class, the intervention group was provided video iPods and the control group was afforded no technology for a period of two weeks. Following the two weeks, the NSP completed a follow-up questionnaire and a clinical evaluation of their urinary catheterization skills in the LRC. Results: Close to zero variation in urinary catheterization competency scores were determined because all of the NSP scored high in this area and, therefore meaningful comparisons were not determined. The confidence levels for performing the catheterization skills did not significantly change by group, procedure, or time and neither were the two-way interactions between group and time, nor between procedure and time significant. Conclusions: Video iPods may be used to enhance nursing skills. However, the results of this pilot study do not suggest a significant change in competency or confidence levels in performing the clinical skills. Further investigation is necessary because increasing the number of participants, video-viewing time, and monitoring the length of time-on-learning may have a positive influence on future student affect and learning outcomes.

Mandatory communication skills training for cancer and palliative care staff: Does one size fit all?

Purpose of the research There is increasing recognition of the importance of good communication between healthcare professionals and patients facing cancer or end of life. In England, a new national 3-day training programme called ‘Connected’ has been developed and is now mandatory for all cancer and palliative care professionals. This study aimed to explore the attitudes of staff in one region to undertaking this training. Methods and sample A survey questionnaire was developed through a series of discussions with experts and semi-structured interviews with five healthcare professionals. The questionnaire was distributed to 200 cancer and palliative care staff; 109 were completed and returned. Key results There were significant differences between doctors’ and nurses’ attitudes to communication skills training, with doctors demonstrating more negative attitudes. More nurses than doctors felt that communication skills training should be mandatory for cancer and palliative care professionals ( p ≤ 0.001), whilst more doctors felt that these staff should already be skilled communicators and not require further training ( p ≤ 0.001). Nurses also self-rated their communication skills more highly than doctors. Conclusions The current ‘one size fits all’ approach being taken nationally to advanced communication skills training does not meet the training preferences of all healthcare professionals, and it is recommended that tailoring courses to individuals’ needs should be considered.