Novice Medical Students Research Articles

Teaching elliptical excision skills to novice medical students: A randomized controlled study comparing low- and high-fidelity bench models

Background:The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals.Aims:To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students.Materials and Methods:Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills’ training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs’ skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances.Results:The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills’ training) was considered large (>0.80) in all measurements.Conclusion:The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.

Transfer of airway skills from manikin training to patient: success of ventilation with facemask or LMA-SupremeTMby medical students

During emergency care, the ability to ventilate the patient's lungs is a crucial skill. Supraglottic airway devices have an established role in emergency care, and manikin trials have shown that placement is easy even for inexperienced users. However, there is current discussion as to what extent these results can be transferred to patients. We studied the transfer of skills learnt on a manikin to the clinical situation in novice medical students during their anaesthesia rotation. They were required to ventilate the lungs of a manikin using a facemask and then position a supraglottic airway device (LMA-Supreme™) and ventilate the lungs. This process was then repeated on anaesthetised patients, with standard ventilator settings to assess adequacy of ventilation. Sixty-three students participated in the manikin study. The success rate for ventilating the lungs was 100% for both devices, but the mean (SD) time to achieve successful ventilation was 27.8 (24.4) s with the facemask compared with 38.6 (22.0) s with the LMA-Supreme (p = 0.008). Fifty-one of the students progressed to the second part of the study. In anaesthetised patients, the success rate for ventilating the lungs was lower for the facemask, 27/41 (66%) compared with the LMA-Supreme 37/41 (90%, p = 0.006). For 26 students who succeeded with both devices, the tidal volume was lower using the facemask, 431 (192) ml compared with the LMA-Supreme 751 (221) ml (p = 0.001), but the time to successful ventilation did not differ, 60.0 (26.2) s vs 57.3 (26.6) s (p = 0.71). We conclude that the results obtained in manikin studies cannot be transferred directly to the clinical situation and that guidelines should take this into account. Based on our findings, a supraglottic airway device may be preferable to a facemask as the first choice for inexperienced emergency caregivers.

Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation

We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.

Acquisition of suture skills during medical graduation by instructor-directed training: a randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n=16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p<0.0000) and felt more confident to carry out sutures (all p<0.0000) when compared to the control. There was no significant difference (all p>0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning.

Comparison of 3 video laryngoscopes with the Macintosh in a manikin with easy and difficult simulated airways

ObjectivesTracheal intubation is used to maintain a patent airway and can occasionally be difficult in a potentially difficult airway, especially for novice managers. In this study, we evaluated the time required, extent of the difficulty, and number of dental clicks in the tracheal intubation for novice medical students between the Macintosh (Truphatek International Ltd, Netanya, Israel) and 3 video laryngoscopes in normal and difficult simulated intubation positions on manikins on both the table and floor. MethodsWe recruited 20 medical students as novice airway managers. They used the Macintosh, Truview (Truphatek International Ltd, Netanya, Israel), Glidescope (Verathon Inc., Bothell, WA), and Airway Scope (AWS) (Pentax Corporation, Tokyo, Japan) laryngoscopes in normal and difficult simulated airways on manikins on both the table and floor. The time to intubate, modified Cormack-Lehane score, intubation difficulty score, and dental click number were estimated and compared. ResultsAll 20 medical students completed the study. The AWS required the shortest intubation time, provided the best glottic view and easiest intubation, and resulted in less dental clicks compared with the other 3 laryngoscopes; these phenomena were particularly prominent in the cervical-spine immobilization position on the floor. Although all video laryngoscopes provided better glottic views than the Macintosh laryngoscopy in terms of time to intubate, intubation difficulty score, and the number of dental clicks, the outcomes from the Macintosh laryngoscope were better than those of the Truview and Glidescope. ConclusionsThe AWS may have the potential for quicker, easier, and safer tracheal intubation in scenarios involving difficult airways for a novice airway manager.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

Although several inanimate bench models have been described for training of suture skills, so far, there is no ideal method for teaching and learning this skill during medical education. The aim was to evaluate whether bench model fidelity interferes in the acquisition of suture skills by novice medical students.36 medical students with no surgical skills' background (novices) were randomized to three groups (n = 12): theoretical suture training alone (control); low-fidelity suture training model (synthetic ethylene-vinyl acetate bench model); or high-fidelity suture training model (pig feet skin bench model). Pre- and post-tests were applied (performance of simple interrupted sutures and subdermal interrupted sutures on ox tongue). Three tools (Global Rating Scale with blinded assessment, effect size, and self-perceived confidence based on Likert scale) were used to measure all suture performances.The post-training analysis showed that the students that practiced on bench models (hands-on training) presented better (all p < 0.0000) performance in the Global Rating Scale evaluation, compared with the control, regardless of the model fidelity. The magnitude of the effect (training) was considered large (> 0.80) in all measurements. Students felt more confident (all p < 0.0000) to perform both types of sutures after training.The acquisition of suture skills on the low-fidelity bench model was similar to that of the high-fidelity bench model, and the increase in the performance of participants that received bench model training was superior to those who received training based on theoretical teaching materials.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

Although several inanimate bench models have been described for training of suture skills, so far, there is no ideal method for teaching and learning this skill during medical education. The aim was to evaluate whether bench model fidelity interferes in the acquisition of suture skills by novice medical students. 36 medical students with no surgical skills' background (novices) were randomized to three groups (n = 12): theoretical suture training alone (control); low-fidelity suture training model (synthetic ethylene-vinyl acetate bench model); or high-fidelity suture training model (pig feet skin bench model). Pre- and post-tests were applied (performance of simple interrupted sutures and subdermal interrupted sutures on ox tongue). Three tools (Global Rating Scale with blinded assessment, effect size, and self-perceived confidence based on Likert scale) were used to measure all suture performances. The post-training analysis showed that the students that practiced on bench models (hands-on training) presented better (all p < 0.0000) performance in the Global Rating Scale evaluation, compared with the control, regardless of the model fidelity. The magnitude of the effect (training) was considered large (> 0.80) in all measurements. Students felt more confident (all p < 0.0000) to perform both types of sutures after training. The acquisition of suture skills on the low-fidelity bench model was similar to that of the high-fidelity bench model, and the increase in the performance of participants that received bench model training was superior to those who received training based on theoretical teaching materials. Embora vários modelos de bancada inanimados tenham sido descritos para o treinamento de habilidades de sutura, até o momento, não existe um método ideal para esse ensino e aprendizagem durante a formação médica. O objetivo foi avaliar se a fidelidade dos modelos de bancada interfere na aquisição de habilidades de sutura em estudantes de medicina iniciantes na prática cirúrgica. 36 estudantes de medicina sem exposição prévia a habilidades cirúrgicas foram randomizados em três grupos (n = 12): treinamento de suturas baseado em materiais didáticos (controle); treinamento de suturas em modelo de baixa-fidelidade (modelo de bancada de etileno vinil acetato); ou treinamento de suturas em modelo de alta-fidelidade (modelo de bancada de pele de pata de porco). Foram aplicados pré e pós-testes (realização de pontos simples e pontos subdérmicos invertidos em língua de boi). Três ferramentas (Global Rating Scale com avaliação cega, tamanho do efeito e autopercepção da confiança baseada em uma escala de Likert) foram utilizadas para mensurar todas as performances de sutura. A análise após o treinamento demonstrou que os estudantes que treinaram nos modelos tiveram um melhor (p < 0.0000) desempenho na avaliação pela Global Rating Scale, quando comparados com o controle, independente da fidelidade do modelo. A magnitude do efeito (treinamento) foi considerada grande (> 0.80) em todas as mensurações. Após o treinamento os alunos sentiram-se mais confiantes (p < 0.0000) para executarem os dois tipos de suturas. A aquisição de habilidades de suturas no modelo de baixa fidelidade foi semelhante à prática no modelo de alta fidelidade, sendo que a melhora no desempenho dos participantes que treinaram nesses dois modelos foi superior à aprendizagem baseada em materiais didáticos.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

Novice medical students: individual patterns in the use of learning strategies and how they change during the first academic year.

Background: Adequate use of different learning strategies is one of the most important prerequisites of academic success. The actual use of learning strategies is the result of an interaction between individual and situational variables. Against this background we conducted a longitudinal study with first year medical students to investigate whether individuals show different patterns in their use of learning strategies and whether these patterns change during the first academic year.Methods: Medical students (N=175, 58% female) were surveyed three times in their first academic year regarding their use of learning strategies. A hierarchical cluster analysis (Ward) was conducted in order to identify groups of students with different patterns of learning strategies. Results: We identified four different patterns in approaches to learning among novice medical students (“easy-going”, “flexible”, “problematic” and “hardworking” learners). Compared to their peers, the problematic learners had the worst final school grades. In addition changes in the use of learning strategies were identified, most of them occurred during the first term.Conclusion: Students start their academic studies with different patterns of learning strategies; the characteristics of these patterns change during the first academic year. Further research is necessary to better understand how individual and situational variables determine students’ learning.

Mental Workload and Stress Perceived by Novice Operators in the Laparoscopic and Robotic Minimally Invasive Surgical Interfaces

High levels of mental workload and stress are experienced by surgeons in the laparoscopic environment. The da Vinci(®) surgical robot was developed to provide surgeons a more user-friendly interface while maintaining the patient benefits associated with laparoscopy. This study examined whether the da Vinci robot reduces mental workload and stress in novice medical students. A detailed understanding of trainees' mental workload and mental stress experiences can aid in the development of training programs that are aimed at facilitating the acquisition of laparoscopic and robotic surgery skills. Fifteen novice first-year medical students performed a standard peg-transfer task at a laparoscopic simulator and the da Vinci Surgical System. Mental workload and stress were assessed with the Multiple Resources Questionnaire (MRQ) and the Dundee Stress State Questionnaire (DSSQ), respectively. Students' mental workload profiles were identical with the two surgical systems and replicated previous MRQ results reported with the laparoscopic system showing high levels of workload. Students experienced a better stress profile with the robotic system, however, when compared wih the laparoscopic system. Our study shows that novice medical students perceive less stress when working with the robotic surgical interface than with the laparoscopic surgery interface. The MRQ and the DSSQ are valuable tools for identifying mental workload and mental stress in the laparoscopic and robotic surgery environments. This information may be useful for facilitating the acquisition of laparoscopic and robotic surgery skills.

Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills

To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students. Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale. Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control). The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.

Role of Instruction Method in Novices' Acquisition of Minimally Invasive Surgical Basic Skills

We investigated the impact of instruction method on novices' acquisition of minimally invasive surgical (MIS) basic skills. One hundred five novice medical students underwent text-based (TB), video-based (VB), or faculty-tutored (FT) single-session instruction in three basic MIS skill tasks on a box trainer. Pre- and postsession, participants completed a 12-item, 5-point Likert-type scale (1=Not confident at all, 5=Completely confident) of self-efficacy for performing basic MIS skills and had performances on each task recorded. Four raters evaluated every video performance of one task, a two-handed peg transfer, using a 16-cm visual analog measurement (VAM). Inter-rater reliability was good (intra-class correlation coefficient=0.82). The relationship between instruction method, self-efficacy mean score change, and mean VAM change was examined using ANOVA analysis. Eighty-five participants (TB=32, VB=24, FT=29) had valid matched data. Mean scores in self-efficacy and task performance increased from pre- to postsession for every instruction method: (1) Δ self-efficacy=1.04±0.64 (TB), 1.36±0.69 (VB), and 1.41±0.82 (FT); (2) Δ VAM=3.77±2.87 (TB), 3.82±2.35 (VB), and 2.57±2.60 (FT). Analysis of variance revealed no relationship between instruction method and self-efficacy (P=.10) or VAM mean score change (P=.14). Self-directed instruction methods (e.g., TB and VB) for novices' acquisition of MIS basic skills offer flexible, learner-centered, and cost-effective alternatives to the more expensive FT method.

Assessment of medical student laparoscopic camera skills and the impact of formal camera training

Background In laparoscopic surgery, the role of camera holder often falls to untrained medical students. Laparoscopic-naive students can easily acquire laparoscopic camera navigation (LCN) skills, yet it is unclear whether this translates into improved LCN performance in the operating room and whether students retain these skills over time. The purpose of this study was to evaluate whether preclinical laparoscopic camera simulator training would result in improved LCN skills, efficiency, and comfort level over the course of a 6-week surgery clerkship. Methods A randomized, controlled study was designed to compare students' preclerkship and postclerkship LCN skills on a previously validated box trainer model. The students (n = 70) were randomized via a computer-generated table of random numbers into study and control groups. The study group (n = 36) received a brief laparoscope training session before the clerkship, while the control group (n = 36) did not. All students also completed a preclerkship and postclerkship questionnaire detailing their experience and comfort level. Results Statistical analysis using Wilcoxon's signed-rank test demonstrated that all students improved in skill level (total score, 4 vs 7; P < .0001), efficiency (time, 76 vs 33 seconds; P < .0001), and comfort level (Likert scale score, 2 vs 4; P < .0001), with no statistically significant difference between the control and study groups. Conclusions This study demonstrates that novice medical students are able to gain laparoscopic camera skills from “hands-on” experience, with no added benefit or retention of skills learned in a preclinical camera simulator training session.

Randomized controlled trial of virtual reality and hybrid simulation for robotic surgical training

To evaluate if two commonly used laparoscopic simulators could be adapted and used successfully for the robotics platform in a laparoscopic and robotic naïve medical student population. We identified two widely validated laparoscopic simulation programs, LapSim(®) (Surgical Science Sweden AB), and ProMIS(®) (Haptica, Ireland)for inclusion in the study. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(®) task set was used for ProMIS, and adapted for the DaVinci(®) console (Intuitive Surgical, Inc., Sunnyvale, CA, USA) robotic platform. We then randomized 20 naïve medical students to receive training on either LapSim or ProMIS, both or neither, and evaluated them before and after training. When the groups were compared at baseline, there were no statistical differences in mean scores amongst the groups in univariate analysis (α= 0.05). When comparing mean scores within groups before and after training sessions, statistically significant performance enhancement in all four robotic tasks were identified in the groups receiving dual training. We have shown that the use of ProMIS hybrid and LapSim virtual reality (VR) simulators in conjunction with each other can considerable improve robotic console performance in novice medical students compared with hybrid and VR simulation alone.

A follow-up study of medical students’ biomedical understanding and clinical reasoning concerning the cardiovascular system

Novice medical students usually hold initial conceptions concerning medical domains, such as the cardiovascular system, which may contradict scientific explanations and thus hinder learning. The purpose of this study was to investigate which kinds of biomedical representations medical students constructed of the central cardiovascular system in their first and second years of study, and how the quality of these representations was related to the students' success in clinical reasoning. Data for 119 medical students were collected in three phases: in the first year of study before and after a cardiovascular course and a follow-up in the second year of study. Biomedical and clinical assignments were utilised. The study revealed that students had a substantial number of different misconceptions, and they decreased only slightly over the period of instruction. Those students who had misconceptions concerning biomedical knowledge also performed poorly in clinical reasoning. Furthermore, those students whose clinical reasoning was excellent had improved their biomedical knowledge between the first and second year remarkably more than students with poorer clinical reasoning. Hence, biomedical understanding seems to act as a mediator in clinical reasoning among novice students. We suggest that domain-specific pedagogical training, which would help medical educators become aware of students' typical misconceptions concerning biomedical knowledge and the role of this knowledge in clinical reasoning, should be carried out to improve medical education.

Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students′ hands: A manikin study

Background and Aim:Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6th year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools.Setting and Design:Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital.Methods:Fifty medical students performed either oral or nasal tracheal intubation using the following four intubating tools: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres′ use among different airway tools were recorded.Results:In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope (P<0.001). Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008).Conclusions:New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.

C-MAC Video Laryngoscope Is Superior to Macintosh Laryngoscope for Intubation Training

A previous study showed that students trained with the GlideScope video laryngoscope performed direct laryngoscopy better than those trained with the Macintosh laryngoscope (JW Emerg Med Jul 23 2010). In the current study, researchers in Germany compared intubation skills in 86 novice medical students who were randomized …

Proficiency-based Fundamentals of Laparoscopic Surgery skills training results in durable performance improvement and a uniform certification pass rate

The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training. For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure. None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points. The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

The aims of this study are to determine construct validity for the HystSim virtual-reality (VR) training simulator for hysteroscopy via a new multimetric scoring system (MMSS) and to explore learning curves for both novices and experienced surgeons. Fifteen relevant metrics had been identified for diagnostic hysteroscopy by means of hierarchical task decomposition. They were grouped into four modules (visualization, ergonomics, safety, and fluid handling) and individually weighted, building the MMSS for this study. In a first step, 24 novice medical students and 12 experienced gynecologists went through a self-paced teaching tutorial, in which all participants received clearly stated goals and instructions on how to carry out hysteroscopic procedures properly for this study. All subjects performed five repeated trials on two different exercises on HystSim (exploration and diagnosis exercises). After each trial the results were presented to the participants in the form of an automated objective feedback report (AOFR). Construct validity for the MMSS and learning curves were investigated by comparing the performance between novices and experienced surgeons and in between the repeated trials. To study the effect of repeated practice, 23 of the novices returned 2 weeks later for a second training session. Comparing novices with the experienced group, the ergonomics and fluid handling modules resulted in construct validity, while the visualization module did not, and for the safety module the experienced group even scored significantly lower than novices in both exercises. The overall score showed only construct validity when the safety module was excluded. Concerning learning curves, all subjects improved significantly during the training on HystSim, with clear indication that the second training session was beneficial for novice surgeons. Construct validity for HystSim has been established for different modules of VR metrics on a new MMSS developed for diagnostic hysteroscopy. Careful refinement and further testing of metrics and scores is required before using them as assessment tools for operative skills.

OSOAP Notes Podcasts for First-Year Medical Students (Out of Print)

Abstract This series of six podcasts were published to help novice medical students learn the components of a clinical note. This series has been used as a supplement to a first-year course entitle...