Post-course Confidence Research Articles

WP6.5 - Setting Up For Success: Supporting New General Surgical Registrars' Non-Operative Technical Skills Development

Abstract Aim Entry into Higher Surgical Training is associated with new challenges to trainees’ clinical, technical, professional and inter-personal skills. A three-day modular “bootcamp” course was designed for new General Surgery ST3s transitioning from Core Surgical Training to bridge the gap and support areas of developmental need. Methods Four varied modules were undertaken by candidates; one focussed on non-operative technical skills in surgery (NOTSS). Following pre-interviews with all stakeholders, immersive scenarios were developed. The programme encompassed operating in a stressful environment with a focus on crisis resource management principles, ward round leadership, theatre prioritisation, difficult communication, and a further workshop on managing bullying and sexual harassment. A multi-professional faculty included anaesthetists, theatre staff, psychiatrists and geriatricians alongside surgeons. Results All 26 trainees were invited to self-rate confidence using a 5-point Likert scale, as well as free text annotation. 13 (50%) completed both pre- and post-course confidence questionnaires. Data showed significant improvement in self-rated confidence across all NOTSS domains, particularly for operating in a stressful environment ("Confident"/ "Strongly Confident" = 69% pre-course to 100% post-course). Free text responses included highly positive feedback for high faculty to trainee ratio allowing detailed personalised feedback, exposure to multi-professional perspectives and opportunities to reflect on difficult professional scenarios. Conclusion Following the success of this course, it has now become part of ST3 Induction in Yorkshire - an opportunity to promote a positive working culture and strengthen professional relationships. A multi-specialty faculty allows for sharing of transferable inter-specialty skills. We recommend all transitional training stages would benefit from embedded induction courses.

Evaluation of just-in-time trauma training for international surgical military preparedness at a US Civilian Levell Trauma Center: A proof of concept.

Increasing global conflicts continue to heighten the need for increased focus on preparedness for military physicians and surgeons. Simulation has recently been adopted by civilian surgical trainees to offset the problem of increased work hour restrictions and shift the current focus toward minimally invasive techniques. We hypothesized that just-in-time trauma training, incorporating both focused clinical and simulated experience at our civilian Level I Trauma Center, would increase the competence and confidence of international military physicians in trauma care. We performed a feasibility study of five Ukrainian physicians (four surgeons and one anesthesiologist) undergoing an intensive 2-week trauma course taught by 25 American clinicians. The training consisted of several previously validated courses including Advanced Trauma Life Support (ATLS®), Advanced Surgical Skills for Exposure in Trauma (ASSE'J®), Advanced Trauma Operative Management (ATO ), and Basic Endovascular Skills for Trauma (BES'J®), among several additional simulated and clinical experiences. Pre- and post-course surveys were analyzed using paired t-tests to assess improvement in trauma care. All five physicians had significant improvement in confidence following the completion of the course, including the management of injuries to the neck, chest, abdomen, and extremities. Additionally, each clinician significantly improved in their confidence to perform common ATLS procedures and resuscitative endovascular balloon occlusion of the aorta skills. Overall, the mean confidence over all survey responses improved significantly following the completion of the course, 2.28 (precourse confid ence range 1.25-3.35) to 3.66 (post-course confidence range 2.95-4.22), p-value = 0.002. All five Ukrainian physicians successfully passed the corresponding post-tests and were certified as having completed ATLS, ATOM, ASSET, and BEST Conclusions: A military and civilian partnership in trauma preparedness is feasible to improve surgeon confidence in trauma care.

Evaluation of an end-of-life teaching programme for unregistered domiciliary care staff.

With increased focus on people being supported to die at home, and increased numbers of people predicted to die in the coming years in the UK, it is recognised that domiciliary carers need to be trained and supported to give end-of-life care. Recent reports suggest that this is not happening. To introduce and evaluate a training programme to upskill unregulated domiciliary care agency staff and integrate them into the palliative care teams, supporting registered nurses in caring for end-of-life patients. A training course was devised and implemented. This report covers the first 3 years of running the course, and evaluates the difference that it made to the first 210 recipients' ability and confidence in delivering end-of-life care, using a mixed-methods approach. Pre- and post-course confidence questionnaires, evaluations, post-course testimonials, and managers' comments all identified improvements in knowledge, skills and attitudes following training. Agency policies were re-written with up-to-date guidance on how to respond to death in the community. This article demonstrates that this model is effective in achieving its aims.

Japanese nurses' confidence in their understanding of telenursing via e-learning: A mixed-methods study.

Telenursing e-learning courses have been shown to enhance nurses' skills and knowledge; however, the subjective learning experience is unclear. In this study, we identified meta-inferences to quantitatively and qualitatively understand this experience, as well as the types of knowledge gained through an e-learning course and how they are linked to each other, in order to enhance nurses' confidence in their understanding of telenursing. We employed a single-arm intervention with a mixed-methods convergent parallel design. We converged participants' self-reported pre- and post-course confidence scores with their reflections on the learning experience, which were reported qualitatively as improved or unimproved. A total of 143 Japanese nurses with a mean of 20 years of nursing experience participated in this study. Among the participants, 72.7% demonstrated improved confidence in their understanding of telenursing after completing the e-learning course. The baseline confidence score was originally higher in the group that reported unimproved confidence (p < .001). Although there was no statistical difference in the usability and practicality scores between the two groups, the qualitative learning experience in these aspects differed in terms of the depth of knowledge of telenursing obtained. Nurses' quantitative confidence in their understanding of telenursing after course completion was incongruent with their qualitative perspectives of the learning experience. Nursing educators, healthcare policymakers, and other stakeholders should consider that learners' overconfidence in their understanding of telenursing and comprehension of e-learning materials may result in their failure to develop key telenursing competencies, skills, and knowledge.

Evaluating a digital hybrid training-of-trainers (TOT) approach for lay first responder trauma education in urban Nigeria during the COVID-19 pandemic

IntroductionRoad traffic injuries (RTIs) are the largest contributor to the global burden of injury, and in 2016 were among the five leading causes of global disability-adjusted life years (DALYs). In regions with limited emergency medical services (EMS), training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied. MethodsUsing a training of trainers (TOT) model, a 5.5-h LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics using videoconferencing software and practical breakout sessions in-person concurrently. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A 23-question, pre- and post-assessment was administered digitally to assess knowledge acquisition. Participants responded to a five-point Likert survey assessing instruction quality and post-course confidence. ResultsTOTs scored a median of 56.5 % (IQR:43.5 %,71.7 %) and 91.3 % (IQR:88.0 %,95.7 %) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4 %). LFR course trainees scored a median of 34.8 % (IQR: 26.0 %, 43.5 %) and 73.9 % (IQR: 65.2 %, 82.6 %) on the pre- and post-assessments respectively, with airway and breathing increasing the most (+48.6 %). All score increases were statistically significant with p < 0.001. All 30 TOT trainers instructed at least one training session after their initial session. LFR participants’ rated confidence in first aid skills went from 3/5 (IQR 3, 4) pre-course to 5/5 (IQR:5,5) post-course, and in emergency transportation it went from 4/5 (IQR:3, 4) to 5/5 (IQR:5, 5), (p < 0.001). LFR course participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5). 144 responders provided emergency care in the six-months following training for a total of 351 interventions. Active responders provided a median of 2 (IQR:1,3) interventions. ConclusionsThis is the first time that a digital hybrid instruction for first responder trainers in low- and middle-income countries has been investigated. Our findings demonstrate negligible attrition, high educational quality ratings, equally effective knowledge acquisition to that of prior in-person courses, and high post-training skill usage. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.

Differential Attainment Within the Specialised Foundation Programme: Creating an Accessible Mentorship Scheme to Increase Diversity Within Academic Medicine.

The Specialised Foundation Programme (SFP), formerly the Academic Foundation Programme, is a highly competitive pathway into academic medicine. There is minimal information available on the demographics of those who apply to the programme, how it scores its applicants and who is successful, making it difficult to assess whether the application process is accessible to all students and promotes a diverse workforce. There are varying levels of support available with coaching, either geographically ring-fenced by universities or available through paid courses. As a result, there is a risk of differential attainment between students who have financial constraints or attend universities where the SFP is less promoted. The aim of the study was to assess student opinion on barriers to the SFP and academic medicine and the demand for the creation of a national, free-to-access SFP mentorship programme to reduce differential attainment amongst student cohorts.Students in the programme received mentorship, peer learning and scheduled teaching events over a six-month period. Surveys were distributed pre- and post-course, and qualitative and quantitative analysis was conducted. Of the respondents,76% felt that medical schools provided insufficient information on SFP, 31% did not feel financially stable at university and 53% stated that they would not enrol if a cost was present. Applicants were tested on pre- and post-course confidence, all of which showed an increase in mean Likert (1-5) scoring post-mentorship. Financial, institutional and geographical barriers to students applying to the programme were identified. Whilst further research is required to better understand the barriers to academic medicine, national, free-to-access mentorship may effectively reduce differential attainment and improve accessibility amongst students.

WTP6.9 Post-operative Management Study Day: Improving knowledge and confidence of senior medical students when managing post-operative patients

Abstract Aim Focus groups run by teaching facilitators with medical students highlighted a lack of confidence around how best to assess and manage post-operative patients. In response we aimed to provide a focussed study day covering key aspects of post-operative management, and complications for undergraduate medical students at St George's University. Methods A study day dedicated to the assessment and management of post-operative patients was created. The day incorporates different types of learning including case-based discussions, game-based learning and simulation. Topics covered are aligned with the curriculum for senior medical students at St George's University, including post-operative pain, bowel obstruction/ileus and haemorrhage. Information gathered from local clinical guidelines. Results Pre-course confidence scores on management of common post-operative complications were on average a 2 out of 5 (5 being very confident, and 1 being not confident at all). Post-course confidence scores increased to an average of 4 out of 5 for managing the majority of common post-operative complications. Feedback on the teaching and content of the course was good, with 95% of participants rating the session as 5 out of 5. Results Post-operative assessment and management is an area of teaching that students feel has been neglected within their prior years of study. This dedicated study day allows for in-depth discussion and practice at assessment of post-operative complications. Future development of the course may include opening the participants to foundation doctors, involvement of senior surgical staff in facilitation and assessment, and use in other local hospitals.

Child Health Essential Skills Stations (CHESS): Development, Implementation, and Evaluation of an Undergraduate Child Health Clinical Skills Course

Background: Teaching undergraduate medical students clinical skills in a child health setting is a particular challenge for clinical educators. Students spend less time with pediatric patients and have fewer opportunities to practice clinical skills. The coronavirus (COVID-19) pandemic further reduced students’ opportunities to observe and practice skills in the workplace. This has necessitated a greater shift towards teaching skills in a "skills lab" setting, which allows for simulated practice in a safe environment. This study reports the design, implementation, and evaluation of a standardized course that utilizes the "skills lab" to train undergraduate medical students in five clinical skills important to child health. Objectives: This study aimed to implement and evaluate a standardized undergraduate clinical skills course for child health and improve students' confidence in performing child health clinical skills. Methods: Evaluations were carried out over approximately one academic year, with a total of 174 participants from a single medical school in the United Kingdom. Qualitative and quantitative data were collected, examining students' self-reported confidence (pre- and post-course) along with free-text course evaluations. A paired t-test was used to calculate the mean difference in students' pre- and post-course confidence scores. Qualitative evaluations were analyzed for themes using framework analysis. Results: The students had greater confidence in all measured learning outcomes following the course. Qualitative data, examined using framework analysis, suggested that the course was valued by students, who felt it was relevant to their future practice. Numerous written comments suggested particular content and teaching methods that were strengths of the course, including practical elements, small group teaching, and feedback from tutors. Conclusions: Implementing a child health clinical skills course in a skills lab setting is feasible and valued by students. The course increased the self-reported confidence of the studied cohort and might therefore support them in practicing these skills with actual patients. Further studies are required to determine whether these effects demonstrate longevity and whether they translate to increased competence in performing the taught skills.

Pediatric basic course goes virtual: transition from face to face to hybrid learning in pediatric critical care

BackgroundTo explore the impact of the transition from a traditional face-to-face course delivering essential contents in pediatric critical care to a hybrid format consisting of an online pre-course self-directed learning, an online facilitated discussion, and a face-to-face edition.MethodsAttendees and faculty were surveyed after the face-to-face course and the hybrid version to evaluate the effectiveness and satisfaction of participants with the course.ResultsFifty-seven students attended multiple formats of the Pediatric Basic Course between January 2020 and October 2021 in Udine, Italy. We compared course evaluation data from the 29 attendees of the face-to-face course with the 28 of the hybrid edition. Data collected included participant demographics, participant self-assessed pre and post-course ‘‘confidence’’ with a range of pediatric intensive care-related activities, and their satisfaction with elements of the course. There were no statistical differences in participant demographics or pre and post-course confidence scores. Overall satisfaction with the face-to-face course was marginally higher, 4.59 vs. 4.25/5, but did not reach significance. Pre-recorded lectures which could be viewed several times, were highlighted as a positive for the hybrid course. Residents found no significant differences comparing the two courses in rating the lectures and the technical skills stations. Hybrid course facilities (online platform and uploaded material) were reported to be clear, accessible, and valuable by 87% of attendees. After six months, they still find the course relevant to their clinical practice (75%). Candidates considered the respiratory failure and mechanical ventilation modules the most relevant modules.ConclusionsThe Pediatric Basic Course helps residents strengthen their learning and identify areas to improve their knowledge. Both face-to-face and hybrid model versions of the course improved attendees’ knowledge and perceived confidence in managing the critically ill child.

Struggle in the bubble - a prospective study on the effect of remote learning and distance education on confidence in practical surgical skills acquired during COVID-19

BackgroundThe coronavirus disease (COVID-19) has significantly changed healthcare systems and medical education. Universities were required to develop innovative curricula based on remote and distance education to continue medical education. This prospective questionnaire-based study aimed to investigate the impact of COVID-19-associated remote learning on the surgical training of medical students.MethodsA 16-item questionnaire-based survey was distributed to medical students at the University Hospital of Münster before and after a surgical skills laboratory (SSL). Two cohorts were included: summer semester 2021 (COV-19), with rigorous social-distancing restrictions requiered SSL to be remotely, and winter semester 2021 (postCOV-19), in which the SSL was provided as a face-to-face, hands-on course.ResultsBoth, cohorts showed a significant improvement in self-assessment of pre- and post-course confidence. While no significant difference in the average gain in self-confidence for sterile working was observed between the two cohorts, improvement in self-confidence was significantly higher in the COV-19 cohort regarding skin suturing and knot tying (p < 0.0001). However the average improvement regarding history and physical was significantly higher in the postCOV-19 cohort (p < 0.0001). In subgroup analysis, gender-associated differences varied in the two cohorts and were not related to specific subtasks, while age-stratified analysis revealed superior results for younger students.ConclusionThe results of our study underline the usability, feasibility, and adequacy of remote learning for the surgical training of medical students. The on-site distance education version, presented in the study, allows the continuing of hands-on experience in a safe environment in compliance with governmental social-distancing restrictions.

Enter and Discuss Orders and Prescriptions (EPA 4): A Curriculum for Fourth-Year Medical Students.

Order entry, entrustable professional activity (EPA) 4, is one of several EPAs that residency program directors identify as a weakness for PGY 1 residents. A multispecialty survey of program directors indicated that only 69% of interns could be trusted to enter and discuss orders and prescriptions without supervision. To address this gap, we developed a formative workshop for fourth-year medical students. Prior to the start of their subinternships, 366 fourth-year medical students engaged in an order entry workshop. Students performed chart reviews on electronic standardized patients within an educational electronic health record (EHR), placed admission orders, customized order sets, responded to safety alerts, utilized decision support tools, and incorporated high-value care considerations. Students used expert-validated rubrics to assess the quality of their admission orders and participated in a facilitated group discussion on key learning points. Finally, students participated in order entry, with all orders requiring cosignature by a supervising physician, during their clinical rotations. Students reported their confidence with order entry before and after the workshop and after the clinical rotation. One hundred seventeen students completed the pre- and postworkshop surveys, and 99 went on to complete the postcourse evaluation. Students showed a statistically significant increase in their confidence level following the workshop. Order entry is a critical, complex skill that requires deliberate instruction. This curriculum, which leverages the features of an educational EHR, can facilitate instruction, practice, and confidence gains regarding order entry prior to further application of these skills in the clinical environment.

Evaluating the Impact of a Simulation Based Training Course in Intellectual Disability Psychiatry and Autism Co-Delivered by Actors With Intellectual Disability

AimsInequalities in health outcomes, and avoidable deaths, in people with intellectual disability has highlighted the need for improved training and education in Intellectual Disability and Autism. Simulation training facilitated by actors with intellectual disability has been shown to improve connection with people with intellectual disability (Attoe et al 2017). The aim of this project was to develop a simulation-based training course, focused on topics in mental health, intellectual disability and autism, to improve participant confidence in clinical knowledge and skills, as well as support leadership and professionalism training. Here we evaluate the impact of the training on participants’ confidence, and the longer-term effect on attitudes and working practice after attendance.MethodsA novel simulation-based training course, directed at Specialty Trainees, was developed based on the Specialty Training in Learning Disability curriculum. The course was co-delivered by a person with intellectual disability. Participants who attended the simulation training completed general feedback, pre-course and post-course confidence questionnaires and attended a semi-structured group interview at 2 months. Questionnaire data weres analysed using descriptive and inferential statistics. Group interview data were analysed using open &amp; axial coding, and thematic analysis of content. The project was approved by East London NHS Foundation Trust Governance and Ethics Committee for Studies and Evaluations.ResultsEight psychiatrists participated in the training and completed the pre-course and post-course questionnaires. Independent t-test found significant increase in confidence for all scores from pre-course (M = 6.54, SE0.24) to post-course (M = 7.81, SE = 0.36), t= –2.93 p = 0.01. This included ratings of confidence in knowledge in areas such as mental health legislation, and improved confidence in skills such as communication with families of people with intellectual disability and difficult conversations with senior supervisors. In follow-up interviews we elucidated themes of the importance of supported, structured training opportunities with people with intellectual disability, and the value of connection with peers and supervisors.ConclusionSimulation based training in psychiatry, co-delivered with actors with intellectual disability, was reported to be an engaging and enjoyable form of learning. The evaluation suggests such training is effective in increasing trainee confidence in knowledge and skills at the time of training as well as resulting in a lasting change in attitudes after the training. We recommend such training be further developed and delivered at both postgraduate and undergraduate level.

A Short Intervention and an Interactive e-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study.

BackgroundPrompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students.ObjectiveOur objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders.MethodsA short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders.ResultsOut of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56).ConclusionsThis study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders.International Registered Report Identifier (IRRID)RR2-10.2196/24664

Teaching clinicians shared decision making and risk communication online: an evaluation study

ObjectivesTo describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties.DesignComparison pre-course...

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic

BackgroundBefore the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format.MethodsThe virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included.ResultsAn average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001).ConclusionsFeedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

Primary trauma care course: Alternative basic trauma course in developing countries. "The Need Of The Hour".

Low- and middle-income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan. Two days of PTC courses were organised and conducted in various regions of Pakistan, participants per course comprising medical students, doctors, house officers, residents, and paramedics. The course comprises lectures of 5hours and 30minutes, skills workshops for 3hours and discussion and multisystem trauma scenarios for 3hours. Trauma management knowledge and clinical confidence of candidates were assessed using a predetermined multiple-choice questionnaire of 30 MCQs both at pre- and post-course, and using clinical scenarios, confidence matrix was assessed. A total 7852 of participants were trained, an average of 2 courses per month and 302 total courses. Mean score of pre-course MCQs was 60% and mean score of post-course MCQs was 82%. Among the participant postgraduate trainees, average in trauma knowledge and trauma clinical confidence were significantly higher in both pre- and post-course. The mean score of pre-course confidence matrix was 70% and the mean score of post-course confidence matrix was 93%; at the end of course, all participants showed a high level of confidence in managing trauma mock scenarios. A total of 5889 (75%) participants had a ≥78.5% post-workshop knowledge score. However, only 1963 (25%) participants had a trauma skill score with ≤75 marks. PTC workshop could be an alternative and cost-effective flexible course for gaining knowledge and clinical skills of initial trauma management and strengthening the capacity of trauma management training in developing countries with minimal resources for saving the life of trauma victims.

O52: THE IMPACT OF STUDENT BACKGROUND ON PERFORMANCE AND STRESS DURING SURGICAL SIMULATION

Abstract Introduction Early exposure of medical students to surgical skills has been associated with an increased interest in pursuing a career in surgery. This study aimed to investigate the impact of student background on basic laparoscopic skills acquisition and perceived stress to workload during simulation. Method Students were recruited to a course modelled on the European Basic Laparoscopic Urological Skills (E-BLUS) programme. Students filled out a pre-course demographic survey, and a post-course survey that evaluated perceived stress to workload (SURG-TLX). Pre- and post-course confidence in laparoscopic skills, performance in the course, as well as SURG-TLX parameters were statistically compared for all demographic factors. Result Twenty-three participants completed the course, fifteen (65%) of which were female. Ten students were junior (first and second year), and thirteen were senior (third year and above). Hobbies were grouped into either requiring hand-eye coordination (n=9), manual dexterity (n=9), or no relevance to surgery (n=5). No significant differences were found in demographic factors for course performance or pre- and post-course confidence. No significant differences were found between male and female students, and between different hobby groups, in all SURG-TLX parameters. Senior students reported a significantly higher Physical Demand of the SURG-TLX compared to juniors (p=0.042). No differences were found in other parameters. Conclusion Our study showed no correlation between student background (notably sex and stage of medical school) and basic laparoscopic skills acquisition or stress during simulation. We therefore suggest that medical students are provided with more exposure to acquire basic laparoscopic skills regardless of their background. Take-home message Medical student background is not a discriminator in surgical simulation performance and stress. All medical students, regardless of their sex or stage of medical school, should be given the opportunity to practice laparoscopic skills.

A virtual emergency: learning lessons from remote medical student education during the COVID-19 pandemic.

PurposeThe COVID-19 pandemic resulted in the cancelation of traditional on-site clinical rotations for medical students across the country. Radiology educators have had to rapidly adapt to a new, virtual educational landscape. We describe our experience restructuring a Trauma and Emergency Radiology Elective to an online format and present survey data obtained from students who completed the course.MethodsThis elective is a 4-week course offered to third and fourth year medical students at a large Level 1 Trauma Center. Changes to the traditional rotation included assigning an increased number of self-study educational resources, independent review of unknown cases using a virtual workstation, and online interactive conferences. At the conclusion of each block, students were asked to complete post-course feedback surveys.ResultsThirteen students enrolled in this online course; 92% submitted post-course surveys. Students strongly agreed that the course was clinically relevant, with accessible, engaging material (average score, 4.92/5), and 91.7% of students were very likely to recommend this rotation to others. Students reported improved post-course confidence in ordering and interpreting imaging studies. A majority (60%) of students who had previously taken an on-site course would have preferred a course that combined traditional and online learning elements.ConclusionsThe success of our online rotation highlights the merits of self-directed learning and flipped-classroom techniques. Many of the principles incorporated into this course could be applied and/or modified to increase medical student engagement when students return to the hospital.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10140-020-01874-2.

Simulation of Pediatric Life-Threatening Emergency Scenarios (SimPLES): The Development, Implementation, and Evaluation of an Undergraduate Immersive Simulation-Based Educational Intervention

Background: Clinical exposure to acutely unwell pediatric patients is often limited during undergraduate medical training. Although limited within undergraduate pediatric curricula, simulation-based education (SBE) offers a tool with which such exposure can be achieved in a safe and effective learning environment. This study describes the development, implementation, and evaluation of an undergraduate multi-center immersive pediatric SBE course. Objectives: We sought to increase medical students’ exposure to acutely unwell pediatric patients and provide practical experience to improve their understanding of the importance of non-technical skills within the clinical workplace, such as teamwork, communication skills, leadership, and situational awareness. Furthermore, we sought to evaluate the impact on students’ confidence in assessing and managing acutely unwell pediatric patients while exploring their perceptions and opinions of the course. Methods: The present study included all final-year students who were on a pediatric clinical placement during the study period. Tutorials on pediatric A-E assessment and fluid management were followed by a series of immersive simulation scenarios and structured debriefs, concentrating on the importance of non-technical skills in the clinical workplace. Also, some mini-tutorials were incorporated into the course design, focussing on the technical and pathophysiological aspects of each presentation. We employed a mixed-method research methodology to evaluate the impact of the course. Also, anonymized post-course and free-text feedback was sought to explore students’ experiences and perceptions of the course. Results: All 80 students completed the pre and post-course confidence questionnaires, reporting statistically significant improvements in confidence across all 11 domains tested. Thematic analysis of the qualitative data identified six core themes: knowledge acquisition, the value of debriefing, the importance of non-technical skills, the value of faculty expertise, the value of repeated practice, and opportunities for exposure to pediatrics. The innovative post-scenario mini-tutorials were favorably received. Conclusions: Our study shows that immersive SBE can improve medical students’ confidence in managing pediatric emergency scenarios. Also, incorporating mini-tutorials within an immersive simulation course design in an undergraduate setting can be helpful and well received by students.

Overview of a novel paediatric surgical simulation-based medical education programme in Myanmar.

Simulation-based medical education (SBME) is an integral part of undergraduate and postgraduate training in high-income countries (HICs). Despite potential benefits to low- and middle-income countries (LMICs), it has not been widely applied. Our aim was to use SBME to address some essential paediatric surgery learning needs in a LMIC. Eleven SBME courses were designed, implemented and evaluated over a 4-year period in partnership with local paediatric surgeons and the University of Medicine 1 in Yangon, Myanmar. All courses were simulation-based and different major SBME modalities were utilized. Evaluation included pre- and post-course questionnaires, other evaluation assessments including Likert scale self-rated confidence in different domains, as well as, mixed method evaluation and Kirkpatrick's hierarchy of evaluation. Over 4 years, a multidisciplinary team consisting of surgical consultants, fellows, and educational specialists delivered 11 courses at a tertiary LMIC paediatric surgical centre. Attendance varied between 23 and 50 healthcare professionals, with some participants attending all of the educational activities. SBME modalities were utilized to meet each courses' learning objectives. All educational courses scored highly and showed statistically significant differences in all the self-rated pre and post-course confidence Likert scale domains. SBME was accepted and embraced by local participants and faculty, and transition to local delivery of educational content has begun. Level 4 of Kirkpatrick's hierarchy of evaluation was demonstrated. SBME can be used to meet essential learning objectives of local staff in a LMIC. Through various modalities, it offers a reliable, proven and affordable means of teaching multiple aspects of paediatric surgical clinical practice. By employing innovative simulation-based solutions, it can be adapted by local faculty to continue meeting ongoing learning needs.