Post-course Test Scores Research Articles

E-Learning versus lecture-based courses in ECG interpretation for undergraduate medical students: a randomized noninferiority study.

An ECG is pivotal for the diagnosis of coronary heart disease. Previous studies have reported deficiencies in ECG interpretation skills that have been responsible for misdiagnosis. However, the optimal way to acquire ECG interpretation skills is still under discussion. Thus, our objective was to compare the effectiveness of e-learning and lecture-based courses for learning ECG interpretation skills in a large randomized study. We conducted a prospective, randomized, controlled, noninferiority study. Participants were recruited from among fifth-year medical students and were assigned to the e-learning group or the lecture-based group using a computer-generated random allocation sequence. The e-learning and lecture-based groups were compared on a score of effectiveness, comparing the 95% unilateral confidence interval (95% UCI) of the score of effectiveness with the mean effectiveness in the lecture-based group, adjusted for a noninferiority margin. Ninety-eight students were enrolled. As compared with the lecture-based course, e-learning was noninferior with regard to the postcourse test score (15.1; 95% UCI 14.2; +∞), which can be compared with 12.5 [the mean effectiveness in the lecture-based group (15.0) minus the noninferiority margin (2.5)]. Furthermore, there was a significant increase in the test score points in both the e-learning and lecture-based groups during the study period (both P<0.0001). Our randomized study showed that the e-learning course is an effective tool for the acquisition of ECG interpretation skills by medical students. These preliminary results should be confirmed with further multicenter studies before the implementation of e-learning courses for learning ECG interpretation skills during medical school.

Improving knowledge, technical skills, and confidence among pediatric health care providers in the management of chronic tracheostomy using a simulation model

The results from a recent national survey about catastrophic complications following tracheostomy revealed that the majority of events involved a loss of airway. Most of the events due to airway loss involved potentially correctable deficits in caregiver education. Training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the knowledge and confidence level of pediatric health care providers at a large tertiary care children's hospital in routine and emergency tracheostomy care and evaluated the efficacy of a comprehensive simulation-based tracheostomy educational program. The prospective observational study was comprised of 33 subjects including pediatric residents, internal medicine-pediatric residents, pediatric hospitalist faculty physicians, and advanced practice registered nurses who are involved in the care of patients with tracheostomies within a tertiary-care children's hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course that employed patient simulation. The outcome measurements included pre- and post-course questionnaires, pre- and post-course test scores, and observational data from the simulation sessions. Before the education and simulation, the subjects' comfort and confidence levels on a five-point Likert scale in performing routine tracheostomy tube care, routine tracheostomy tube change, and an emergency tracheostomy tube change were as follows (median (Q1, Q3)): 1 (1, 2), 1 (1, 2), and 1 (1, 2), respectively (n = 28). The levels of comfort and confidence after completing the course improved significantly to 4 (4, 5), 4 (4, 5), 4 (4, 5), respectively (P < 0.001) (n = 20). For the knowledge assessment, the pre-course test mean score was 0.53 ± 0.50, and the scores on the post-course test improved significantly with a mean score of 0.82 ± 0.39 (P < 0.001). During the educational intervention, specific deficiencies observed included a lack of understanding or familiarity with different types of tracheostomy tubes (e.g., cuffed versus uncuffed), physiological significance of the cuff, mechanism of action and physiological significance of the speaking valve, and the importance of the obturator in changing the tracheostomy tube. There is a need for improved tracheostomy education among pediatric health care providers. Incorporation of patient-simulation into a tracheostomy educational program was effective in improving knowledge, confidence, and skills. Pediatr Pulmonol. 2016;51:696-704. © 2015 Wiley Periodicals, Inc.

An Elective Course on Dermatological Topics and Cosmeceutical Compounding

To implement and assess a pharmacy dermatology and cosmeceutical compounding elective course and its impact on graduates' careers. A 3-credit elective course that incorporated classroom lectures on ambulatory dermatologic diseases and cosmeceutical products with case studies, weekly quizzes, and a comprehensive business plan project was implemented in a doctor of pharmacy (PharmD) program in 2010. Assessment instruments including weekly quizzes, a business plan project, and pre- and post-course tests were used to evaluate course content. Across 3 offerings of the course (2010, 2011, 2012), pre- and post-course test scores improved. Results of a postgraduate survey showed that 54% of respondents worked at a pharmacy offering compounding services, and 57% felt that the course played a significant or very significant role in their counseling on dermatologic conditions. Assessment methods revealed student learning of course content and the course appeared moderately beneficial to graduates' early careers. A more longitudinal analysis is needed to assess the course's impact on long-term career choices, particularly those dealing with compounding of cosmeceutical products.

NASPGHAN Nutrition University as a Model for Continuing Education Within Pediatric Nutrition

The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Nutrition Committee developed the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Nutrition University (N2U) as an education resource designed to address the nutrition topics identified by pediatric gastroenterologists. N2U was initially designed as a series of lectures. Participants completed a precourse, immediate postcourse, and 6-month postcourse assessment. The average pretest score was 74%. Participants reported learning "a great deal" and immediate postcourse test score average was 90%. Feedback from N2U participants will shape future course design, focusing on the interactive learning sessions. N2U may serve as a model for offering topic-directed continuing medical education based on targeted physician responses and feedback.

Multimedia Instructional Tools and Student Learning in a Computer Applications Course

Advances in technology and changes in educational strategies have resulted in the integration of technology in the classroom. Multimedia instructional tools (MMIT) provide student-centered active-learning instructional activities. MMITs are common in introductory computer applications courses based on the premise that MMITs should increase student learning. This study examined the use of MMIT in an introductory computer applications course to determine if a significant relationship existed between the level of use of the MMIT and student learning. Subjects included students enrolled in an online introductory computer applications course at one southeastern university. The researchers used descriptive statistics to demonstrate students' use of the MMIT and used pre and post-course test scores to determine changes in learning. This study revealed no significant impact on student learning based on level of use of the MMIT grader assignments or training activities. A significant difference was found for the level of use of MMIT quizzes.

A structured four‐step curriculum in basic laparoscopy: development and validation

The objective of this study was to develop a four-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component. A four-step curriculum was developed. The methodology was different for each step. Step 1: A 1-day course in basic laparoscopy developed on the background of a regional needs analysis. Step 2: A multiple-choice test, developed and validated through interviews with experts in laparoscopy and subsequently through a Delphi audit involving regional chief physicians. Step 3: A procedural training task (a salpingectomy) on a validated virtual reality simulator. Step 4: An operation on a patient (a salpingectomy) with following formative assessment based on a validated assessment scale. University hospital, Copenhagen, Denmark. Fifty-two first-year residents in obstetrics and gynecology from 2009 to 2011. Observational cohort study. Completion rate. All participants completed step 1 and improved post-course test scores compared with pre-course test scores, p=0.001. Step 2 was completed by 75% (37/52); all improved test scores after 6months, p=0.001. Step 3 was completed by 75%. Participants used 238min (range 75-599) and 38 repetitions (range 8-99) to reach proficiency level on a virtual reality simulator. Step 4 was completed by 55%. There was no correlation between test scores and simulator training time. Protected training time was correlated with increasing completion rate. A four-step curriculum in basic laparoscopy is applicable in residency training. Protected training time correlated with increasing completion rate.

Simulation Model for Tracheotomy Education for Primary Health-Care Providers

We performed this study to evaluate the competency of health-care providers managing patients with tracheotomies, and assess the need for, and efficacy of, a multidisciplinary educational program incorporating patient simulation. The prospective observational study included 87 subjects who manage patients with tracheotomies within a tertiary-care hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course using patient simulation. The outcome measurements included pre-course and post-course questionnaire and test scores, as well as observational data collected during recorded patient simulation sessions. Before the education and simulation, the subjects reported an average comfort level of 3.3 on a 5-point Likert scale across 10 categories in the questionnaire, which improved to 4.4 after the training (p < 0.0001). The subjects' mean scores improved from 56% on the pre-course test to 91% on the post-course test (p < 0.0001). The specific deficiencies observed during patient simulation scenarios included unfamiliarity with different tracheotomy tube types, misunderstanding of speaking valve physiology, and delayed recognition and treatment of a plugged or dislodged tracheotomy tube. There is a significant need for improved tracheotomy education among primary health-care providers. Incorporating patient simulation into a comprehensive tracheotomy educational program was effective in improving provider confidence, increasing provider knowledge, and teaching the skills necessary for managing patients with a tracheotomy.

ESSENTIAL ETAT: ONE-DAY PAEDIATRIC RESUSCITATION TRAINING IN A RESOURCE-LIMITED SETTING

Objectives & BackgroundWHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5–5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost...

G118 Essential ETAT: Feasibility of Short Duration Paediatric Resuscitation Training in a Resource-Limited Setting

AimsETAT and ETAT+ training courses provide comprehensive training in paediatric emergency care over 3.5–5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and...

Does a Mixed Training Course on the Oxford Unicompartmental Knee Arthroplasty Improve Non-Technical Skills of Orthopaedic Surgeons?

To determine whether a mixed course on the Oxford unicompartmental knee arthroplasty (UKA) could improve the non-technical (cognitive) skills of performing UKA. 120 delegates consisting of consultant orthopaedic surgeons and advanced surgical trainees attended a 2-day course. 104 (87%) of the delegates had performed total knee arthroplasties, whereas 79 (66%) had performed UKAs. The course consisted of didactic lectures, interactive surgical demonstrations, and practical dry-bone skills workshops. Cognitive skills were assessed at the start (day 1) and end (day 2) of the course using 10 multiple-choice questions. The maximum test score was 10. Multilevel modelling was used to compare the pre- and post-course test scores. The pairings of pre- and post-course scores were not known because of a confidentiality clause. Of the 120 delegates, 71 (59%) took the pre-course test and 120 (100%) took the post-course test. The median score improved significantly from 2 (interquartile range [IQR], 0.5-3.5) to 6 (IQR, 4.5- 7.5) [bootstrap p<0.0001] for every single one of the randomly allocated pairings. Most delegates had poor cognitive skills for the UKA before the course and improved significantly after the course. Sub-analysis of each question topic showed significant improvement in scores for all topics after the course (bootstrap p<0.0001). Nonetheless, the extent to which individual topic scores improved varied widely. The odds ratio for the pre- versus post-course total test score was 4.36. A mixed continuing medical education course could enhance the non-technical (cognitive) skills for UKA.

‘I am the nurse who does io!’: impact of a ‘training of trainers’ paediatric resuscitation training programme in malawi

AimsTo determine the impact of a single ‘training of trainers’ ETAT (Emergency triage, assessment and treatment) paediatric resuscitation training programme on clinical practice of participating healthcare workers in Malawi.MethodsTraining was...

Integrating Evidence Based Medicine Into Undergraduate Medical Education: Combining Online Instruction With Clinical Clerkships

Background: Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). Description: During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. Evaluation: Paired data were available from 139 students. Postcourse test scores ( M= 77.7; 95% CI = 59–96.4) were significantly higher than precourse scores ( M= 66.6; 95% CI = 46.5–86.7), p< .001. Paired evaluations demonstrated an average improvement of 11.1 ± 20.0 points. All of the students submitted 4 independently derived questions and successfully retrieved and appraised evidence. Conclusions: Medical students successfully acquired and independently applied EBM skills following extended, online, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.

Leadership and Management Training for Residents and Fellows: A Curriculum for Future Medical Directors

Management of laboratories and pathology practices is increasingly complex. Residents and fellows in laboratory medicine and pathology need more structured curricula in leadership and management (L&M) training to function as medical and laboratory directors. To define a curriculum that provides basic competency in L&M for residents and fellows in pathology. A year-long formal L&M course included didactic lectures, interactive sessions, case scenarios, team-building exercises, formal team presentations (capstone project), and precourse and postcourse assessment of L&M knowledge. The curriculum meets requirements of American College of Graduate Medical Education and supports goals for leadership training of the College of American Pathologists. Participants evaluated (5-point scale) the content and speakers of all sessions. Trainees were evaluated after considering postcourse examination results, quality of the capstone presentation, and a global assessment. The 5 non-capstone sessions received evaluation scores ranging from 4.4 (informatics) to 5 (L&M basics). Postcourse test scores showed significant improvement when compared with the pretest scores for the 2003-2004 and 2004-2005 trainee cohorts. Short-term results indicate that the course described improves trainee knowledge of L&M issues.

The development of continuing education for trauma care in an African nation

A trauma continuing education course was developed to meet the needs of rural hospitals in Ghana. The course's effectiveness was evaluated by pre-course and post-course test scores; and by interviews with course participants 1 year afterwards. Mean test scores improved from 69% (% correct) to 80%. There were improvements in all major categories: initial management, torso, plastic surgery, orthopaedics, and X-ray interpretation. Follow-up interviews revealed high level of utilisation of basic airway manoeuvres (93% of participants utilising at least once) and chest tube insertion (67%), but limited utilisation of advanced airway manoeuvres (20%). Participants reported that their provision of most categories of care had improved. Categories with less improvement were: management of open fractures (33% not improved), closed fractures (20%), and diagnosis of abdominal injury (20%). This locally developed course improved the participants' knowledge and their self-reported process of trauma care. Aspects of trauma care with low test scores indicate areas needing reinforcement. Aspects with low subsequent utilisation, such as advanced airway management, indicate areas that might need attention to other components of care, such as equipment availability and training of ancillary staff. These findings provide lessons for efforts to improve trauma care in other low-income countries.

Trauma life support education: a didactic and caprine laboratory course for Nigerian physicians

The purpose of this study was to introduce the principles of initial hospital assessment and treatment of injured patients, tailored to the facilities and resources available in Nigeria. A 3-day didactic and laboratory course was presented by four trauma surgeons. The didactic session stressed the initial assessment and treatment of injured patients. The caprine laboratory taught the performance of common resuscitation manoeuvres: cricothyroidotomy, tube thoracostomy, i.v. cut-down, diagnostic peritoneal lavage, etc. The mean pre-course test score was 49.3 per cent and the mean post-course test score was 69.5 per cent; 93.5 per cent of the 124 participants increased their test scores. This represents a significant increase in knowledge in Nigerian physicians. Academic medical centres are encouraged to make such courses available in developing countries.