Pre-course Score Research Articles

Advanced life support provider course in Italy: A 5-year nationwide study to identify the determinants of course success

IntroductionThe advanced life support (ALS) provider course is the gold standard for teaching and assessing competence in advanced resuscitation. Outcomes over a 5-year period of European Resuscitation (ERC)/IRC ALS provider courses in Italy were investigated, and the factors associated with course success are described. MethodsIn 2008, the Italian Resuscitation Council (IRC) created a database in which every ERC/IRC ALS course was recorded. Data from courses organized from 2008 to 2012 were analysed. The data included: candidate's age and degree (medical doctor (MD) or nurse), medical specialty of MD candidates, course outcomes, duration and reference guidelines, number of instructors and course director. Relationships between the course outcomes and the courses and candidates’ characteristics were analysed using logistic regression. ResultsA total of 13,624 candidates were evaluated from 871 courses. Among the candidates, 55% were MDs and 45% were nurses. Ninety-seven percent of candidates passed the final evaluation, while 3% failed. Candidates who passed were younger (37 [31–44] vs. 43 [37–50] years, p<0.0001) and had a greater pre-course resuscitation knowledge (multiple choice quiz (MCQ) score: 88 [83–93] vs. 80 [73–87], p<0.0001) compared to those who failed. The course pass rate was higher for MDs compared to nurses (98% vs. 95%, p<0.0001) and participants in emergency disciplines were most significantly associated with course success (χ2 71, p<0.0001). In the multivariate analysis, an older age (OR 0.926, 95%CI [0.915–0.937]) was independently associated with course failure, while being a MD (OR 3.021, 95%CI [2.212–4.132]), having a higher pre-course MCQ score (OR 1.033, 95%CI [1.026–1.040]) together with a higher candidate/instructor ratio (OR 1.314, 95%CI [1.067–1.618]), and having a longer course duration (OR 1.717, 95%CI [1.090–2.703]), were independently associated with success. ConclusionsYounger age, professional background, and pre-course resuscitation knowledge are the most important predictors of ALS provider course success, together with higher candidate/instructor ratios and longer course durations.

How useful are Primary Trauma Care courses in sub-Saharan Africa?

IntroductionMore than five million deaths occur each year from injury with the vast majority occurring in low and middle-income countries (LMICs). Africa bears the highest road traffic related mortality rates in the world. Despite this, formal training in trauma management is not widely adopted in these countries. We report our results of 10 consecutive Primary Trauma Care (PTC) courses delivered in seven East and Central African countries, as part of the COSECSA Oxford Orthopaedic Link (COOL) initiative. MethodsCandidate's knowledge and clinical confidence in trauma management were assessed using a multiple-choice questionnaire and a confidence matrix rating of eight clinical scenarios. We performed descriptive statistical analysis on knowledge and clinical confidence scores of candidates before and after the course. We sub-analysed these scores, examining specifically the difference that exist between gender, job-roles and instructors versus non-instructors. ResultsWe have trained 345 new PTC providers and 99 new PTC instructors over the 10 courses. Data sets were complete for 322 candidates. Just under a third of candidates were women (n=94). Over two-thirds of candidates (n=240) were doctors, while the remainder comprised of nurses, medical students and clinical officers. Overall, the median pre-course MCQ score was 70% which increased to 87% post course (p<0.05). Men achieved a higher MCQ score both pre- and post-course compared to women (p<0.05); however there was no significant difference in the degree of improvement of MCQ scores between gender. Instructors outperform non-instructors (p<0.05), and similarly doctors outperform non-doctors on final MCQ scores (post-course). However, it was the non-doctors who showed a statistically significant improvement in scores before and after the course (20% non-doctors vs 16% doctors, p<0.05). Candidate's clinical confidence also demonstrated significant improvement following the course (p<0.05). ConclusionOur work demonstrates that COOL-funded PTC courses in the COSECSA region delivered to front-line health staff have helped improve their knowledge and confidence in trauma management, irrespective of their job-roles and gender. Further follow-up is needed to establish the long-term impact of PTC courses in this region.

Is an 'Introduction to ENT course' the answer for safe ENT care?

ENT presentations are common both in primary care and accident and emergency departments. Unfortunately, many clinicians are not comfortable handling ENT emergencies due to a lack of knowledge and skill stemming from an undergraduate level onwards. An 'Introduction to ENT' course has been cited as an answer to bridge the gap in knowledge and promote confidence in doctors. A pre- and post-course analysis was performed on 29 participants attending an 'Introduction to ENT' course using a standardised questionnaire. Five were excluded from our analysis. Of the remaining 24, there was a lack of significant changes on the amount of ENT knowledge gained (pre-course mean score 2.71 vs post-course mean 4.63, p=0), confidence in dealing with ENT emergencies (pre-course mean score 2.54 vs post-course mean score 4.58, p=0) and confidence performing ENT procedures (pre-course mean score 2.375 vs post-course mean score 4.46, p=0). We feel that the course alone is insufficient in providing a basic and safe emergency ENT service. We suggest a period of shadowing be introduced in addition to the compulsory induction programme for junior doctors rotating through ENT.

“iBIM” — Internet-based interactive modules: an easy and interesting learning tool for general surgery residents

The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

Course in basic surgical skills.

The Basic Surgical Skills (BSS) course provides an introduction to basic surgical techniques. The course was held in Norway for the first time in 2009. This study was carried out to evaluate the learning outcomes of the course. The participants from four consecutive courses were invited to take part in the study and were tested in three practical exercises immediately before and after the course. Their performance was measured using an Objective Structured Assessment of Technical Skills (OSATS) for two of the exercises and by time needed to complete the third exercise. The participants also undertook two self-evaluations of competence on each exercise, one prior to and one after completing the course. A total of 57 out of the 65 course participants were included in the study. The participants' scores were significantly higher for all three practical exercises after course completion, compared with the pre-course score (p < 0.001). The self-evaluations indicated that the participants felt more competent after the course. The study indicates that the BSS course provides better basic surgical skills. In view of the lack of equivalent courses at core surgical training, consideration should be given to introducing this as a compulsory part of the surgical training in Norway.

The integration of cancer survivorship training in the curriculum of hematology/oncology fellows and radiation oncology residents.

e20667 Background: The population of cancer survivors is steadily increasing. Cancer specialists require an understanding of survivors’ needs to insure optimal delivery of post-treatment care. Residency and fellowship training traditionally focus on cancer therapy, while survivorship care is often not emphasized. As a paradigm shift in our training programs, we instituted a Cancer Survivorship Workshop. Methods: In academic year 2011-2012 a Cancer Survivorship Workshop course was held at the James P. Wilmot Cancer Center/University of Rochester, a comprehensive cancer center with accredited training programs in Hematology Oncology (HO) and Radiation Oncology (RO). Course objectives included 1) learning about survivorship from patient, primary care physician, and oncologist perspectives using an evidenced-based curriculum; 2) designing treatment summaries (TS) and survivorship care plans (SCP) for 5 malignancies (lung, breast, prostate, colon, lymphoma) for integration into the electronic medical record and dissemination to patients; 3) establishing collaboration between HO and RO trainees by working together in assigned teams. Course impact was assessed pre- and post- training with a 13 question survey. Questions were answered using a 10 point scale, with a pre-defined rating system for each question. Results: Significant differences in responses to several survey questions were observed comparing pre- and post-course experience. Improvement in comfort level when discussing survivorship issues with patients (median pre-course score=6, post-course=8; p=.001), reported knowledge of survivorship care for 5 types of cancer (5 to 7; p=.002), confidence in ability to explain a SCP to a patient (5 to 8; p=.001), and comfort discussing late effects of treatment with patients (5 to 8; p=.001). The number of articles read regarding cancer survivorship increased. Five unique sets of TS and SCP’s were completed. Conclusions: This study demonstrates the feasibility of implementing cancer survivorship education into the curriculum of HO and RO training. This represents, to our knowledge, the first documented educational undertaking of its kind nationally in HO and RO Programs.

The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology

BackgroundTo investigate the effect of a structured, supervised, cataract simulation programme on ophthalmic surgeons in their first year of training, and to evaluate the level of skill transfer.MethodsTrainees with minimal...

The Impact of Religious Studies Courses: Measuring Change in College Students' Attitudes

This study explores a variety of educational outcomes on undergraduate student attitudes as a result of religious studies curriculum. Based on data collected from pre- and post-course surveys of a combined 1,116 students enrolled at Arizona State University and 2 Phoenix, Arizona area community colleges, the research examines student change across 5 outcomes: religiosity, attributional complexity, multi-religious awareness, commitment to social justice, and the first to be developed, neo-colonial measures. The sample was taken in the fall of 2009 from courses including Religions of the World, introductory Islamic studies courses, and a control group consisting of engineering and political science students. The findings were mixed. Select within-group changes showed a statistically significant positive shift, but when comparing across-groups and the control group, analysis of covariance did not reveal statistically significant findings after controlling for key variables. The students’ pre-course survey score was the best predictor of their post-course survey score. In response to the neo-colonial critiques, the non-findings suggest the critiques have been overstated in terms of their impact pedagogically or in the classroom.

How to confidently teach EBM on foot: development and evaluation of a web-based e-learning course

BackgroundScarcity of well-trained clinical tutors is a key constraint in integrating teaching of evidence-based medicine (EBM) into clinical activities.ObjectivesWe developed a web-based educational course for clinical trainers to confidently teach...

The impact of intense airway management training on paramedic knowledge and confidence measured before, immediately after and at 6 and 12 months after training

IntroductionAirway management is a core component in the practice of advanced life support (ALS) paramedics.ObjectiveTo determine if an intense airway management course would improve ALS paramedic knowledge and confidence and...

Team‐based learning methods in teaching topographical anatomy by dissection

While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described. In the recently reintroduced 7-week elective anatomy by whole body dissection course for senior medical students at Sydney Medical School, team-based learning (TBL) principles were used in the course design and implementation. In the 2011 course, 42 senior medical students participated. The effectiveness of TBL pedagogy was assessed by knowledge acquisition and retention and by administration of a questionnaire to evaluate the impact of the principles of this pedagogy. The course produced a marked increase in topographical anatomical knowledge. The median pre-course assessment score was 9/20 (interquartile range 5) and the median post-course assessment score was 19.5/20 (interquartile range 1.75). The difference was statistically significant (P < 0.001). There was near universal agreement by students that five key principles of TBL (small groups, instructor selected allocation to groups, regular assessments, inter- and intra-group competitiveness, and prescribed out-of-class preparation), contributed to this knowledge acquisition. The application of TBL methodology to teaching human anatomy by dissection enables a large group of students to have small group experiences without a large number of teachers. It results in effective acquisition of topographical anatomical knowledge and appears to provide better acquisition of such knowledge than the previous methods of anatomy teaching to which these students had been exposed.

Can the WRAT-4 Math Computation Subtest Predict the Final Grade in a College-Level Math Course?

Abstract 121 freshman through graduate college students (68 men, 53 women; M age = 23.3 yr., SD = 7.8) in 10 different math classes were administered the Wide Range Achievement Test Fourth Edition (WRAT–4) Math Computation Test in their first (pre-course) class. Predictive validity coefficients were calculated relative to the criterion of the final class grade. The validity coefficient for the pre-course WRAT score was statistically significant. The WRAT–4 Math subtest can be used by instructors to examine performance on specific items to judge the appropriateness of a student's placement in either entry-level math courses. However, high school grades are a better predictor of completing the college curriculum.

Continuing dental education: evaluation of the effectiveness of a disinfection and decontamination course

To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. Pre- and post-course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. Mean pre-course score was 45.3%, rising to 87.0% in the post-course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. Attending the disinfection and decontamination course significantly improved participants' knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.

Back to the future: teaching anatomy by whole‐body dissection

To evaluate the 2010 "Anatomy by whole body dissection" course, a 7-week elective course offered to senior medical students at the University of Sydney at the end of their third year. In the 2010 course, 29 students divided into eight groups carried out whole-body dissections on eight cadavers over a 34-day period. Surgical trainees acted as demonstrators, and surgeons and anatomists as supervisors. The students were assessed by practical tests involving the identification of 20 tagged structures in four wet specimens before, during, at the end of, and 1 month after the course. In addition, students were asked to complete an anonymous feedback questionnaire about the course. Acquisition of topographical anatomical knowledge, and student feedback on the usefulness of the course. A significant increase in topographical clinical anatomical knowledge was demonstrated among the participants and was maintained in the short term. The median pre-course assessment score was 8/20 (interquartile range [IQR], 4) and the median post-course assessment score was 19/20 (IQR, 1). This difference was statistically significant (P<0.001). All students rated the course as "very good", and unanimously recommended that the course be available to all students as part of the medical curriculum. Students' knowledge of anatomy improved significantly between the pre-course and post-course assessments, and all students rated the course very favourably. This supports our view that dissection anatomy should be an integral component of medical education.

Can Learning to Sustain Life be BASIC? Teaching for the Initial Management of the Critically Ill in Australia and New Zealand

Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. Of 796 participants, 338 (42%) were in Australia and 458 (58%) in New Zealand. Compared to New Zealand, Australian non-intensive care consultants and junior medical staff attended more commonly at 9% vs 4% and 62% vs 42% respectively, while nurses more frequently attended in New Zealand (47% compared to 12%, P < 0.001). The pre-course open book examination result averaged 79% (95% confidence interval 78 to 80) and the post-course closed book examination was 64% (95% confidence interval 63 to 65). The post-course examination score was predicted by pre-course examination score (beta = 0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (beta = -3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (beta = 0.22, 95% confidence interval 0.17 to 0.27, R2 = 0.38, P < 0.001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.

Teaching and assessing systems-based practice: a pilot course in health care policy, finance, and law for radiation oncology residents.

Under the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, residency programs are required to provide data on educational outcomes and evidence for how this information is used to improve resident education. To teach and assess systems-based practice through a course in health care policy, finance, and law for radiation oncology residents, and to determine its efficacy. We designed a pilot course in health care policy, finance, and law related to radiation oncology. Invited experts gave lectures on policy issues important to radiation oncology and half of the participants attended the American Society for Therapeutic Radiation and Oncology (ASTRO) Advocacy Day. Participants completed pre- and postcourse tests to assess their knowledge of health policy. Six radiation oncology residents participated, with 5 (84%) completing all components. For the 5 residents completing all assessments, the mean precourse score was 64% and the mean postcourse score was 84% (P = .05). Improvement was noted in all 3 sections of health policy, finance, and medical law. At the end of the course, 5 of 6 residents were motivated to learn about health policy, and 4 of 6 agreed it was important for physicians to be involved in policy matters. Teaching radiation oncology residents systems-based practice through a course on health policy, finance, and law is feasible and was well received. Such a course can help teaching programs comply with the ACGME Outcome Project and would also be applicable to trainees in other specialties.

Which factors predict candidate outcome in advanced life support courses? A preliminary observational study

PurposeTo identify factors associated with candidate outcome in the European Resuscitation Council (ERC) advanced life support (ALS) provider courses.MethodsMedical doctors participating as candidates to consecutive ALS courses organised by an ERC training centre in Italy were enrolled in this prospective cohort study. The association between the ALS course outcome and candidate demographics, professional background and pre-course knowledge measured by using the pre-course multiple choice quiz (MCQ) was investigated by using logistic regression.ResultsA total of 283 candidates, median age 31 years, were evaluated. Among them, 269 (95.1%) passed the final evaluation and 14 (4.9%) failed. Candidates who passed were younger (median age 31 vs. 37.5 years; p = 0.006) and attained a higher pre-course MCQ score (median 84 vs. 72.5%; p < 0.0001). On multivariate analysis, a higher pre-course MCQ score (OR 1.18 [95%CI 1.09–1.28]) and a basic life support (BLS) certification (OR 5.00 [95%CI 1.12–22.42]) were independent predictors of candidate success, while older age was associated with a significantly higher risk of failing (OR 0.90 [95%CI 0.83–0.97]). Female candidates had higher pass rates (97.2 vs. 91.2%; p = 0.048); however, after correction for confounders gender was not significantly associated with candidate outcome. Neither candidate specialty nor site of work was a predictor of candidate success.ConclusionsOn ALS courses, younger age and a higher level of specific pre-course knowledge, as measured by both the pre-course MCQ and the presence of BLS certification, are the most important predictors of success. Candidate gender and professional background did not show a significant correlation with course outcome.

Genetic Literacy of Undergraduate Non–Science Majors and the Impact of Introductory Biology and Genetics Courses

ABSTRACT With the advancement of genetic information and technologies, there is an increasing need for a genetically literate public. This study looks critically at student learning and at the current instruction of genetics in introductory non–science major biology and genetics courses at the undergraduate level. A new diagnostic tool, the Genetic Literacy Assessment Instrument, was administered pre- and postcourse to more than 300 students in six introductory nonmajor courses that emphasize genetics to varying degrees. Current data from students in these courses show a precourse average score of 43 percent correct zn the inventory. Postcourse scores increased only modestly, to an average of 49 percent. In this article, we discuss the impact of teaching methods and course content on scores, as well as student learning in the different content areas of genetics. The results suggest that further studies in genetics education are needed to better understand the effect of teaching methods on achieving geneti...

Learning Assessment at Shoulder Surgical Skills Course

Surgical skills courses are an important part of learning during surgical training. The assessments at these courses tend to be subjective and anecdotal. Objective assessment using multiple choice questions (MCQs) quantifies the learning experience for both the organisers and the participants. Participants of the open shoulder surgical skills course conducted at The Royal College of Surgeons of England in 2005 and 2006 underwent assessment using MCQs prior to and after the course. The participants were grouped as non-consultants (14) and consultant orthopaedic surgeons (8). All participants improved after attending the course. The average improvement was 17% (range, 4-43%). We compared the two groups while adjusting for the association between pre-course score and score gain. We found a strong correlation between pre-course score and score gain (r = 0.734; P = 0.001). Adjusted for pre-course score, we found that the score gain (learning) for the non-consultants was slightly larger than for the consultants, but this did not reach statistical significance (P = 0.247). All participants had a positive learning experience which did not have a significant correlation to the grade of surgeon.

Reproductive Health Education of Conscripts in Turkish Armed Forces: First Evaluation of Training Courses

In the frame of the Reproductive Health Program of Turkish Armed Forces, conscripts have been given 1-day participatory, interactive courses by the field military medical trainers in all military garrisons. Pre- and posttest knowledge levels of soldiers were tested by 25 true-false questions. Demographic characteristics and test scores were routinely transferred from the training rooms to the reproductive health database by authorized field trainers using the network of the army. Two hundred forty-eight thousand seven hundred ninety-six soldiers with perfect entrance of data have been selected for descriptive analyses. Of all the soldiers, 39.2% were born in 1984. Primary school graduates have constituted the largest group with 34.4%. Only 7.4% of the soldiers were married. The mean precourse score was 65.7% +/- 15.4%, while the postcourse score was 83.5 +/- 12.73% (SD) (p < 0.001). Those who used to live in the east region of Turkey have obtained significantly lower scores on both pre- and posttests in comparison to scores of those who used to live in other regions (p < 0.001). Groups based on five educational levels have obtained significantly different scores, ascending gradually from uneducated to the higher educational level (p < 0.001). The ratio of increase in knowledge was highest in the groups with the lowest educational level and unmarried (p < 0.001). Training courses seem to succeed in increasing the knowledge of conscripts, particularly of those with a low socioeconomic and cultural status. However, it requires time to determine whether this increase in knowledge level with promote behavioral change positively and will improve young males' own and their partners' reproductive health status.