Self-assessed Confidence Research Articles

Role of video-based learning on competency level of direct laryngoscopic skills of novice anaesthesiologists - A randomised clinical trial.

Video laryngoscopes are often used for education and training of intubation skills. This study aimed to examine the influence of video-assisted guidance and video replay on intubation skills of novice anaesthesiologists. Adult patients of American Society of Anesthesiologists physical status grade I-II, with a normal airway and scheduled to undergo elective surgical procedures requiring general anaesthesia and orotracheal intubation were included in this randomised study. Ten trainee anaesthesiologists, with no prior experience of performing tracheal intubation were enroled and randomly divided into group STD (received traditional learning) and group VL (received video-based learning). After initial mannequin training, the first seven intubations in patients in both the groups were done under supervision. In group VL, in addition to traditional cues, posttracheal intubation, the trainee and instructor had a session of video replay to discuss the entire process of laryngoscopy and tracheal intubation with areas of improvement. For the subsequent 15 intubations in patients, the trainees intubated independently using a standard Macintosh blade. The primary objective was to compare time required to intubate (TTI) for both groups using Mann-Whitney U test. Secondary objectives included comparison of difficulty in intubation (using a 5-point Likert scale), self-confidence scores (1-10, 10 - most confident), and intubation-related trauma. The mean TTI was significantly lower in group VL than in group STD - 40s [Interquartile range (IQR): 32-50] versus 52s [IQR: 39-76], P = 0.002. No difference was seen in self-assessed confidence levels, rating of difficulty in intubation, and airway trauma. Video replay of the intubation process has a positive impact on direct laryngoscopy learning.

Impact of an in-person small group surgical skills course for preclinical medical students in an era of increased e-learning

ObjectiveThe COVID-19 pandemic led to a dramatic decrease in face-to-face teaching. This can particularly impact medical students' skills development. This prompted development of an in-person surgical skills course as guided by the General Medical Council "Outcomes for Graduates" facilitated by tutors with surgical experience. This study aimed to primarily assess participant confidence in surgical skills following the course. DesignThis was an interventional study assessing both qualitative and quantitative data collected prior to, during, and post course completion. Data were collected from students via online forms, which included a mixture of "Yes/No" responses, self-assessed confidence levels via Likert scales, and free type questions. SettingThe study assessed feedback for a 5-session surgical skills course delivered at the authors' institution. This is a newly designed course using low-cost materials which was free for all attendees. ParticipantsParticipants were all in the first or second year of medical school. There was capacity for 60 students, and all attendees provided informed consent to participate. ResultsA total of 446 students applied for the course with 58 participants in the final study, 31% of whom had prior surgical skills experience. There was a statistically significant increase in student confidence levels following the course for all taught surgical skills (P = .0001). Participants were also more confident that they possessed the skills required for clinical placements (P = .0001) and to work as a junior doctor (P = .01). Thematic qualitative analysis revealed a reliance on third parties for previous surgical experience; this course improved knowledge and skills for future practice. Limitations included session duration and equipment choice. ConclusionThis study demonstrates high demand and student satisfaction from this course, offering a potential framework to improve undergraduate surgical skills teaching. The results presented here have the potential to inform wider curricula development across medical schools in the future. CompetenciesMedical knowledge; practice-based learning and Improvement.

Future-proofing our Doctor of Veterinary Medicine degree program: building student confidence in self and peer assessment.

Future-proofing our Doctor of Veterinary Medicine degree program: building student confidence in self and peer assessment.

Simulation-Based Outreach Program Improves Rural Hospitals' Team Confidence in Neonatal Resuscitation.

Introduction: Neonatal resuscitation is a high acuity, low occurrence event (HALO), and in rural community hospitals, low birth rates prevent providers from regular opportunities to maintain essential resuscitation skills. Simulation is an effective training modality for medical education, although resources for simulation are often limited in rural hospitals. Our primary objective was to test the hypothesis that in situ neonatal resuscitation simulation training improves rural hospitals' delivery room team confidence in performing key Neonatal Resuscitation Program® (NRP®) skills. Our secondary objective was to compare confidence to performance as measured by adherence to NRP® guidelines.Methods: We conducted a quasi-experimental pre-training survey and post-training survey of delivery room team confidence in NRP® skills at five level one delivery hospitals before and after an in situ simulation training program. Participants included rural hospitals’ usual delivery room team members. Participants rated their confidence on a five-point Likert scale. Simulations were analyzed using an adapted version of a validated scoring tool for NRP® adherence and presented as overall percentage scores.Results: Our data demonstrate a significant improvement in self-assessed confidence levels pre- and post-simulation training in key areas of neonatal resuscitation. Participants reported higher confidence in airway management (4 vs. 3, p=0.003), emergency intravenous access (3 vs. 2, p=0.007), and the ability to manage a code in the delivery room (4 vs. 3, p=0.013) and the operating room (4 vs. 3, p=0.028). Improvements were also noted in their team member’s knowledge and skills to perform neonatal resuscitation. While improvements were appreciated in confidence, the performance of skills (NRP® adherence scores) was often in the sub-optimal performance range.Conclusions: An in situ-based neonatal resuscitation outreach simulation program improves self-confidence among rural delivery room teams. Additional research is needed to understand how to translate improved confidence into actual improved performance.

35126 Education to improve general medical doctors’ dermatology referrals

General hospital doctors often find it challenging to correctly diagnose and appropriately refer common benign and malignant skin lesions. A series of dermatology images of melanoma, nonmelanoma malignancies, actinic keratosis and benign lesions was presented in a quiz format to general medical doctors in a model 3 hospital. Dermatology experience, confidence in lesion recognition and decision for dermatology referral was surveyed pre-teaching. A teaching session with follow-up quiz and self-assessed confidence of lesion recognition and diagnosis was surveyed. Comparison pre and post quiz scores were analyzed. Twenty-four medical doctors ranging from intern to consultant participated in this study. 96% (n = 23) had no prior dermatology experience. Following teaching, 61% (n = 14) expressed feeling confident in their diagnosis of presented images, compared with 17% (n = 4) preteaching. The follow-up quiz showed a global 24% increase in lesion recognition. Correct referral of actinic keratosis improved from 79% to 100%, acral melanoma improved from 75% to 90%, melanoma referral improved from 77% to 93% and BCC referral improved from 88% to 100%. 91% (n = 21) found the teaching session helpful for future practice. The teaching session improved the ability to correctly identify features of common benign, premalignant and malignant skin lesions. The follow-up quiz demonstrated improvement in appropriate referrals for premalignant and malignant lesions. Regular dermatology teaching with images and self-assessment quizzes should improve the confidence of general hospital doctors to correctly recognize and refer to dermatology services. This study demonstrates the need for dermatology teaching to general medical doctors to improve the accurate diagnosis and referral of common skin lesions.

789 The Impact of a Virtual Orthopaedic On-Call Survival Course on Junior Doctors’ Confidence in Managing an Orthopaedic On-Call

Abstract Aim Junior doctors often feel underprepared for their orthopaedic on-call shifts during their foundation placements. Studies have shown that medical schools are failing to prepare students to manage trauma and orthopaedic patients. The aim of this study was to assess the effects of an orthopaedic on-call survival course on the confidence levels of junior doctors in managing an orthopaedic on-call. Method We developed a one day orthopaedic on-call survival course, designed to provide junior doctors with the relevant knowledge to be able to confidently navigate an orthopaedic on-call shift. We designed a pre-course and post-course questionnaire which were distributed to the participants. Self-assessed confidence levels were recorded in managing an orthopaedic on-call and a number of orthopaedic knowledge domains using visual analogue scale 1–5. The course was delivered over 4 hours using Microsoft Teams. Results We received 47 matched pre- and post-course questionnaires. Overall, 87% of participants reported an increase in confidence in managing an orthopaedic on-call shift. 83% of participants reported an increase in confidence in orthopaedic radiology teaching. 80% of participants reported an increase in confidence in both upper limb emergencies and lower limb emergencies. 91% of participants reported an increase in confidence in spinal trauma. Conclusions An orthopaedic on-call survival course can provide junior doctors with the knowledge to be able to confidently manage trauma and orthopaedic patients during on-call shifts. We recommend that an orthopaedic on-call survival course can be used as an effective teaching method towards preparing junior doctors for their on-calls during foundation training.

A metacognitive confidence calibration (MCC) tool to help medical students scaffold diagnostic reasoning in decision-making during high-fidelity patient simulations.

The purpose of this study was to 1) help novice students scaffold problem-solving and engage safely in the deliberate practice of diagnostic reasoning and medical decision-making in real time; 2) assess how accurately students gather and apply data in medical reasoning and treatment during high-fidelity patient simulations (HFPSs); 3) identify students' scientific misconceptions related to the case; 4) promote student metacognitive processing, self-assessment, and self-efficacy; and 5) facilitate the explicit calibration of student confidence in deliberate reasoning with patient outcomes. In a mixed-method design, a metacognitive calibration self-assessing (MCC) survey tool was applied to HFPS (n = 80, 20 teams of 6 medical students) and semistructured interviews were conducted with faculty (n = 5). When scored by faculty with a rubric, the mean student accuracy ranged from 23% to 74%, whereas their self-assessment of confidence ranged from 71% to 86%. This result revealed overconfidence bias in novice students regarding the correctness of their wrong responses. The most common misconception identified was inverting cause and effect: metabolic acidosis was pointed to as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus. The most common treatment error was overtreatment, with unnecessary added medication. Interviews with faculty suggested that the MCC tool improved the team process by slowing students down, requiring them to think through their answers, and that overall the tool improved their critical thinking. This study demonstrated the feasibility of using a metacognitive confidence calibration tool to assist novice students in learning safely to make deliberate diagnostic reasoning and decisions on patient care in real time during complex simulations while observing objectively their levels of psychological confidence against patient outcomes.NEW & NOTEWORTHY This study demonstrates the feasibility of a metacognitive confidence calibration tool (MCC) to assess and promote novices in the learning of diagnostic reasoning and treatment decisions on patient care in real time during high-fidelity patient simulations while comparing confidence and accuracy data and identifying students' scientific misconceptions. Results revealed the presence of overconfidence bias, overtreatment, and the misconception of metabolic acidosis as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus.

Simulation translation differences between craft groups

BackgroundMany simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described.ObjectivesTo understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs.DesignQualitative descriptive study design using pre- and post-SBCEE questionnaires.SettingsA large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals.MethodsParticipants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians’ experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts.ResultsThree overarching themes were identified regarding simulation participants’ perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized ‘confidence-building’ as a key indicator of improved workplace performance achieved through SBCEE learning.ConclusionA diverse range of factors influences healthcare workers’ experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.

A behavioural intervention to increase lay-people's intentions to initiate CPR in the event of Out-of-Hospital Cardiac Arrest: results from BICeP pilot trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council Background Cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from out of hospital cardiac arrest (OHCA). Even when trained, most lay-people don’t attempt CPR when they encounter OHCA. Working closely with intended users and CPR experts we developed a theory-based text-messaging intervention designed to increase rates of CPR. This pilot study was conducted to evaluate the acceptability of the messages, explore participant responses to them and to trial measures for a full evaluation. Design A before-and-after study plus qualitative interviews Methods Twenty lay-people from across Scotland agreed to take part and to receive the intervention (35 text-messages over approx. 6 weeks) At baseline and after participants had received intervention (approx. 6 weeks later) we measured how likely people were to perform CPR (intention) in relation to 4 scenarios and self-assessed competence and confidence about performing CPR (self-efficacy) in general. We conducted qualitative interviews with 10 participants to elicit their views of the intervention Results Twenty lay-people (6F, 14M; aged 20-84) participated, all providing full baseline data. 19/20 participants received at least 20 messages. 15/20 provided follow-up data and ten were interviewed. Baseline intentions to initiate CPR in CPR scenarios were high (18.1) but still greater after the intervention (19.5). Increases in theory-based predictors of intention, self-efficacy (pre:74.5 post:81.0) and self-assessed competence (pre:19.5 post:20.5) were also observed following the intervention. Qualitative data suggested the intervention was positively received and viewed as helpful in improving confidence by reinforcing and building on messages from training. Interviewees suggested additional options for delivery format and pace would be helpful. Conclusions A behaviour-change text-message intervention delivered after CPR training is acceptable, easily scalable and may help improve rates of lay CPR initiation. Full scale evaluation of effectiveness is planned.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

BackgroundThe aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).Materials and methodsBoth 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.ResultsOverall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).ConclusionThere was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Reevaluating Innovations in Medical Student Neurosurgery Education: Lessons Learned Today from Data Collected Before COVID-19

Virtual learning has made neurosurgery education more available to medical students (MSs) of all stages than ever before. We aimed to evaluate the impact of on-site learning in order to assess whether a return to this method of teaching, when safe, is warranted for MSs of all years. Registrants of the 2019 MS Neurosurgery Training Camps were sent precourse and postcourse surveys to assess changes in self-assessed confidence in concrete neurosurgical skills. Data were analyzed using a 2-tailed paired Student's t-test for continuous variables. A P value <0.05 was considered significant. The 2019 Training Camp had 105 attendees, of whom 94 (89.5%) completed both surveys. Students reported statistically significant improvements in every surveyed skill area, except for understanding what is and is not sterile in an operating room. The cohort of MS 3/4 students indicated a postcourse decrease in confidence in their ability to understand what is and is not sterile in an operating room (93.69 ± 16.41 vs. 86.20 ± 21.18; P < 0.05). MS 3/4 students did not benefit in their ability to perform a neurologic examination or tie knots using a 1-handed technique. Neurosurgical education initiatives for MSs should continue to be developed. Hands-on neurosurgical training experiences for MSs serve as a valuable educational experience. Improvement in training models will lead to capitalizing on MS education to better improve readiness for neurosurgical residency without concern for patient safety.

Effectiveness of a Clay Pelvic Model: A Hands-on Approach to Understanding Pelvic Floor Anatomy.

Understanding pelvic anatomy is an important part of education during obstetrics and gynecology residency. Traditional teaching methods to learn pelvic anatomy have obstacles and are often costly. We provide a self-constructed clay pelvic model to aid in the mastery of pelvic anatomy for obstetrics and gynecology residents and to estimate whether building a clay pelvic model would increase residents' confidence and knowledge in pelvic anatomy. Each resident constructed a clay pelvic model on a bony pelvis, along with the traditional didactic on pelvic anatomy. Demographics of the participants were obtained, followed by a knowledge test and confidence level and satisfaction surveys. Descriptive analysis and Wilcoxon signed-rank test were used for data analysis. Nine residents (three postgraduate year [PGY]-1, one PGY-2, two PGY-3, three PGY-4) completed the knowledge and confidence questions before and after the simulation, along with the satisfaction survey. The median score from the 10 multiple-choice knowledge questions was 50% (30-70%) on the pretest and 70% (40-100%) on the posttest (P=not significant). Although most residents scored higher on the posttest, two residents scored 10% lower. Overall, 66.7% of residents improved their knowledge scores up to 30% after the simulation session. Self-assessed confidence level scores improved from 2-3 to 4 (1, lowest; 5, highest) for all questions asked (P=.010 to approximately .019). A majority of residents responded with 4 or 5 to the satisfaction statements. A low-budget clay pelvic model is easy to build and did increase residents' confidence in pelvic anatomy knowledge and satisfaction. Self-constructing a clay pelvic model would provide an excellent way of reviewing the major landmarks of pelvic anatomy.

Coupling gamified continuing education with confidence-based assessment to address knowledge gaps and assess attitudes towards liquid biopsy for cancer screening among primary care providers.

11012 Background: Blood-based liquid biopsy assays offer a simplified approach to detect cancer early, guide clinical decision making, and predict treatment success. Given their novelty, primary care providers need education to improve knowledge and confidence regarding their use. The use of gamification in continuing medical education (CME) has been shown to increase engagement and knowledge transfer, and confidence-based learning can improve the educational experience by identified areas in which learners lack comfort. Methods: We provided a gamified CME activity based on the principles of confidence-based learning designed to educate primary care providers (PCPs) on the latest advances regarding the use of liquid biopsy for cancer screening. The game coupled knowledge questions with self-assessment of confidence to gage awareness of these topics. Pre- and post-test was used to quantify the impact of the education. The CE activity was available for credit from March 31, 2021 to March 31, 2022. Results: As of January 2022, 389 PCPs have participated. Overall, participants scored an average 76% on gaming questions related to the rationale behind the use of cell free DNA (cfDNA) for cancer screening and the benefits of liquid biopsy over tissue biopsy, demonstrating relatively high baseline knowledge on these topics. Self-reported confidence among those who answered correctly, however, was only 3.4 out of 5.0, suggesting a lack of comfort with the concepts despite answering correctly. On topics related to specific studies that demonstrated the clinical utility of liquid biopsy, participants scored only 59% and confidence scored averaged 3.17 out of 5.0, demonstrating a lack of knowledge and comfort on these topics. Across all topics, providers scored a 61% on a pre-test. Post-learning, providers scored 89%, highlighting the impact of the education on knowledge gaps. Moreover, while 52% of participants had never ordered a liquid biopsy for cancer screening prior to the education, 69% report being likely or extremely likely to do so because of the education provided. Conclusions: Integration of gamified and confidence-based learning into CE activities is an impactful way to identify and address knowledge gaps while also informing the need for future education. In this study, while self-report of confidence generally correlated with knowledge scores, confidence scores were only average even among those who answered correctly, demonstrating the need for skills-based learning that may improve comfort with liquid biopsy in the clinical setting.

Surgical simulation training for escharotomy: A novel course, improving candidate’s confidence in a time critical procedure

BackgroundCircumferential deep burns on the limb lead to a constrictive, tourniquet-like effect causing critical limb ischaemia. The treatment, escharotomy, is a time-critical procedure that sometimes is required before the patient arrives at a burn centre. At present, no practical method of teaching this procedure is incorporated into formal educational courses. MethodsThe feasibility of a comprehensive education package to teach upper limb escharotomy was assessed in a group of plastic and general surgery trainees in Wales. Small group workshops focused on the clinical presentation of patients requiring escharotomy. Participants then executed this on a custom-made high-fidelity simulation upper limb model. The articulated limb has subcutaneous silicone fat which bulges upon decompression and a finger-tip which turns pink indicating satisfactory reperfusion. A before and after five-point Likert scale was used to evaluate changes in participants’ self-assessed confidence in the surgical management of escharotomy. Statistical significance between scores was assessed using the Wilcoxon signed-rank test. ResultsA total of 34 participants took part. Following completion of the course, general surgery trainees’ confidence in executing the procedure increased from a median score of 1.00 “not confident at all” (IQR 1.00–2.00) to 4.00 “fairly confident” (IQR 4.00–5.00, p < 0.01). Plastic surgery trainees’ confidence increased from a median score of was 3.00 “somewhat confident” (IQR 1.75–4.00) to 4.00 “fairly confident” (IQR 3.00–4.25, p < 0.01). DiscussionWe developed a comprehensive simulator course that has been demonstrated to improve candidate’s confidence in performing escharotomy. The next stage in the course development is to confirm the results in a larger cohort. By developing this simulator course we aim to improve emergency burn care education in the UK and globally.

Randomized Controlled Trial of Interactive Spaced Education to Support Constipation Management by Pediatric Primary Care Providers.

Integrating continuing medical education and quality improvement (QI) initiatives is challenging. We aimed to compare one method, Interactive Spaced Education (ISE/QI), with standard (sTD/Qi) education embedded within a constipation management Qi initiative. We conducted a randomized, controlled study to compare ISE/QI and STD/QI education. Pediatric primary care providers (PCPs) were recruited from a network of local private practices. The QI initiative was implemented with all providers before education interventions. ISE/QI participants received questions by email weekly, provided answers, received feedback, and repeated questions over a 4-month period. The STD/QI group received a Power Point with the same educational content. Pre- and post-surveys evaluated usability, self-assessed confidence, and practice changes while quizzes evaluated knowledge. Process control charts tracked subsequent visits to gastroenterology (GI). Of the 212 eligible PCPs, 101 (48%) enrolled, with 49 PCPs in the ISE/QI arm and 52 in STD/QI education arm. Quiz scores improved in the ISE/QI arm with a strong effect size (Cohen d 1.76). Mean increase in confidence managing difficult cases was higher in the ISE/QI group (1.84 vs 1.21, P = 0.030). ISE/QI participants were more likely to rate the activity better than most online education (odds ratio [OR] 18.1, P < 0.0001) and incorporate practice changes (OR 3.35, P = 0.0152). Visits to GI decreased among the entire population, but the effect on GI visits within each education arm was mixed. ISE/QI improved knowledge and confidence managing difficult cases. ISE/QI participants reported higher likelihood to change practice, but no differences were seen in GI referrals.

Development of a Novel, Low-Cost, Low-Fidelity Simulation Model for Pudendal Nerve Block Application.

Pudendal nerve block is an important alternative to neuraxial anesthesia, yet studies demonstrate that 3% to 50% of pudendal nerve blocks are ineffective. Lack of clinician training is the most common cause, and there are no simulation models currently described. To develop and test a novel, low-cost, low-fidelity simulation model for training residents in the placement of a pudendal nerve block. A pudendal nerve block model was developed using commonly found supplies, with a cost of $20.57. First-year to fourth-year obstetrics and gynecology (OB/GYN) and family medicine (FM) residents were invited to 1 of 4 pudendal nerve block 1-hour simulation sessions from December 2019 to March 2021 during their required teaching sessions. Expert faculty led a discussion of pudendal nerve blocks, then participants practiced with the described model. A survey about the model was created by the authors and administrated prior to and immediately after the session. Pre- and post-surveys were analyzed by Wilcoxon signed rank tests, and Bonferroni correction was performed. Thirty-four out of a total of 36 eligible residents participated (94%). Residents showed improvement in knowledge (median pre-simulation score 43.99 compared with 70.06 post-simulation, P<.00625) and self-assessed confidence (median pre-simulation score 1.7 compared with 3.2 post-simulation, P<.00625) of a pudendal block placement after simulation training. This new, low-cost, reusable, low-fidelity simulation model for pudendal nerve block placement improved knowledge and confidence in OB/GYN and FM residents after 1 hour of simulation training.

Are 3D-printed Models of Tibial Plateau Fractures a Useful Addition to Understanding Fractures for Junior Surgeons?

Tibial plateau fractures are often complex, and they can be challenging to treat. Classifying fractures is often part of the treatment process, but intra- and interobserver reliability of fracture classification systems often is inadequate to the task, and classifications that lack reliability can mislead providers and result in harm to patients. Three-dimensionally (3D)-printed models might help in this regard, but whether that is the case for the classification of tibial plateau fractures, and whether the utility of such models might vary by the experience of the individual classifying the fractures, is unknown. (1) Does the overall interobserver agreement improve when fractures are classified with 3D-printed models compared with conventional radiology? (2) Does interobserver agreement vary among attending and consultant trauma surgeons, senior surgical residents, and junior surgical residents? (3) Do surgeons' and surgical residents' confidence and accuracy improve when tibial plateau fractures are classified with an additional 3D model compared with conventional radiology? Between 2012 and 2020, 113 patients with tibial plateau fractures were treated at a Level 1 trauma center. Forty-four patients were excluded based on the presence of bone diseases (such as osteoporosis) and the absence of a CT scan. To increase the chance to detect an improvement or deterioration and to prevent observers from losing focus during the classification, we decided to include 40 patients with tibial plateau fractures. Nine trauma surgeons, eight senior surgical residents, and eight junior surgical residents-none of whom underwent any study-specific pretraining-classified these fractures according to three often-used classification systems (Schatzker, OA/OTA, and the Luo three-column concept), with and without 3D-printed models, and they indicated their overall confidence on a 10-point Likert scale, with 0 meaning not confident at all and 10 absolutely certainty. To set the gold standard, a panel of three experienced trauma surgeons who had special expertise in knee surgery and 10 years to 25 years of experience in practice also classified the fractures until consensus was reached. The Fleiss kappa was used to determine interobserver agreement for fracture classification. Differences in confidence in assessing fractures with and without the 3D-printed model were compared using a paired t-test. Accuracy was calculated by comparing the participants' observations with the gold standard. The overall interobserver agreement improved minimally for fracture classification according to two of three classification systems (Schatzker: κconv = 0.514 versus κ3Dprint = 0.539; p = 0.005; AO/OTA:κconv = 0.359 versus κ3Dprint = 0.372; p = 0.03). However, none of the classification systems, even when used by our most experienced group of trauma surgeons, achieved more than moderate interobserver agreement, meaning that a large proportion of fractures were misclassified by at least one observer. Overall, there was no improvement in self-assessed confidence in classifying fractures or accuracy with 3D-printed models; confidence was high (about 7 points on a 10-point scale) as rated by all observers, despite moderate or worse accuracy and interobserver agreement. Although 3D-printed models minimally improved the overall interobserver agreement for two of three classification systems, none of the classification systems achieved more than moderate interobserver agreement. This suggests that even with 3D-printed models, many fractures would be misclassified, which could result in misleading communication, inaccurate prognostic assessments, unclear research, and incorrect treatment choices. Therefore, we cannot recommend the use of 3D-printed models in practice and research for classification of tibial plateau fractures. Level III, diagnostic study.

Self-assessed Confidence of Dentists in Pediatric Dentistry: A cross-sectional study

Aim: To assess the confidence of dentists in provision of dental treatment for children and to explore the status of the current pediatric dental services offered by the dental practitioners. Methodology: A self-structured questionnaire was administered. Data was collected from both academic and non-academic dental practitioners and specialists. Pediatric dentists were excluded from the study. Results: The results show that there is lack of undergraduate training in the subject of pediatric dentistry. Dentists reported low confidence in various pediatric dental procedures. The provision of dental services to the pediatric patients was also observed to be inadequate. Conclusion: The undergraduate education of pediatric dentistry is of paramount importance. The curriculum should be structured in such a way so that it translates into provision of best dental services to the children. There is need for continuing education courses for dentists in pediatric dentistry in order to ensure adequate dental care for children. MeSH Keywords: Dentist's Practice Pattern, Pediatric Dentistry, Pedodontics

Obstetrics and gynecology residents' satisfaction and self-confidence after anal sphincter injury simulation-based workshop in Indonesia: a pre- and post-intervention comparison study.

PurposeObstetric anal sphincter injury is one of the most common complications during delivery. Simulation models with manikins can be used as an effective medical learning method to improve students’ abilities before encountering patients. The present study aimed to describe the development of an anal sphincter injury model and to assess residents’ satisfaction and self-confidence after a perineal repair workshop with an anal sphincter injury simulator in Indonesia.MethodsThis was a cross-sectional study with evaluation of outcomes before and after the workshop. We created a silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and used it as a simulation model for the workshop. We asked residents about their satisfaction with repairing anal sphincter injuries using a simulation model and residents’ self-confidence when practicing anal sphincter injury repair.ResultsAll residents felt the simulation-based workshop was valuable (100%). Most of the scores for the similarity of the simulation model were good (about 8 out of maximum 10). The self-assessment of confidence was measured before and after the workshop. Overall self-confidence increased significantly after the workshop in identifying the external sphincter ani (EAS) (P=0.031), suturing the anal mucosa (P=0.001), suturing the internal sphincter ani (P=0.001), suturing the EAS (P<0.001), and evaluating the sphincter ani tone (P=0.016).ConclusionThe anal sphincter injury simulator improved residents’ self-confidence in identifying the EAS, suturing the anal mucosa, suturing the internal sphincter ani, suturing the EAS, and evaluating sphincter ani tone.

Teaching \u201cmedical interview and physical examination\u201d from the very beginning of medical school and using \u201cescape rooms\u201d during the final assessment: achievements and educational impact in Japan

BackgroundThere is no consensus regarding the best time to teach two fundamental pillars of clinical medicine: medical interview and physical examination. We investigated the impacts of teaching the course “Medical Interview and Physical Examination” in Japan from the very beginning of medical school. In addition, we also evaluated the educational value of using “Escape Rooms”, a series of timed, game-based scenarios using simulators, as a part of the final assessment of the course.MethodsAt the end of the course, the interview capabilities of 140 first year medical students at International University of Health and Welfare (Japan) were assessed by physicians who acted as simulated patients. Physical examination skills were assessed using the “Escape Room” team task method. Students also self-assessed their confidence in their physical examination skills pre and post “Escape Rooms.” A day prior to the final assessment, students completed an anonymous course evaluation.ResultsThe average global rating of the students’ medical interview skills using a rating scale from 1 to 6 (1-fail 6-outstanding, no different from practicing junior physician’s level) was 4.6. Twenty-two students scored the highest mark of 6. An average of 89% of “Escape Room” teams finished all the physical examination tasks correctly within the allotted time. All teams that could not finish in time completed all tasks correctly when given an additional 3 to 5 min. Students’ self-assessed confidence in their physical examination skills increased from 49 to 73 (out of 100) pre and post “Escape Rooms.” In the course evaluation questionnaire, 99% of students answered “this course enhanced their motivation” (response rate 89%) and 99% also answered “this course was interesting and useful” (response rate 86%).ConclusionsThis descriptive study analyzing both quantitative and qualitative data showed that the course not only achieved the intended objectives of successfully conducting comprehensive medical interview and basic physical examination skills, but also enhanced student motivation. “Escape Rooms”, used for the course assessment, in itself enhanced students’ self-perceived physical examination skills and had an added educational value.