Significant Increase In Confidence Research Articles

Does Training with a Simulation Stethoscope Facilitate the Acquisition of Cardiopulmonary Knowledge and Confidence in Doctor of Physical Therapy Students

Purpose: The purpose of this study was to determine whether or not training with a computerized stethoscope could impact Doctor of Physical Therapy (DPT) student cardiopulmonary assessment knowledge and confidence. Methods: Eighty-seven (87) DPT students in years 2 (DPT2s, n=39) and 3 (DPT3s, n=48) participated after previously completing a cardiopulmonary course. All subjects took a baseline test and confidence survey for cardiopulmonary skills. Two weeks later, DPT2s attended a 1-hour lab session with simulation stethoscopes and did a post-test and survey. Test scores and confidence data were compared within DPT2s, and for DPT2s vs DPT3s. Results: After training, DPT2 test scores increased significantly (p=0.005, effect size r=0.32). DPT2s also reported significant increases in confidence, with moderate effect sizes, in the following areas: respiratory physical assessment (p=0.001, r=0.37); assessing PT effectiveness for respiratory disease (p = 0.002, r=0.35); cardiovascular physical assessment (p=0.006, r=0.31); and assessing PT effectiveness for cardiovascular disease (p=0.004, r=0.32). The item “assessing PT effectiveness for most disease states” improved but did not reach statistical significance (p=0.058). DPT2s and DPT3s scored similarly in the pre-test (p=0.511), but DPT2s post-test scores were significantly better than DPT3 pre-test scores (p=0.001, r=0.33). Baseline DPT2 and DPT3 confidence scores were not significantly different, but overall DPT2 confidence post scores were significantly higher than the DPT3 baseline. Conclusions: A one-hour lab session utilizing simulated stethoscopes resulted in increased cardiorespiratory assessment knowledge and confidence. Simulated stethoscopes may be a useful didactic supplement to a cardiorespiratory curriculum.

Utilization of Video Otoscopes for Otoscopy Skills Training of Third Year Medical Students.

Effective teaching and assessment of otologic examinations are challenging. Current methods of teaching otoscopy using traditional otoscopes have significant limitations. We hypothesized that use of all-in-one video otoscopes provides students with an opportunity for real-time faculty feedback and re-practicing of skills, increasing self-reported confidence. An otoscopy microskills competency checklist was provided to third-year medical students during their pediatric clerkship to self-assess otoscopy technique during patient examinations, and to clinical preceptors to assess and provide feedback during exams. Over the course of two years, we collected data from students randomly assigned to train on a video otoscope or a traditional otoscope during the clerkship. Pre- and post-clerkship surveys measured confidence in performing otoscopy microskills, making a diagnosis and documentation of findings. For those students who trained on the video otoscope, we solicited post-clerkship feedback on the experience of using a video otoscope. Pre-clerkship confidence did not differ between the groups, but the video otoscope trained group had significantly higher scores than the traditional otoscope trained group on all self-reported technical and diagnostic microskills confidence questions items post-clerkship. Students trained on video otoscopes had a significant increase in confidence with all microskills items (p-values<0.001), however confidence in the traditional otoscope trained group did not change over time (p-values>0.10). Qualitative feedback from the video otoscope trained group reflected positive experiences regarding "technique/positioning" and "feedback from preceptors.". Teaching otoscopy skills to pediatric clerkship medical students using a video otoscope significantly enhanced confidence compared to those training on a traditional otoscope by 1. enabling preceptors and students to simultaneously visualize otoscopy findings 2. allowing preceptors to provide real-time feedback and 3. providing opportunity for deliberate practice of microskills. We encourage the use of video otoscopes to augment student confidence and self-efficacy when training in otoscopy.

Simulation in Surgical Resident Education: A Porcine Hemostasis and Laparoscopic Model.

The steep learning curve associated with learning laparoscopic techniques and limited training opportunities represents a challenge to general surgery resident training. The objective of this study was to use a live porcine model to improve surgical training in laparoscopic technique and management of bleeding. Nineteen general surgery residents (ranging from PGY 3 to 5) completed the porcine simulation and completed pre-lab and post-lab questionnaires. The institution's industry partner served as sponsors and educators on hemostatic agents and energy devices. Residents had a significant increase in confidence with laparoscopic techniques and the management of hemostasis (P = .01 and P = .008, respectively). Residents agreed and then strongly agreed that a porcine model was suitable to simulate laparoscopic and hemostatic techniques, but there was no significant change between pre- and post-lab opinions. This study demonstrates that a porcine lab is an effective model for surgical resident education and increases resident confidence.

Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization.

Background Studies have demonstrated the use of resuscitative endovascular balloon occlusion catheters of the aorta (REBOA) in the setting of postpartum hemorrhage and traumatic hemorrhagic shock. However, REBOA is infrequently utilized leading to a lack of clinician comfort. This study's aim was to demonstrate the utility of REBOA in a hemorrhaging pregnant trauma patient and improve clinician comfort with the placement of REBOA while emphasizing collaboration between medical specialties. Methods A multidisciplinary in-situ simulation was developed for the management of a pregnant patient with an abdominal gunshot wound evaluated by obstetrics and surgery teams. A trauma survey, emergency c-section, massive transfusion protocol (MTP), and evaluation for and placement of REBOA were indicated during the simulation. A standardized Return on Learning questionnaire was utilized to determine participants' reactions and confidence gained during the simulation. Results A total of 32 of 41 participants completed the survey (78%). A statistically significant increase in confidence was reported in the ability toprioritize the care of a pregnant patient with hemorrhagic shock (p = 0.016), apply MTP to the appropriate clinical setting (p = 0.03), and analyze critical decisions made for abdominal trauma in pregnant patients (p = 0.006). Specifically for physicians, a significant increase in confidence in the ability to identify indications/contraindications for REBOA placement in hemorrhaging patients was observed (p = 0.021). Conclusions A multidisciplinary simulation for the management of a pregnant patient in hemorrhagic shock secondary to penetrating abdominal trauma improved learner confidence in MTP, care of pregnant patients in hemorrhagic shock, and abdominal trauma in pregnancy. Physician learners gained confidence in indications for REBOA placement in abdominal trauma. This simulation was highly relevant to all participants.

Target-Oriented Clinical Skill Enhancement (TOCSE) Builds Up Confi dence of Fourth-Year Medical Students During First-Time Patient Encounter: An Effective Bridging Tool After Online Didactic Undergraduate Classes During the COVID-19 Pandemic

Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p&lt;0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p&lt;0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p&lt;0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p&lt;0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p&lt;0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p&lt;0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p&lt;0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic

Ultrasound Simulation for Training Trainees when the Luxury Becomes Essential: Opinion and Evidence Obtained during the Latvian Research Council Project Implementation.

Simulation as a proxy tool for conditional clinical training became a powerful technique for introducing trainees to the ultrasound imaging world, allowing them to become a trained sonographer taking into consideration different rates of progress in completing a specific task against the time and ensuring the long-lasting maintenance of the obtained practical skills. Adding a costly, but effective high-fidelity simulator to the residency program justified the expense, demonstrating efficiency of training for improving the clinical performance and confidence of trainees. A pilot study in Riga Maternity Hospital within the framework of the study "Role of metabolome, biomarkers and ultrasound parameters in successful labor induction" (Fundamental and Applied Research Programme lzp-2021/1-0300) was performed between March 1st 2022 and 31st April 2022. A virtual-reality simulator (ScanTrainer, MedaphorTM, Cardiff, UK) was used with the teaching module for assessment of the uterine cervix. Five trainees in obstetrics and two young specialists included in the study. None of them had Fetal Medicine Foundation certificate of competence in the assessment of the uterine cervical lenght before. The time used on the simulator, the number of simulations and a mean confidence in cervical length assessment before and after simulation were recorded. The study on assesment of uterine cervical lenght demonstrated statistically significant increase in confidence (p=0.008) and statistically significant decrease in time needed to complete correctly the same tasks for the trainees (p=0.008) that shows a positive learning curve over the time of training on ScanTrainer, Medaphor. The simple task allows to become a certified specialist in uterine cervical assessment in the short period of time. That support the productiveness of the simulation-based education. The training program should be updated taking into consideration simulation curriculum.

Plastic Surgery Diversity, Equity, and Inclusion Mentorship Program and Workshop: A Single Institution's Experience.

Several minority groups and students without home plastic surgery programs remain underrepresented in plastic surgery. To address these barriers, our division created the Plastic Surgery Diversity, Equity, and Inclusion Mentorship Program and Workshop. Students meeting at least one of the following eligibility criteria were invited in fall of 2020: medical student in years 1 though 3 or a research year who is (1) underrepresented in medicine, including African American, Hispanic/Latinx, Native American, Pacific Islander; (2) lesbian, gay, bisexual, transgender, or queer (LGBTQ); (3) first-generation low-income; or (4) does not have a plastic surgery residency program associated with their medical school. Students participated in quarterly meetings with their resident mentor and the annual hands-on workshop. The workshop was held on March 20, 2020, with both virtual and in-person participants. It included various didactic lectures, a suture laboratory, a resident panel, a social lunch hour, and extremity and head cadaver dissections with fracture plating. Twenty-four students attended the workshop. The course was rated 9.4 of 10 by students. The top met goals were gaining didactic plastic surgery knowledge (100%), exposure to a plastic surgery residency program (100%), resources to help overcome minority-specific barriers (96%), and technical skills such as suturing (96%). At the conclusion of the workshop, students had a significant increase in confidence in various aspects of plastic surgery knowledge and technical skills. The Plastic Surgery Diversity, Equity, and Inclusion Mentorship Program and Workshop demonstrated preliminary success in providing support for students underrepresented in medicine and students without home programs.

Confidence among Veterinary Students to Perform Canine Orchiectomy: The Impact of Live Animal Surgical Clinical Training.

Canine orchiectomy (COE) is one of the most commonly performed procedures in small animal veterinary surgery. The aim of this study was to assess veterinary students' confidence in performing this surgery in relation to their previous surgical experience of the procedure. The hypothesis was that confidence to perform canine orchiectomies among recent veterinary graduates increased when having participated in the procedure as part of practical surgical training. A cross-sectional survey was conducted and included 65 fifth-year veterinary graduate students at the Swedish University of Agriculture in Uppsala, Sweden. The survey investigated how differences in experience of COE affected students' confidence to perform the procedure. Of the responding students, 24.6% had performed the procedure, 47.7% had observed the procedure live, and 27.7% had not seen nor performed the procedure. They were asked how confident they were to perform the procedure both with and without assistance. Data were compared using a non-parametric test (Mann-Whitney U test). The results showed a statistically significant increase in confidence to perform COEs in the group that had previously performed or observed COE compared with the group that had neither performed nor observed the procedure. In conclusion, veterinary students' participation in COEs significantly contributed to their clinical confidence to perform the procedure.

The Effectiveness of Language-Specific Personal Care Education on Improving the Knowledge and Skills of Vietnamese American In-Home Supportive Service Caregivers.

In-Home Supportive-Services (IHSS) caregivers provide personal care assistance to low-income older adults. According to the California Social Service Department, 20.2% of IHSS caregivers spoke Vietnamese in one county. The purpose of this project was to improve the knowledge and skills among these Vietnamese American caregivers by providing a language-specific and culturally appropriate education on personal care. The project used a pre- and post-test design. Under the guidance of nursing faculty, four Vietnamese-speaking nursing students provided a 2-hr educational program on personal care (e.g., bathing, oral care) to registered Vietnamese IHSS caregivers. A pre- and post-survey was conducted. Overall, 55 caregivers completed the surveys. The surveys showed significant increases in confidence in knowledge and skills related to personal care topics (all ps < .001). The findings demonstrated that the cultural and language-specific education was effective in increasing knowledge and confidence of Vietnamese IHSS caregivers related to personal care for older adults.

"Into the fire" approach to teaching endoscopic foreign body removal using a modular simulation curriculum.

As flexible endoscopy becomes an increasingly valuable minimally invasive approach to surgical challenges, an efficient and comprehensive training curriculum is needed to train surgeons in therapeutic endoscopy. We developed a modular curriculum utilizing a simulation-based, "into the fire" approach to endoscopic foreign body removal for practicing physicians with task performance pre- and post-testing. From 2020 to 2021, two sessions of our advanced flexible endoscopy course were taught by two expert surgical endoscopists using ex-vivo porcine models. The course focused on safe removal techniques for various foreign bodies as part of an overall endoscopy curriculum that uses hands-on simulation-based pre-testing, didactics, and mentored practice sessions, followed by post-course examination. Pre- and post-course assessments and surveys were used to evaluate knowledge, performance, and confidence of participants, and subsequently analyzed using the Wilcoxon-signed rank test. Of the 16 practicing physicians who participated in the course, 43.8% were certified in Fundamentals of Endoscopic Surgery, and 62.5% had completed > 200 prior upper endoscopies. Upon course completion, scoring on knowledge-based written examinations improved from 3.4 ± 1.9 to 5.8 ± 2.0 (p < 0.001). Technical facility of each participant demonstrated significant overall improvement with post-course score increased from 15.8 ± 2.5 to 23.6 ± 1.6 (p < 0.001), with skill refinement noted in technical subcategories of appropriate instrument use (p < 0.001), foreign body manipulation (p < 0.001), and successful foreign body removal (p < 0.001). Confidence surveys likewise demonstrated significant increase in confidence after completion of the curriculum 11.6 ± 3.4 to 23.0 ± 5.5 (p < 0.001). The "into the fire" approach to teaching endoscopic foreign body removal utilizing our simulation module provides an effective curriculum to improve knowledge, confidence, and overall technical performance. Our methodology utilizes hands-on, simulation-based pre-testing prior to instruction. This introduces clinical scenarios and technical challenges, while accounting for and tailoring to provider-specific variation in knowledge and experience, facilitating training efficiency.

COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study.

BackgroundEffective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy.ObjectiveThis work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem.MethodsWe collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem.ResultsThe percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=–0.92, df=21, t=–10.94, 95% CI –0.97 to –0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=–0.62, df=25, t=–3.94, 95% CI –0.81 to –0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95% CI 0.00-0.12, t=2.03, P=.04).ConclusionsThe percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media.

The impact of an educational tool in cervix image registration across three imaging modalities.

Accurate image registration is vital in cervical cancer where changes in both planning target volume (PTV) and organs at risk (OARs) can make decisions regarding image registration complicated. This work aims to determine the impact of a dedicated educational tool compared with experience gained in MR-guided radiotherapy (MRgRT). 10 therapeutic radiographers acted as observers and were split into two groups based on previous experience with MRgRT and Monaco treatment planning system. Three CBCT-CT, three MR-CT and two MR-MR registrations were completed per patient by each observer. Observers recorded translations, time to complete image registration and confidence. Data were collected in two phases; prior to and following the introduction of a cervix registration guide. No statistically significant differences were noted between imaging modalities. Each group was assessed independently pre- and post-education, no statistically significant differences were noted in either CBCT-CT or MR-CT imaging. Group 1 MR-MR imaging showed a statistically significant reduction in interobserver variability (p=0.04), in Group 2, the result was not statistically significant (p=0.06). Statistically significant increases in confidence were seen in all three modalities (p≤0.05). At The Christie NHS Foundation Trust, radiographers consistently registered images across three different imaging modalities regardless of their previous experience. The implementation of an image registration guide had limited impact on inter- and intraobserver variability. Radiographers' confidence showed statistically significant improvements following the use of the registration manual. This work helps evaluate training methods for novel roles that are developing in MRgRT.

Improving Clinical Skills in Psychiatry Using Online Simulation

AimsThe COVID-19 pandemic impacted medical education with teaching moving online. The aim of this study was to evaluate whether online simulation is an effective tool for the delivery of student psychiatric clinical skills teaching. This has important implications for the future planning of psychiatric clinical skills teaching.Methods162 students were divided across nine online psychiatric simulation sessions held over a four month period. The sessions lasted 3.5 hours and consisted of three simulated scenarios with a professional actor and experienced facilitator. Students were asked to rate: confidence in taking a psychiatric history, conducting a mental state exam, formulating treatment plans, conducting risk assessment, assessing capacity and communicating with patients in psychiatry. Confidence ratings were completed pre and post session on Likert scale (1 = least confident, 10 = most confident). Students were also given the opportunity to provide qualitative feedback after the sessions. The study was conducted with permission from Associate Dean for Undergraduate Teaching and QMUL Centre Lead for Psychiatry.Results137 (92.7%) of students attending the workshop completed pre-session questionnaire and 122 (82.4%) completed post-session questionnaire. 95.1% students rated workshops as good/very good. Pre and post confidence comparisons showed significant increases in average confidence for all questions from pre (M = 5.1, SE = 0.2) to post (M = 7.1, SE = 0.2), t = 10.7 p &lt; 0.001. Paired t-tests were used to compare average pre and post-session results for individual questions from the same session. All questions showed significant increases in scores. Qualitative feedback indicated that students valued the opportunity to practice, obtain feedback and requested more sessions.ConclusionResults show significant increases in confidence in psychiatric clinical skills using online psychiatric simulation. This supports our hypothesis that online simulation is an effective tool for delivery of student psychiatric clinical skills teaching. Students may benefit from online simulation increasing their confidence prior to attending psychiatric placements. This teaching method will also provide an additional method for practising clinical skills with increasing student numbers and demands on psychiatric placements. It therefore has important implications in the future of psychiatric education and could be adapted for use across clinical years and medical schools.

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.

Development of a Standardized Assessment of Simulation-based Extracorporeal Membrane Oxygenation Educational Courses.

BackgroundIn 2020, the Extracorporeal Life Support Organization education task force identified seven extracorporeal membrane oxygenation (ECMO) educational domains that would benefit from international collaborative efforts. These included research efforts to delineate the impact and outcomes of ECMO courses.ObjectiveDevelopment of a standardized online assessment tool to evaluate the effectiveness of didactic and simulation-based ECMO courses on participants’ confidence, knowledge, and simulation-based skills; participant satisfaction; and course educational benefits.MethodsWe performed a prospective multicenter observational study of five different U.S. academic institution–based adult ECMO courses that met Extracorporeal Life Support Organization endorsement requirements for course structure, educational content, and objectives. Standardized online forms were developed and administered before and after courses, assessing demographics, self-assessment regarding ECMO management, and knowledge examination (15 simple-recall multiple-choice questions). Psychomotor skill assessment was performed during the course (time to complete prespecified critical actions during simulation scenarios). Self-assessment evaluated cognitive, behavioral, and technical aspects of ECMO; course satisfaction; and educational benefits.ResultsOut of 211 participants, 107 completed both pre- and postcourse self-assessment forms (97 completed both pre- and postcourse knowledge forms). Fifty-three percent of respondents were physician intensivists, with most (51%) practicing at academic hospitals and with less than 1 year of ECMO experience (50%). After the course, participants reported significant increases in confidence across all domains (cognitive, technical, and behavioral, P < 0.0001, 95% confidence interval [CI], 1.2–1.5; P < 0.0001, 95% CI, 2.2–2.6; and P = 0.002, 95% CI, 1.7–2.1, respectively) with an increase in knowledge scores (P < 0.001; 95% CI, 1.4–2.5). These findings were most significant in participants with less ECMO experience. There were also significant reductions in times to critical actions in three of the four scored simulation scenarios. The results demonstrated participants’ satisfaction with most course aspects, with more than 95% expressing that courses met their educational goals.ConclusionWe developed and tested a structured ECMO course assessment tool, demonstrating participants’ self-reported benefit as well as improvement in psychomotor skill acquisition, course satisfaction, and educational benefits. Course evaluation is feasible and potentially provides important information to improve ECMO courses. Future steps could include national implementation, addition of questions targeting clinical decision making to further assess knowledge gain, and multilanguage translation for implementation in international courses.

Medical Student Confidence in Diagnosis of Dermatologic Diseases in Skin of Color.

PurposeTo evaluate medical student confidence in diagnosing dermatologic diseases in skin of color.MethodsA voluntary supplemental module was implemented as part of the second-year dermatology curriculum at Wayne State University School of Medicine (WSU SOM) in Detroit, Michigan. The goal of the module was to ascertain whether it may increase confidence in students with their approach to diagnosing diseases in darker skin tones.ResultsSeventy-seven of 295 students (26%) completed a “Skin of Color” optional module consisting of thirteen cases of common skin pathologies in African American patients. A pre- and post-survey performed to assess students’ confidence using a five-point Likert scale. After completing the module, medical students demonstrated a statistically significant increase in confidence in diagnosing skin pathologies in skin of color.ConclusionDermatology pre-clinical course work should include supplementary materials to increase student confidence in diagnosing skin diseases in darker skin tones.

College/University Independent Medical Care in the COVID-19 Era

Purpose: Legislation was created for NCAA Divisions I, II, and III to guarantee an independent medical care administrative structure designed to give “unchallengeable autonomous authority” regarding diagnosis, management, and return to play decisions to primary athletics health care providers (physicians and athletic trainers). The purpose of this project was to 1) explore the structure of athletic health care in NCAA athletic institutions as it relates to independent medical care, and 2) describe changes in those structures that have occurred as a result of the COVID-19 pandemic. Methods: We used a cross-Sectional Study. Setting: College/University. In 2017, 162 supervising athletic trainers responded to our survey. Variables collected included health care delivery model, AHCA selection, decision making and injury reporting structure, confidence in independent medical care, COVID-19 response involvement, changes due to COVID-19. Results: The overall demographic characteristics indicated that most supervising athletic trainers were male (117/162, 72.2%), 48 ± 10 y old, and have been at the institution for a significant tenure 15 ± 11y. In 2020, responses from 174 supervising athletic trainers were recorded in the survey. The majority of respondents were male (108/174, 62.1%). Average age of the population was 45 ± 11y with 22 ± 10y of experience and 15 ± 10y of experience at their current institution The athletics health care model is most common across all NCAA Divisions (n=163 80.7%). Average confidence was rated 4.54 ± 0.67. Results indicate a significant increase in confidence from 2017 to 2020 that patient care decisions are independent of influence. The majority of supervising athletic trainers indicated that they were involved in COVID-19 response (n=190, 94.1%) Conclusions: More NCAA Institutions should transition to a medical model of health care delivery to ensure independent medical care. Athletic trainers were used in the policy creation and implementation of COVID-19 protocols for their institutions and athletics programs.

363 Developing an International Clinical Teaching Programme for Final Year Medical Students for the COVID Pandemic and Beyond, an Italian Experience

Abstract Introduction During the COVID-19 pandemic medical students’ time in a clinical setting in the University of Pavia (UNIPV) had been greatly reduced for justifiable safety concerns. Aim Providing clinical teaching to medical students with an international network of UNIPV alumni. Method We recruited a cohort of UNIPV alumni, now working as junior-doctors throughout the UK and Ireland to teach and share their experience in assessing patients and creating management plans for commonly encountered scenarios on-call. 12 sessions were held over Zoom Online Videoconferencing and covered a broad surgical and medical syllabus via clinical cases. Pre- and post- teaching questionnaires were used to review the outcomes of intervention. Results Students reported an average confidence increase from 4.48/10 to 6.63/10 in patient assessment. Encouragingly, confidence in history taking stood at 8.38/10 after participating in the course. 37.5% of participants were interested in becoming tutors when running the course again next year and overall, 75% of participating students would recommend this course to students in successive years. Conclusions From our results the significant increase in confidence of students in assessing, examining, and patients as expected of day one junior doctors is notable. One limitation was the inability to substitute the practical skills aspect of clinical teaching due to the online delivery of the course. A future ‘blended’ delivery may overcome this. Given its positive response, we hope that this course can leave a lasting impact with further courses being run in the future for successive years by the future UNIPV alumni.

Diversifying Faculty Leadership in Academic Medicine: The Program to Launch Underrepresented in Medicine Success (PLUS).

PLUS (Program to Launch Underrepresented in Medicine Success) is a 2-year cohort program at Indiana University School of Medicine providing professional development, funding and skills to produce scholarship, and a community to mitigate social and/or professional isolation for underrepresented in medicine (URiM) faculty. In year 1, scholars participate in leadership and professional development seminars and regular meetings with their mentor(s). They are assigned a PLUS Advisory Council advisor with whom they meet 2 to 3 times annually. In year 2, scholars participate in monthly seminars focused on research methods, writing productivity, and wellness. Additionally, scholars engage in a writing accountability group and practice reflective writing. Connections events, designed to combat isolation and cultivate community, occur monthly. At program completion, scholars complete a project resulting in a scholarly product for submission and dissemination in a peer-reviewed forum. To date, 3 cohorts, totaling 24 people, have participated: 20 (83%) Black, 4 (17%) Latinx; 12 (50%) females. Five scholars have completed the full program, whose pre- and postsurvey results are described. Program surveys demonstrate significant gains in scholars' confidence to secure leadership opportunities, connect with colleagues, and advocate for themselves and others. Scholars reported statistically significant increases in confidence to pursue leadership roles (t = -3.67, P = .02) and intent to submit their dossier for promotion (t = -6.50, P = .003). They were less likely to leave academic medicine (t = 2.75, P = .05) or pursue another academic appointment (t = 2.75, P = .05) after PLUS completion than at baseline. All scholars adequately met requirements for their third-year review (tenure track only), were promoted, or achieved tenure in less than 3 years since program completion. This article describes PLUS program objectives, evaluative components, and lessons learned during implementation, as a model to support URiM faculty at other institutions.

A "diversity and inclusion" lecture for promoting self-awareness among medical students.

The concept of 'diversity and inclusion' is being adopted worldwide, but it is not yet understood well in Japan. We conducted this study to evaluate the impact of a lecture aimed at increasing awareness of academic careers and the benefits of having diversity and inclusion. Two female surgeons delivered a 120-min lecture on "diversity and inclusion" to third-year medical students at Tokushima University. To assess the impact of the lecture, a questionnaire was distributed, for participants to complete anonymously before and after the lecture. Eighty-two students participated in the study (39 men, 38 women, and 5 unknown). Based on the questionnaire responses, 57.1% of the students had already perceived inequality in conduct because of gender. A comparison of pre- and post-lecture responses revealed a significant increase in confidence to succeed in their medical career (56.5% vs. 77.5%, p < 0.01). Learners were more likely to believe that gender would not become a barrier to career development (42.4% vs. 66.7%, p < 0.01). Moreover, 90.4% of the students felt positively about a career in surgery following the lecture. The lecture promoted awareness about diversity, self-awareness, and career development and motivated students to consider specializing in surgery later in their career.