Significant Increase In Confidence Research Articles

141 Simulation Training: The Impact on the Confidence and Preparedness of Novice Otolaryngology ST3 Registrars

Abstract Aim This research employs the HoloLens2™ and a variety of models to evaluate the impact on the confidence and preparedness of ST3 trainees following their engagement in simulated otolaryngology cases. Method A total of 29 ST3 trainees engaged in ten 1-hour long simulation stations across a span of two days. The participants engaged in both technical and non-technical skills within elective, emergency, and ward-based scenarios. Questionnaires were used to document self-reported confidence and preparedness before and after each simulation. Primary outcomes included change in trainee confidence and preparedness pre- and post-station. Results The participants reported a significant increase in confidence (p<0.001) and preparedness (p<0.001) after all stations. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. A significant improvement in self-confidence (p<0.001) and self-preparedness (p<0.0001) was observed after the non-technical HoloLensTM session. Conclusions The use of Otolaryngology simulation stations improved confidence and preparedness of managing common ENT presentations in the ward, elective, and emergency settings for ENT ST3 trainees. This approach serves as a valuable supplement to the conventional surgical apprenticeship, facilitating the acquisition of both technical and non-technical skills. The implementation of mixed reality technology creates an immersive environment to develop trainees’ non-technical skills. However, future work is required to assess the impact on the long-term benefits of trainee skill retention and clinical proficiency.

756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study

Abstract Aim The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors & medical students, as well as the correlation between confidence and practical skills. Method 83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance & normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted. Results Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event & post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event & post-event 1.71, 4.16 respectively, p = p = 2.99 10-23). Conclusions The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.

Dermoscopy can be safely and reliably used in ophthalmology

ObjectiveTo determine if dermoscopy, a technique widely utilized in dermatology for improved diagnosis of skin lesions, can be used comfortably for evaluating periorbital, eyelid, and conjunctival lesions. DesignProof-of-concept study in which a technique for performing dermoscopy near the eye was developed, related educational material was prepared, and a protocol for dermoscopic image capture was created. MethodsTechnicians used the developed materials to learn to take high-quality pictures with a 10x dermoscope attached to a standard cell phone camera. The images were assessed for diagnostic utility by an oculoplastic surgeon and two dermatologists. Participants115 patients recruited from ophthalmology clinics from July 2021 to April 2023 were photographed, yielding 129 lesions with high-quality dermoscopic images as assessed by an oculoplastic surgeon and two dermatologists. ResultsTechnicians reported a significant increase in confidence (measured on a 1–10 scale) with dermoscopy after training (pre-instruction mean = 1.72, median = 1, mode = 1, IQR = 1.25 vs mean = 7.69, median = 7.75, mode = 7 and 8, IQR = 1.5 post-instruction. Wilcoxon rank sum test with continuity correction, W = 0, p < 0.001, paired t = 13.95, p < 0.0001). Incorporating a contact plate with a 4 × 4mm reticule on the dermoscope aided in photographing ocular and periocular lesions. ConclusionMedical support staff in eye-care offices can be taught to use dermoscopes to capture high-quality images of periorbital, eyelid, and conjunctival lesions. Dermoscopy illuminates diagnostic features of lesions and thus offers a new avenue to improve decision-making in ophthalmology. Dermoscopy can be incorporated into telemedicine evaluations by ophthalmologists, oculoplastic surgeons, or affiliated dermatologists for triage of or rendering advice to patients and for planning of surgery if needed.

Prehospital mass casualty incident triage simulation builds knowledge and confidence in medical trainees.

Mass casualty incident (MCI) triage simulation is an increasingly useful tool for teaching triage systems to medical students, trainees, and hospital staff. MCI simulation in the prehospital setting has not yet been studied in this population. We aimed to assess the effectiveness of a prehospital MCI simulation in medical students, residents, and fellows. Our primary outcome was knowledge of the components of the triage algorithms used in MCI response. Our secondary outcome was each participant's confidence level if required to assist with or lead a MCI response. This was an observational study with pre-post surveys. We recruited 30 medical students, 14 emergency medicine (EM) residents, and four pediatric EM fellows to fill out a survey before and after a 3-h simulation session practicing the START and JumpSTART algorithms on two prehospital MCI scenarios. Overall, all groups demonstrated significant improvement in knowledge of triage colors, information needed to assign a triage color, pediatric airway management during a MCI, and indications for breaths-first CPR. They also demonstrated significant increase in confidence both in assisting with and in leading a MCI response. Simulated practice triaging patients in prehospital MCI scenarios improves knowledge of triage algorithms and increases confidence in assisting with or leading a MCI response in medical trainees.

Development of a brief inpatient curriculum to enhance trainee skills in assessment and treatment of adolescents with substance use and co-occurring mental health problems

Background Adolescence is a critical period for substance use intervention, yet few youth receive evidence-based treatment for both co-occurring substance use and mental health problems. Gaps in professional training limit adequate assessment and treatment of substance use problems among youth receiving psychiatric treatment. Methods We developed a two-session curriculum, integrated into a child/adolescent psychiatry inpatient rotation, to improve knowledge and skills in evidence-based practices for screening, brief intervention, psychoeducation, and care coordination, among multidisciplinary mental health clinicians. A pre/post survey evaluated perceived helpfulness, confidence in clinical skills, and intentions to engage in evidence-based practices. Results Trainees perceived the content as helpful and reported significant increases in confidence and intention to engage in the targeted evidence-based practices. Conclusions Implementation of a brief, focused, skills-based curriculum in clinical settings can effectively introduce trainees to core concepts not currently adequately covered in existing curricula.

Do Not Freak Me Out! The Impact of Lip Movement and Appearance on Knowledge Gain and Confidence

Virtual agents (VAs) have been used effectively for psychoeducation. However, getting the VA’s design right is critical to ensure the user experience does not become a barrier to receiving and responding to the intended message. The study reported in this paper seeks to help first-year psychology students to develop knowledge and confidence to recommend emotion regulation strategies. In previous work, we received negative feedback concerning the VA’s lip-syncing, including creepiness and visual overload, in the case of stroke patients. We seek to test the impact of the removal of lip-syncing on the perception of the VA and its ability to achieve its intended outcomes, also considering the influence of the visual features of the avatar. We conducted a 2 (lip-sync/no lip-sync) × 2 (human-like/cartoon-like) experimental design and measured participants’ perception of the VA in terms of eeriness, user experience, knowledge gain and participants’ confidence to practice their knowledge. While participants showed a tendency to prefer the cartoon look over the human look and the absence of lip-syncing over its presence, all groups reported no significant increase in knowledge but significant increases in confidence in their knowledge and ability to recommend the learnt strategies to others, concluding that realism and lip-syncing did not influence the intended outcomes. Thus, in future designs, we will allow the user to switch off the lip-sync function if they prefer. Further, our findings suggest that lip-syncing should not be a standard animation included with VAs, as is currently the case.

Efficacy of 3D-printed eye model to enhance retinoscopy skills

We conducted a prospective study to evaluate the efficacy of simulation-based education using a three-dimensional (3D)-printed schematic eye model in improving the retinoscopy refraction skills of medical students. A schematic eye model was printed using a fused deposition modeling-based 3D printer. Twenty medical students randomized into 3D (n = 10) and control (n = 10) groups received a 1-h lecture on the principles and methods of manifest refraction and were shown how to use the retinoscope and sciascope bars. The 3D group additionally attended a tutorial on the schematic eye. Both groups performed refractive examinations on four eyes of volunteer patients, and the results were recorded as a baseline. Instructor feedback and refraction practice was provided with the 3D group or with control group. To account for subject fatigue, patients spent no more than 8 min on the examination. After a 1-h break to allow for fatigue and familiarity, refraction tests were repeated on four randomly selected eyes of patients. Students’ refraction readings were compared with the autorefractor values using a spherical equivalent value and blur strength. All participants measured the time required to complete the refraction test and reported their subjective confidence in the results of each refraction test. Refractive errors before and after training did not differ between the control and 3D groups, with a significant improvement in errors observed in both groups (p = 0.005 and 0.008, respectively). The time to complete refraction before and after training did not differ between the two groups, both of which showed a significant reduction in time (p = 0.005 and 0.028, respectively). Pre- and post-training confidence scores for the accuracy of each refraction on a 10-point Likert scale were not significantly different. However, when comparing score changes between pre- and post-training, only the control group showed a significant increase in confidence (p = 0.005). Tests for the non-inferiority of refractive errors after training indicated that the 3D group was non-inferior to the control group. In conclusion, training in retinoscopy refraction skills using a 3D-printed eye model resulted in significant improvement in accuracy and speed compared to practice with real patients. Except for better confidence in the control group, schematic eye model training was not inferior to practice with real patients.

Improving the Knowledge and Competency of UK Foundation Doctors in Nasogastric Tube Placement: A National Study.

Objective This study aims to improve foundation doctors' knowledge of guidelines for confirming nasogastric (NG) tube position and to enhance their confidence and competency in NGtube placement. Methods A three-part educational approach was designed, which included an educational leaflet and allowed the assessment of a participant's knowledge of guidelines pertaining to NG tube positioning before and after education. This educational leaflet and accompanying pre- and post-learning assessments were distributed among NHS Foundation Trusts in the UK between January 2022 and June 2022. All participants were foundation doctors in the UK. Those who had entered further training after the completion of their foundation training, at the time of assessment distribution, were excluded. Results A total of 173 participants completed this assessment. We found a significant increase in confidence among participants following the education (p<0.05). There was also a significant improvement in objective knowledge of guidelines on NG tube position confirmation following education (p<0.05). Conclusions Current knowledge on NG tube positioning is lacking among foundation doctors, but this can be significantly improved with simple educational leaflets. Furthermore, many participants felt that more training is needed, and this topic should be included in an essential teaching program.

Educating families of brain injury patients during acute rehabilitation: a quality improvement project.

Lack of information is cited as a source of distress for caregivers of patients with brain injury during the recovery process. This is a quality improvement project with the purpose of educating family members of brain injury patients about acute inpatient rehabilitation and providing a reliable source of information through the Model Systems Knowledge Translation Center (MSKTC) Traumatic Brain Injury Model Systems (TBIMS) Factsheets. The study was conducted in the brain injury unit of an acute inpatient rehabilitation facility and a total of n = 32 family members participated in the study. Educational sessions were provided verbally by phone based on the MSKTC-TBIMS "Traumatic Brain Injury and Acute Inpatient Rehabilitation" Factsheet. Surveys with five confidence statements and Likert scale graded responses were verbally administered by phone immediately before and after each educational session to evaluate for understanding. There was a statistically significant increase in confidence for all five confidence statements when comparing pre-and post-education responses (p < 0.05, Wilcoxon signed-rank test). This quality improvement project thereby presents an effective and feasible framework for teaching, improving communication, and providing valuable information to families early in the brain injury rehabilitation course.

Preparing healthcare leaders of the digital age with an integrative artificial intelligence curriculum: a pilot study

ABSTRACT Artificial intelligence (AI) is rapidly being introduced into the clinical workflow of many specialties. Despite the need to train physicians who understand the utility and implications of AI and mitigate a growing skills gap, no established consensus exists on how to best introduce AI concepts to medical students during preclinical training. This study examined the effectiveness of a pilot Digital Health Scholars (DHS) non-credit enrichment elective that paralleled the Dartmouth Geisel School of Medicine’s first-year preclinical curriculum with a focus on introducing AI algorithms and their applications in the concurrently occurring systems-blocks. From September 2022 to March 2023, ten self-selected first-year students enrolled in the elective curriculum run in parallel with four existing curricular blocks (Immunology, Hematology, Cardiology, and Pulmonology). Each DHS block consisted of a journal club, a live-coding demonstration, and an integration session led by a researcher in that field. Students’ confidence in explaining the content objectives (high-level knowledge, implications, and limitations of AI) was measured before and after each block and compared using Mann-Whitney U tests. Students reported significant increases in confidence in describing the content objectives after all four blocks (Immunology: U = 4.5, p = 0.030; Hematology: U = 1.0, p = 0.009; Cardiology: U = 4.0, p = 0.019; Pulmonology: U = 4.0, p = 0.030) as well as an average overall satisfaction level of 4.29/5 in rating the curriculum content. Our study demonstrates that a digital health enrichment elective that runs in parallel to an institution’s preclinical curriculum and embeds AI concepts into relevant clinical topics can enhance students’ confidence in describing the content objectives that pertain to high-level algorithmic understanding, implications, and limitations of the studied models. Building on this elective curricular design, further studies with a larger enrollment can help determine the most effective approach in preparing future physicians for the AI-enhanced clinical workflow.

Evaluating students' research literacy knowledge, confidence, and attitudes at the beginning and end of a doctor of chiropractic program.

The doctor of chiropractic program (DCP) graduate must demonstrate competency in clinical research literacy (CRL), per accreditation standards. This study aimed to compare student CRL knowledge, confidence, and attitudes between the beginning and end of their DCP. We collected data on 245 matriculating students' CRL knowledge, confidence, and attitudes between 2017 and 2018. In 2021 and 2022, 78 of these students enrolled in a course with an extra credit assignment that was used to re-collect CRL data as they approached graduation. We assessed changes between entry and exit using statistical analyses in STATA17. Paired data were collected for 56 students. The mean CRL scores on a scale of 10 at the DCP beginning and end were 5.25 (SD 2.06) and 6.54 (SD 1.89), respectively (p = .0001). We observed statistically significant (p ≤ .05) positive changes in students' abilities to answer questions about Medical Subject Headings, the hierarchy of evidence, systematic reviews, meta-analyses, and the limitations of abstracts. There was also a statistically significant increase in confidence, with over 80% of students nearing graduation reporting good or excellent abilities to find and judge health information for their patients. The proportion of students who envisioned searching a database to help manage a challenging clinical case decreased from 96% to 89% (p > .05). The proportion seeing themselves submitting a case report for publication declined from 16% to 4% (p ≤ .05). Students' self-perceived CRL abilities and knowledge improved between the beginning and end of their DCP; however, their attitudes toward applying these in practice declined.

An innovative approach to remodelling bioscience undergraduate final year projects to develop key transferable skills sought by graduate employers

Undergraduate Biomedical Science dissertations are the culmination of a student’s academic journey and allow students to refine technical proficiencies, experimental design and data analysis. However, traditional dissertation projects may not fully meet the requirements of diverse student populations and employer’s needs. This research project aims to assess the effectiveness of modifying the assessment format for final-year projects, incorporating elements such as lay summaries, project proposals, scientific research papers, and oral poster defences. The objective was to cultivate higher-order critical thinking skills and enhance written and verbal communication competencies, in addition to developing a suite of transferable skills which are highly sought by employers. Quantitative data were primarily generated via end-of-module feedback reports and the module satisfaction survey. Students rated their confidence in a suite of transferable skills pre and post-completion of the project module using a four-point Likert scale. Staff perceptions (n = 30) and module board reports were also evaluated. For all data, a paired t-test for related groups was conducted. Thematic analysis was used to analyse qualitative data using the Braun and Clark Framework. The end-of-module feedback was overwhelmingly positive with all students agreeing that they were satisfied with the module. Students reported a statistically significant increase in confidence within 11 transferable skills which are considered core within the industry, for example, critical thinking, problem-solving and time management. Furthermore, the mean module mark increased following the module redesign from 66.3% ± 0.2% in 2019 to 70.9% ± 0.6% in 2020 (p ≤ 0.05). Staff provided free text comments, reporting an overall improvement in the module, a reduction in workload and a better teaching experience. Students exhibited appreciation of the new module structure, assessment suit and creative liberty within the projects. The redesigned project module enhanced the teaching experience for staff, whilst students appreciated the diverse range of projects and assessments that featured shorter word limits and a creative flair. Universities must reinvent undergraduate dissertations to equip students with essential employability skills.

Comparative effectiveness of standard vs. AI-assisted PET/CT reading workflow for pre-treatment lymphoma staging: a multi-institutional reader study evaluation

BackgroundFluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) is widely used for staging high-grade lymphoma, with the time to evaluate such studies varying depending on the complexity of the case. Integrating artificial intelligence (AI) within the reporting workflow has the potential to improve quality and efficiency. The aims of the present study were to evaluate the influence of an integrated research prototype segmentation tool implemented within diagnostic PET/CT reading software on the speed and quality of reporting with variable levels of experience, and to assess the effect of the AI-assisted workflow on reader confidence and whether this tool influenced reporting behaviour.MethodsNine blinded reporters (three trainees, three junior consultants and three senior consultants) from three UK centres participated in a two-part reader study. A total of 15 lymphoma staging PET/CT scans were evaluated twice: first, using a standard PET/CT reporting workflow; then, after a 6-week gap, with AI assistance incorporating pre-segmentation of disease sites within the reading software. An even split of PET/CT segmentations with gold standard (GS), false-positive (FP) over-contour or false-negative (FN) under-contour were provided. The read duration was calculated using file logs, while the report quality was independently assessed by two radiologists with &amp;gt;15 years of experience. Confidence in AI assistance and identification of disease was assessed via online questionnaires for each case.ResultsThere was a significant decrease in time between non-AI and AI-assisted reads (median 15.0 vs. 13.3 min, p &amp;lt; 0.001). Sub-analysis confirmed this was true for both junior (14.5 vs. 12.7 min, p = 0.03) and senior consultants (15.1 vs. 12.2 min, p = 0.03) but not for trainees (18.1 vs. 18.0 min, p = 0.2). There was no significant difference between report quality between reads. AI assistance provided a significant increase in confidence of disease identification (p &amp;lt; 0.001). This held true when splitting the data into FN, GS and FP. In 19/88 cases, participants did not identify either FP (31.8%) or FN (11.4%) segmentations. This was significantly greater for trainees (13/30, 43.3%) than for junior (3/28, 10.7%, p = 0.05) and senior consultants (3/30, 10.0%, p = 0.05).ConclusionsThe study findings indicate that an AI-assisted workflow achieves comparable performance to humans, demonstrating a marginal enhancement in reporting speed. Less experienced readers were more influenced by segmentation errors. An AI-assisted PET/CT reading workflow has the potential to increase reporting efficiency without adversely affecting quality, which could reduce costs and report turnaround times. These preliminary findings need to be confirmed in larger studies.

Feasibility, accuracy, and usability analysis of MapAML, a first-in-class app for integrated diagnosis in acute myeloid leukemia.

Performing a comprehensive diagnosis of acute myeloid leukemia (AML) is complex and involves the integration of clinical information, bone marrow morphology, immunophenotyping, cytogenetic, and molecular analysis, which can be challenging to the general hematologist. The aim of this study was to evaluate the usability and accuracy of MapAML, a smartphone app for integrated diagnosis in AML, created to aid the hematologist in its clinical practice. App performance was evaluated in dedicated sessions, in which 21 hematologists or fellows in hematology performed an integrated diagnosis of deidentified real-world clinical AML cases, first without and posteriorly with MapAML use. Diagnosis accuracy increased after MapAML utilization, with the average score going from 7.08 without app to 8.88 with app use (on a scale from 0 to 10), representing a significant accuracy improvement (p = .002). Usability evaluation was very favorable, with 81% of users considering the app very or extremely simple to use. There was also a significant increase in confidence to perform a complete and accurate diagnosis in AML after app use, with 61.9% of the participants willing to use the app in their clinical practice. In this study, MapAML increased accuracy with excellent usability for integrated diagnosis in AML.

CHIME-GP trial of online education for prescribing, pathology and imaging ordering in general practice – how did it bring about behaviour change?

BackgroundThere is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia’s online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future.MethodsThis mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework.ResultsOf the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs’ perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions.ConclusionsOur education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).

Effectiveness of E-learning on clinical application of dental injection anatomy via simulation manikins.

E-learning is frequently integrated into dental education, yet little is known on the effectiveness of e-learning in both instilling foundational knowledge and facilitating translation of newly acquired knowledge and skill into clinical application. The objective of this study was to investigate the impact of learning modality on acquisition of knowledge and translation to clinical skill using objective feedback from oral anesthesia manikins and subjects' self-reported confidence scores. This mixed-method study involved first year dental students (n=52) who volunteered to participate in a learning intervention, simulation exercise, and survey in 2022. Students were randomly assigned to lecture (n=26) or e-learning (n=26) cohorts and then participated in the intervention, postintervention assessment, and a simulation to evaluate correct approaches for each dental block and attempts to success. All subjects scored significantly higher on post-intervention assessment compared to pre-intervention assessment (8.2vs. 5.9; p<0.0001) with no significant differences between intervention groups when comparing preintervention and postintervention scores. Furthermore, there were no significant differences between the two cohorts when comparing abilities to correctly approach each dental block or attempts to success. Finally, all students reported a significant increase in confidence in most categories following intervention and simulation, with no significant differences between lecture and e-learning cohorts. Our findings suggest students learning via e-learning are equally capable as those learning via lecture at demonstrating newly acquired knowledge and skill in both assessments and clinical simulations. Results support incorporating supplemental e-learning and oral anesthesia manikin exercises for students learning the anatomy of dental injections.

Assessing knowledge and confidence of surgical residents in inguinal hernia repair using a low-cost synthetic model.

Open repair of groin hernia is an essential skill for the general surgeon. This study aimed to develop a low-cost hernia model based on a validated high-fidelity model and assess its effectiveness in teaching inguinal hernia repair to surgical trainees from many institutions throughout Africa. Using inexpensive, locally available materials, a low-cost hernia model was created. Six models were constructed, and a workshop was conducted for surgical residents. Pre- and post-workshop surveys were administered to assess knowledge, confidence, and understanding. Statistical analyses were performed using paired t tests and the Wilcoxon signed-rank test. The low-cost hernia model consisted of various readily available materials and cost an average of $5.07. Sixty-eight trainees participated in the workshop, and 59 completed the post-workshop survey. Participants reported a significant increase in confidence for both mesh and non-mesh repairs and an improved understanding of hernia anatomy after the workshop. Trainees scored an average of 5.6 (SD 1.9) out of 10 questions on the pre-workshop quiz and 7.9 (SD 1.4) out of 10 on the post-workshop quiz (p < 0.001), indicating improved knowledge. All trainees supported the use of the model for education. The low-cost hernia model demonstrated its effectiveness in enhancing trainees' understanding of hernia anatomy and increasing their confidence in hernia repair. Integrating low-cost hernia models into training programs can help improve trainees' knowledge and confidence in a safe and affordable environment.

The influence of defaecating proctograms on clinical decision-making in pelvic floor disorders.

Defaecating proctogram (DP) studies have become an integral part of the evaluation of patients with pelvic floor disorders. However, their impact on treatment decision-making remains unclear. The aim of this study was to assess the concordance of decision-making by colorectal surgeons and the role of the DP in this process. Four colorectal surgeons were presented with online surveys containing the complete history, examination and investigations of 106 de-identified pelvic floor patients who had received one of three treatment options: physiotherapy only, anterior Delorme's procedure or anterior mesh rectopexy. The survey assessed the management decisions made by each of the surgeons for the three treatments both before and after the addition of the DP to the diagnostic work-up. After the addition of the DP results; treatment choice changed in 219 (52%) of 424 surgical decisions and interrater agreement improved significantly from κ = 0.26 to κ = 0.39. Three of the four surgeons reported a significant increase in confidence. Agreement with the actual treatments patients received increased from κ = 0.21 to κ = 0.28. Intra-anal rectal prolapse on DP was a significant predictor of a decision to perform anterior mesh rectopexy. The DP improves interclinician agreement in the management of pelvic floor disorders and enhances the confidence in treatment decisions. Intra-anal rectal prolapse was the most influential DP parameter in treatment decision-making.

Evaluating the effects of a classroom-based bicycle education intervention on bicycle activity, self-efficacy, personal safety, knowledge, and mode choice

IntroductionThis study provides an evaluation of the impacts of classroom-based adult bicycle education on bicycling activity, confidence and competency self-perceptions while bicycling, knowledge of the bicycling rules of the road, and mode choice in a sample of residents of the San Francisco Bay Area in the US.MethodsChanges were measured with self-administered surveys completed before and six weeks after the course intervention. Self-reported data were validated using objective data collected using the Ride Report app. We used multivariable regression analyses to examine changes in self-reported data over time.ResultsParticipants reported statistically significant increases in confidence while bicycling in both traffic and car-free areas, feelings of safety while bicycling in car-free areas, and knowledge of the rules of the road. While there were significant changes in the proportion of trips by foot, transit and TNC, there was no change in the count of trips made by bicycle.DiscussionAlthough overall changes in bicycling activity did not change, participants with initial low confidence increased bicycling activity and feelings of safety in traffic, compared to participants overall. Classroom-based bicycle education courses can improve bicycling confidence self-perception and increase knowledge of the bicycling rules of the road.

Twine virtual patient games as an online resource for undergraduate diabetes acute care education

BackgroundVirtual patients provide a safe way to simulate authentic clinical practice. Twine is an open-source software that can be used to create intricate virtual patient games, including elements like non-linear free text history taking and time-related changes to the game’s narrative. We evaluated the incorporation of Twine virtual patient games into a diabetes acute care online learning package for undergraduate medical students at the University of Glassgow, Scotland.MethodsThree games were developed using Twine, Wacom Intuous Pro, Autodesk SketchBook, Camtasia Studio, and simulated patients. Online material included three VP games, eight microlectures, and a single best answer multiple choice question quiz. The games were evaluated at Kirkpatrick Level 1 with an acceptability and usability questionnaire. The entire online package was evaluated at Kirkpatrick Level 2 with pre- and post-course multiple choice and confidence questions, with statistical analysis performed using paired t-tests.Results122 of approximately 270 eligible students provided information on resource utilisation, with 96% of these students using at least one online resource. 68% of students who returned surveys used at least one VP game. 73 students provided feedback on the VP games they had played, with the majority of median responses being “agree” on positive usability and acceptability statements. The online resources were associated with a mean multiple choice score increase from 4.37 out of 10 to 7.96 out of 10 (p < 0.0001, 95% CI + 2.99 to + 4.20, n = 52) and a mean total confidence score increase from 4.86 out of 10 to 6.70 out of 10 (p < 0.0001, 95% CI + 1.37 to + 2.30, n = 48).ConclusionsOur VP games were well-received by students and promoted engagement with online material. The package of online material led to statistically significant increases in confidence and knowledge in diabetes acute care outcomes. A blueprint with supporting instructions has now been created to facilitate rapid creation of further games using Twine software.