Skills Laboratory Research Articles

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis

BackgroundParasitological investigation of bone marrow, splenic or lymph node aspirations is the gold standard for the diagnosis of visceral leishmaniasis (VL). However, this invasive test requires skilled clinical and laboratory staff and adequate facilities, and sensitivity varies depending on the tissue used. The direct agglutination test (DAT) is a serological test that does not need specialised staff, with just minimal training required. While previous meta-analysis has shown DAT to have high sensitivity and specificity when using parasitology as the reference test for diagnosis, meta-analysis of DAT compared to other diagnostic techniques, such as PCR and ELISA, that are increasingly used in clinical and research settings, has not been done.MethodsWe conducted a systematic review to determine the diagnostic performance of DAT compared to all available tests for the laboratory diagnosis of human VL. We searched electronic databases including Medline, Embase, Global Health, Scopus, WoS Science Citation Index, Wiley Cochrane Central Register of Controlled Trials, Africa-Wide Information, LILACS and WHO Global Index. Three independent reviewers screened reports and extracted data from eligible studies. A meta-analysis estimated the diagnostic sensitivity and specificity of DAT.ResultsOf 987 titles screened, 358 were selected for full data extraction and 78 were included in the analysis, reporting on 32,822 participants from 19 countries. Studies included were conducted between 1987–2020. Meta-analysis of studies using serum and DAT compared to any other test showed pooled sensitivity of 95% (95%CrI 90–98%) and pooled specificity of 95% (95%CrI 88–98%). Results were similar for freeze-dried DAT and liquid DAT when analysed separately. Sensitivity was lower for HIV-positive patients (90%, CrI 59–98%) and specificity was lower for symptomatic patients (70%, CrI 43–89%). When comparing different geographical regions, the lowest median sensitivity (89%, CrI 67–97%) was in Western Asia (five studies).ConclusionsThis systematic review and meta-analysis demonstrates high estimated pooled sensitivity and specificity of DAT for diagnosis of VL, although sensitivity and specificity were lower for different patient groups and geographical locations. This review highlights the lack of standardisation of DAT methods and preparations, and the lack of data from some important geographical locations. Future well-reported studies could provide better evidence to inform test implementation for different patient populations and use cases.PROSPERO registrationCRD42021240830

Integrating peer instruction and peer assessment with competency-based four-step approach: effectiveness on wound dressing skill acquisition and motivation among nursing students

BackgroundA student-friendly atmosphere and interactive learning experience enhance students' motivation and skill acquisition. Thus, integrating students' interactive participation in the teacher-led demonstration would add more enthusiasm and motivation. AimTo determine the effect of integrating peer instructions and assessment with competency-based four-step approach on wound dressing skill acquisition and motivation among nursing students. DesignA quasi-experimental, two-group pretest-posttest study was carried out at the skill labs of the College of Health and Sport Sciences. MethodsA convenience sampling of 121 nursing students were assigned to two groups; the control group received the traditional Peyton's 4-Steps-Approach (P4-SA). These steps included (a) demonstration; teacher performed the complete skill without comments or explanation, (b) deconstruction; teacher performed every sub-step slowly with detailed explanation, (c) comprehension; teacher performed the skill for third time, following the student's instructions and explanation of every sub-step, (d) execution; student described and execute the skill step by step simultaneously (n = 59). While the study group received the modified P4-SA approach where peer learning and peer assessment were applied in step 4 (n = 62). ResultsThe study revealed that 71.0% of students in the study group obtained good total percent skills scores immediately after receiving the intervention, compared to 18.6% of those in the control group (p<0.001). Moreover, 93.5% had good total percent scores of skills after eight weeks of the intervention, compared to only 46.6% of those in the control group (p< 0.001). Regarding motivation, students in the study group also reported higher intrinsic and extrinsic goal orientation, task value, self-efficacy for learning and performance, and test anxiety control of learning beliefs. ConclusionsIntegrating a student-centered teaching approach effectively promoted their motivation while performing complex nursing competencies such as wound dressing and facilitating skill acquisition and retention. Therefore, nursing educators could utilize their educational toolkit with various strategies for empowering nursing students' active participation in their learning.

Off to the Races: Effectively Using Downtime Between Skills Lab Stations.

Off to the Races: Effectively Using Downtime Between Skills Lab Stations.

A42A palliative care skills study day is an effective way of meeting palliative care registrar curriculum Direct Observation of Procedural Skills (DOPs) requirements

The new Speciality Training curriculum for Palliative Medicine from August 2022 identifies key procedural skills that, for the first time, can be performed in a simulation (SIM) skills lab to demonstrate proficiency [1]. These include tracheostomy care, managing non-invasive ventilation (NIV) and the management of indwelling ascitic drains. These skills can be difficult to acquire in non-hospital settings like hospices and in the community. A bespoke, pilot palliative care skills day was organized to assess the suitability for theory, skills training and subsequent opportunity to demonstrate proficiency by sign off against curriculum competencies. A total of 11 palliative care trainees from the Northern Deanery attended a pilot SIM study day in March 2023. Three parallel workshops were planned – tracheostomy care, the insertion and management of ascitic drains and managing NIV. Each workshop was delivered by local experts in the area (non- palliative care professionals) with experience of teaching and training other professionals. assessing internal medicine trainees. Trainers were briefed on learning outcomes prior to the session by two palliative care consultants, and the clinical context of each session was set within relevant palliative care environments for e.g. the care of a patient in a hospice, in the community or in a hospital. Trainee confidence was assessed before and after SIM training with the use of 10-point Likert scales and free text comments. Overall self-reported trainee confidence and competence scores increased for all three workshops (Paracentesis 7 to 8.8 out of 10, NIV 4.5 to 8.6, tracheostomy care 3.8 to 8.9). All trainees agreed it was an effective and educational way of addressing curriculum objectives; and agreed it should be a rolling programme offered regionally. Trainees commented on the positive learning environment, the small group sizes, the benefit of being taught by experts and having the opportunity to be assessed for curriculum requirements. Trainees who had previously achieved competencies commented on the benefit of refreshing skills. One area for development identified was the lack of standardization on DOPs forms about the level of proficiency required. This will be fed back to the regional training committee for the future. Trainees identified further clinical skills that could be addressed in a skills lab and hence, a second skills day will be organized. SIM training is an effective tool for delivering training around procedural skills for palliative care registrars. It also brings opportunity to demonstrate proficiency in specific practical skills. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Analysis of Basic Laboratory Skills of Science Education Students Using Pictorial-Based Instruments

Laboratory skills are an important aspect of natural sciences in schools and higher education, often linked to psychomotor aspects of learning. Several studies have developed several methods that can be used to evaluate laboratory skills, for example, the use of observation sheets equipped with rubrics. However, often using this method requires a longer learning time. Therefore, there is a need for research that examines how to evaluate students' basic laboratory skills. This research aims to analyze students' basic laboratory skills using pictorial-based instruments. This research method uses descriptive qualitative. This instrument is equipped with pictures that provide visualization. The basic laboratory skills are focused on experiments on making standard solutions from solids, making standard solutions from concentrated solutions, and acid-base titrations. Based on the analysis, it was found that the basic laboratory skills of science students in the experiment of making standard solutions from solids contained six basic skills, including selecting tools, weighing solids, transferring solids into a beaker, putting them in a volumetric flask, marking the solution, reading the meniscus mark. In the experiment of making a standard solution, there are five basic skills, namely selecting tools, taking the stock solution, transferring it into a volumetric flask, marking the solution, and reading the meniscus mark. The titration experiment consists of 8 skills, including selecting equipment, taking the analyte solution, taking the titrant solution, adding a titration indicator, using the titration technique, observing the endpoint of the titration, reading the meniscus, and calculating the solution's concentration.

Development of the Cognitive Load Inventory for Surgical Skills: preliminary validity evidence

PurposeThe operating room requires simultaneous processing of considerable information. Trainee learning and performance in this environment are restricted by working memory. Cognitive learning theory, which describes three types of cognitive load (CL), suggests that learning is maximized when intrinsic load (IL) is matched to experience, extraneous load (EL) is minimized, and germane load (GL) is optimized with schemas. The ability to measure CL is critical to maximize learning. The Cognitive Load Inventory for Colonoscopy (CLIC) measures the three types of CL during colonoscopy training. We adapted the CLIC for surgical skills education and aimed to gather validity evidence for this tool.MethodsWe initially developed a 21-item, 5-point Likert instrument, the Cognitive Load Inventory for Surgical Skills (CLISS), through a multi-step process. To support content validity, we revised CLIC content to reflect surgical skills, obtaining feedback from CLIC creators to ensure adjustments adequately retained IL, EL, and GL concepts. To examine the response process, we conducted cognitive interviews with surgical residents to assess wording and clarity and issued the survey in different settings (simulation exercises, operating room cases), relative to different tasks, and with different respondents (residents, fellows, faculty). To assess internal structure, we examined internal consistency using Cronbach's alpha and conducted confirmatory factor analysis (CFA) to confirm that relationships among the items were as hypothesized. We evaluated adequacy of the 3-factor model with three model fit indices, including Bentler’s Comparative Fit Index (CFI), the Tucker–Lewis Index (TLI), and root mean square error of approximation (RMSEA). A sensitivity analysis was performed eliminating items with factor loading estimates that (1) are less than 0.40, (2) are not statistically significant, or (3) load onto 2 or more factors.ResultsThe CLISS was distributed in 7 clinical and simulated procedural settings to 138 participants and yielded 100 responses (72% response rate). Of the respondents, 99 (99%) completed the entire CLISS. No respondents raised content questions. Each item garnered a range of responses. All 3 types of cognitive load had a Cronbach’s alpha above 0.7. However, several individual items were found not to correlate with other items within that load. CFA revealed a range of loadings for each factor. Model fit indices were outside the conventional cut-offs (CFI = 0.627, TLI = 0.579, RMSEA = 0.124), suggesting consensus that the initial 3-factor, 21-item model was not a good fit. Sensitivity analysis yielded a revised 11-item tool, which demonstrated improved Cronbach’s alpha for IL and GL and improved model indices (CFI = 0.940, TLI = 0.920, RMSEA = 0.076). An additional item was removed to further support content validity.ConclusionsThe CLISS can be a practical tool for administration in the skills lab and clinical settings, particularly if administered immediately after the session or requested individually. While promising, further study is needed to establish additional validity evidence for the CLISS.

Rubrics For Learning &amp; Self-assessment In Open Schooling

In the teaching-learning process, various tools and techniques are being used by the teacher at different levels of understanding, memorizing, and reflection. The relevance of various tools for knowledge gathering, enrichment, and assessment is well acknowledged by research studies around the globe. In order to strengthen the degree of competency of the learner, the latest research studies recognize the wide applicability of rubric not only in performance assessment but also in other different dimensions of development by different means of children with different needs. In this present study, the researcher aimed to explore the potential of the rubric as a tool to assess targeted skills in a more detailed manner through explicit explanation of performance expectations for the learners of Open School. This paper investigated the impact of using rubrics as a learning and self-assessment tool for improving the science laboratory skills of the learners of the National Institute of Open School (NIOS). The study was carried out in three phases, the pre-intervention, intervention, and post-intervention phase. The quasi-experimental design was adopted with one sample, pre-post test design. As a sample, 28 learners of Senior Secondary (Science stream) of 3 different study centers of NIOS located in Delhi, NCR were selected. Rubric as a tool of self-learning and assessment was used in this study. The science practical was attended by the sample at their respective study centers and the researcher reached the sample in their respective places. Sessions were conducted to prepare the sample about the preparation and usage of Rubrics for their own learning and performance check. The learners were urged to use it to improve their own learning and execution perfection level in their Science practical classes after a series of sessions, once they had a clear comprehension of the preparation and usage. The qualitative interpretation of the findings in the study revealed that the learners got a better understanding and clarity on the expectations of perfection in performing an experiment, which helped them to bring that precision while conducting the practical. Also, it was acknowledged by most of the learners that the rubric helped them to focus on their work, produce work of better quality, and assisted them to earn better grades without feeling nervous about the given task. The descriptive analysis of pre and post-intervention phases revealed that there was a gain difference of 14.95 between pre-test and post-test scores in each dimension of the rubric. The hypothesis testing was done through the Wilcoxon signed rank test (statistical analysis), Z: -3.936, Asymp. Sig. (2-tailed): 0.000, the P value was less than 0.05 (0.000&lt;0.05), indicating that there was a significant difference in the performance, and hence, H0 was rejected. The multiple benefits of using a rubric as a learning and scoring instrument are discussed in this paper. This study promotes the use of rubrics as a learning and assessment tool to enhance the knowledge and skills of learners in formal and open learning environments.

A level of trust: Exploring entrustable professional activities as a feedback tool in a skills lab

IntroductionThere is a lack of data on use of entrustable professional activitie (EPA) statements and levels of entrustment as a feedback tool in pharmacy education. This study examined EPAs as a feedback tool for student pharmacists in a skills lab series. MethodsEighty-seven third-year student pharmacists ranked their perceived level of entrustment using a three-point scale for 13 EPA core statements in two consecutive semesters. Each semester, students were provided with an individualized EPA report that disclosed the levels of entrustment generated from a feedback model. These levels of entrustment were determined based on student performance in objective structured clinical examination stations and high-stakes activities. The primary objective compared the difference in median entrustment scores between the self-assessment survey and the feedback model. Changes over time in self-assessment accuracy and bias were explored as secondary objectives. ResultsA significant difference was observed between self-assessment and feedback scores for most EPAs in both the fall (Z = −2.38) and spring semesters (Z = −7.77). Self-assessment accuracy significantly improved over time. (T1 = 0.67, T2 = 0.62). Students displayed under confidence of self-assessment in the fall and overconfidence in spring. The Cronbach's alpha values for the study instruments were above 0.8, indicating good reliability. ConclusionsThe difference between self-assessment and feedback scores highlighted the potential of using EPAs to enhance self-awareness and provide feedback in a skills lab series. Self-evaluation of EPAs in a skills lab may also benefit student development as self-reported growth in autonomy was observed over time.

Opportunities and challenges in clinical learning of midwifery students in public Universities of Tigray Region, Ethiopia, 2020: a qualitative study

BackgroundClinical learning focuses on real problems in the context of professional practice in which learners are motivated by its relevance and active participation. Studies showed that midwifery students were challenged by the absence of a variety of cases in non-teaching hospitals, overcrowded teaching hospitals, absence of objective-based evaluation methods, and lack of supervision from clinical instructors. If the theory learned in class was applied in practice, it is helpful to produce skillful and competent midwifery professionals. The aim of this study was exploring opportunities and challenges for midwifery students in the clinical learning environment.Methodsthe study was conducted in public Universities of Tigray, Ethiopia. Phenomenology study design and purposive sampling technique were employed; four focused group discussions and five key informant interviews were conducted. Data were collected using an open-ended guide, transcribed verbatim, entered into ATLAS ti7 software, and translated. Then codes and themes were derived from the transcribed data, and finally analyzed thematically.Resultsa total of 33 participants in which 28 in four focused group discussions and five key informant interviews participated in this study. Based on the result, midwifery students were getting opportunities to practice when they were assigned to non-teaching hospitals, working with close supervision, having smooth relationships with staff, receiving constructive feedback, and evaluated based on their skills. Whereas, they were challenged by aggressive staff, poor follow up, overcrowded teaching hospitals, low usage of skills lab, and short time for clinical practice.ConclusionMidwifery students have positive attitude, and were getting opportunities to practice while they were assigned to a very conducive clinical learning environment with supportive and skillful clinical instructors/ preceptors. However, they have negative attitude, and were challenged to work due to the poor attention given to midwifery students’ clinical learning. It is recommended that midwifery students have to practice well in skills lab before they assigned for clinical practice so that the skills lab have to be strengthen with all necessary materials for clinical practice and clinical instructors have to be integrated to teaching hospitals so as to educate students while their hands-on.

Procedural simulation in venipuncture for medical undergraduates and its transfer to the bedside: a cluster randomized study.

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

Effect of the Implementation of the Postpartum Care Laboratory Skill Integrated Learning Model on Improving the Competence

The conventional laboratory learning model has proven to be inadequate in improving competencies. Therefore, there is a need to develop a learning model that integrates the knowledge gained with the skills and attitudes required when providing care, namely an integrated laboratory skills learning model. The purpose of this study was to analyze the effect of the implementation of an integrated postpartum care laboratory skill learning model on improving the competencies of Diploma-3 midwifery students. This study adopted a quasi-experimental pretest-posttest nonequivalent control group design with 79 students divided into two groups: the intervention group consisting of 39 students from STIKes Indramayu and the control group consisting of 40 students from Poltekkes BPH Cirebon. The intervention group was given the integrated learning model, while the control group was given the conventional learning model. Data analysis was conducted using t-tests, Mann-Whitney tests, and chi-square tests with a significance level of p&lt;0.05. The results showed that the pretest competencies of the intervention group were 33 (84.6%) who were not competent, while in the control group, 35 (87.5%) were not competent. There was an increase in competencies in the intervention group by 49% (0-887) and in the control group by 19.4% (0-50.9). Further analysis indicated a significant difference in competency improvement between the group given the integrated laboratory skills learning model and the group given the conventional laboratory skills learning model (p&lt;0.05). The conventional laboratory skills learning model was a risk factor causing students to be incompetent with a relative risk of 1.64 (95% CI 1.15-2.35) and NNT 3.2. The Integrated model of laboratory skills has a positive impact on students’ skill elevation.

An Online CURE Taught at a Community College During the Pandemic Shows Mixed Results for Development of Research Self-Efficacy and In-class Relationships

The Bee the CURE is a novel course-based undergraduate research experience (CURE) that engages introductory biology students in DNA barcoding (DNA extraction, amplification, and bioinformatics) in partnership with the Tucson Bee Collaborative and the University of Arizona. The first iteration of this CURE taught at Pima Community College (PCC) occurred during the Fall 2020 semester in which the course was taught online and students focused on bioinformatics. Due to the online format, students were unable to participate directly in the wet-lab components (extraction and amplification) of the course. These were approximated with videos of the instructor performing the tasks. A qualitative case study of this semester built from student interviews found that students were able to form positive relationships with instructors and peer mentors but that the online format of the class posed some challenges to relationship formation. Students reported developing self-efficacy in bioinformatics skills while online lab participation disrupted student’s gaining “hands-on experiences” and seldom led to development of science self-efficacy in wet lab skills. Our findings from a study of a synchronous online CURE allowed us to characterize a context in which online learning posed a challenge and perhaps even a threat to research self-efficacy, especially regarding skill development and self-efficacy in “hands-on” areas, such as wet-bench research skills. Yet optimistically, our study highlights the potential of online community college learning environments to provide mastery experiences in online science contexts (e.g., bioinformatics) and opportunities for relationship building.

Is participation enough? Impact of simulation curriculum structure on performance of basic surgical skills

PurposeThe optimal strategy for curricular construction and feedback implementation, both critical for skill acquisition, is unknown in the simulation curricula setting. To address this gap, we examined the impact of individual components of our basic surgical skills curriculum on intern performance.MethodsThe basic surgical skills curriculum consists of skills lab sessions, self-recorded “homework” exercises graded with a score and narrative feedback, and a scored final assessment. Using linear regression, we assessed the association between assessment performance (scores) and four other curricular components (skills lab attendance, homework submission, homework scores, and receipt of feedback on homework). Narrative feedback quality was graded by three raters for relevance, valence, and specificity. Pearson’s r was used to calculate the association of each feedback variable with the assessment score.ResultsAmong the 71 (73%) surgical interns who completed the curriculum, for each additional homework assignment that received structured feedback, assessment score increased by 0.54% (p < 0.001; effect size 0.16). For each percentage point increase in homework score, assessment score increased by 0.21% (p = 0.02; effect size 0.07). Pearson’s r revealed significant correlations between assessment score and relevant feedback (r = 0.26, p = 0.02), relevant feedback and corrective feedback (r = 0.70, p < 0.001), and between relevant and specific feedback (r = 0.74, p < 0.001). Relevant feedback comments were not correlated with reinforcing feedback (r = 0.01, p = 0.47).ConclusionsOur findings reiterate the value of practice when accompanied by relevant feedback. We identified a default to providing lower-quality reinforcing feedback and higher-quality corrective feedback. Future feedback training may yield positive results.

Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India.

The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Retrospective observational and comparative study from single rural tertiary care referral center of western India. A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.

Preferred Learning Styles and Teaching Methods Among Medical Students: A Cross-Sectional Study.

Introduction Knowingthe learning styles of medical students is an important factor as it can help in making learning more effective. Research has shown that medical students in various years of studies have selective learning styles and liking to a particular teaching strategy. The aim of the present study was to identify the preferred learning styles and teaching methods of medical students through all the years of study using the VARK (for Visual, Aural, Read/Write, Kinesthetic) questionnaire. Method A cross-sectional study was conducted among the medical students of year 1 (MD1) to year 6 (MD6), except MD5, at the College of Medicine and Health Sciences, Sohar, Oman. The VARK questionnaire was used to record the learning stylepreference of the students, and an additional question was asked to know the teaching method that the students preferred to be used. Results A total of 292 students responded to the questionnaire. The majority of the students had preference for the multimodal style of teaching (54%), mostly bimodal (30%). This was followed by the kinesthetic mode of learning (30%) in the unimodal style. The MD1 and MD6 students had preference for the unimodal style whereas the other years (MD2, MD3, MD4) had preference for the bimodal style. The teaching method preferred by most of the students included clinical skills lab (64%) followed by interactive lecture (59%) and lab work (57%). Conclusion The study showed that most of the students had preference for more than one (bimodal) learning style. The research findings can help the teachers recognize the learning problems among students and execute the needed teaching strategies.

Simulation in medical education in Iceland

Skills labs and simulation centers have become an integrated part of teaching methods in many medical schools. This study aims to describe the status of simulation in medical education in Iceland by examining student and faculty experience, facilitating and barring factors for its use in teaching and how the concept appears in the Course Catalog. The study was threefold. In parts one and two, electronic surveys were sent to students and faculty members at the Faculty of Medicine, University of Iceland. Part three was a key word search in the University´s course catalogue relating to simulation. Response rate for both student and faculty surveys was 65%. Simulation as a teaching method was reported for 10% of faculty according to students but approximately a third of faculty, according to faculty. Attitudes of students and faculty were positive. Faculty, previously exposed to simulation, were more likely to use simulation, as were those who had received training in educational methods. Main barriers identified were lack of facilities, equipment, funds, and training. Key words related to simulation appeared rarely in the University Course Catalogue. Student and faculty experience with simulation is limited, less than third of faculty claim to have used simulation when teaching medical students. Barring factors in Iceland are similar to what has been reported elsewhere. Lack of words describing simulation in the Course Catalog may raise questions about emphasis on teaching methods or lack thereof. Potential ways to increase the use of simulation could be to improve infrastructure and offer training in diverse educational methods, including simulation, to selected faculty.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BackgroundThe effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.MethodsA prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student’s communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).ResultsFifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].ConclusionSimulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

Teaching transferable skills in teamwork, accountability, goal setting, writing, and problem-solving in a non-major microbiology lab: the unknown bacteria experiment redefined.

College to Career is a phrase that we often use to describe the skills and abilities that students should achieve while preparing for college and/or careers. To help prepare our students for their future careers, we developed a microbiology laboratory curriculum based on factors identified to improve college-to-career readiness. These factors include content knowledge, analyzing and interpreting data, accountability, goal setting, and teamwork. At the core of the design are inquiry and problem-based learning. This approach allows students to actively engage in the scientific process while collaborating with classmates and learning technical and transferable career skills. The curriculum includes microbiology laboratory skills, including plating, serial dilutions, and biochemical tests, with integrated opportunities for students to engage in critical thinking, analysis and interpretation of data, teamwork, goal setting, decision-making, and scientific writing.

From recipe to enquiry – a curriculum tool for science teachers to align policy with practice in practical lessons

ABSTRACT Internationally, second level curriculum policy for STEM education is concentrating its efforts on promoting curriculum-making pedagogies, with enquiry-based teaching and learning at the forefront of this change. Policy aspirations have not translated well into practice, evidenced by science practical lessons consistently being delivered as recipes to be followed. In recognition of this, national STEM policies are calling for quality pedagogical resources that can support teachers to engage in teaching practical work through scientific enquiry. This article describes how Design Based Research was used as a methodology to create and evaluate a resource, the Structured Enquiry Observation Schedule (SEOS), as a tool to identify student achievement of procedural (enquiry and laboratory) skills in practical biology lessons. Data collected using the SEOS, was triangulated with interview, video and audio data over three iterative research cycles. Findings indicated that the SEOS provides a lens to compare and align policy intentions with classroom enactment of practical work by identifying the basic procedural skills that should underpin any enquiry-based practical lesson, and by highlighting the importance of student attainment of those skills. If used by practising teachers, it has potential to answer calls for quality resources to support the transition to enquiry-based science pedagogy.

Applying objective metrics to neurosurgical skill development with simulation and spaced repetition learning.

Surgical skills laboratories augment educational training by deepening one's understanding of anatomy and allowing the safe practice of technical skills. Novel, high-fidelity, cadaver-free simulators provide an opportunity to increase access to skills laboratory training. The neurosurgical field has historically evaluated skill by subjective assessment or outcome measures, as opposed to process measures with objective, quantitative indicators of technical skill and progression. The authors conducted a pilot training module with spaced repetition learning concepts to evaluate its feasibility and impact on proficiency. The 6-week module used a simulator of a pterional approach representing skull, dura mater, cranial nerves, and arteries (UpSurgeOn S.r.l.). Neurosurgery residents at an academic tertiary hospital completed a video-recorded baseline examination, performing supraorbital and pterional craniotomies, dural opening, suturing, and anatomical identification under a microscope. Participation in the full 6-week module was voluntary, which precluded randomizing by class year. The intervention group participated in four additional faculty-guided trainings. In the 6th week, all residents (intervention and control) repeated the initial examination with video recording. Videos were evaluated by three neurosurgical attendings who were not affiliated with the institution and who were blinded to participant grouping and year. Scores were assigned via Global Rating Scales (GRSs) and Task-based Specific Checklists (TSCs) previously built for craniotomy (cGRS, cTSC) and microsurgical exploration (mGRS, mTSC). Fifteen residents participated (8 intervention, 7 control). The intervention group included a greater number of junior residents (postgraduate years 1-3; 7/8) compared to the control group (1/7). External evaluators had internal consistency within 0.5% (kappa probability > Z of 0.00001). The total average time improved by 5:42 minutes (p < 0.003; intervention, 6:05, p = 0.07; control, 5:15, p = 0.001). The intervention group began with lower scores in all categories and surpassed the comparison group in cGRS (10.93 to 13.6/16) and cTSC (4.0 to 7.4/10). Percent improvements for the intervention group were cGRS 25% (p = 0.02), cTSC 84% (p = 0.002), mGRS 18% (p = 0.003), and mTSC 52% (p = 0.037). For controls, improvements were cGRS 4% (p = 0.19), cTSC 0.0% (p > 0.99), mGRS 6% (p = 0.07), and mTSC 31% (p = 0.029). Participants who underwent a 6-week simulation course showed significant objective improvement in technical indicators, particularly individuals who were early in their training. Small, nonrandomized grouping limits generalizability regarding degree of impact; however, introducing objective performance metrics during spaced repetition simulation would undoubtedly improve training. A larger multiinstitutional randomized controlled study will help elucidate the value of this educational method.