Skills Centre Research Articles

Veterinary parasitology teaching at London – Meeting the ‘Day-One Competency’ needs of new veterinarians

Over the past four decades, there has been an exponential increase in veterinary parasitology knowledge, coinciding with the advent of molecular biology in research. Therefore, it is unrealistic for teachers to expect students to graduate with an encyclopaedic knowledge of the subject. As a result, a new curriculum was introduced at The Royal Veterinary College (University of London) in 2007, designed to meet the needs of our new graduates, i.e. RCVS Day-One Competences. The aims of this curriculum are, inter alia, to ensure that new graduates have an up-to-date body of core knowledge and are able to apply such knowledge and newly-acquired information to scientific and clinical problem-solving. Veterinary parasitology is taught primarily in Year 2, following a brief introduction in Year 1; clinical aspects are covered in Year 3, with original research projects undertaken in Years 4 and 5. Parasitology is taught in parallel with other subjects, enabling both horizontal and vertical integration. Core material is provided in lectures supplemented by directed learning (DL) in small groups and interactive, clinical scenario-based practical classes. Student learning is supported by Moodle 3.2 (Virtual Learning Environment [VLE], RVC Learn) which provides access to an on-line study guide (annotated using Adobe Reader), PowerPoint presentations with synchronized lecturer commentary (Echo Active Learning Platform [ALP]), detailed feedback for DL and practical classes, parasite ‘potcasts’ and CAL packages, and a Clinical Skills Centre. A parasitology textbook has also been published recently to support courses taught at the College. Assessment of student learning is achieved using a variety of written formats (essay, problem-solving questions [PSQ], multiple choice questions [MCQ] and extended matching questions [EMQ]), integrated oral examinations and objective structured clinical examinations (OSCEs).

Preface to training in minimal access surgery

A few years ago, it came to mind when both of us were teaching a minimal access (laparoscopic) surgery course in the Cuschieri Skills Center in Dundee, Scotland, that here we were, teaching young surgeons the basic and advanced skills in colorectal surgery and that we had never been taught how to do so.

Preface to training in minimal access surgery

A few years ago, it came to mind when both of us were teaching a minimal access (laparoscopic) surgery course in the Cuschieri Skills Center in Dundee, Scotland, that here we were, teaching young surgeons the basic and advanced skills in colorectal surgery and that we had never been taught how to do so.

Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran.

Background:Spiritual health can cause mental health promotion and well-being of the people's lives but it is still neglected in practice so that there is no trace of spiritual training in medical education in Iran. This study was conducted to develop a training course for spiritual counselors in the Iranian health-care system.Methods:In this qualitative study, senior managers of the Ministry of Health (MOH) and experts in the related fields were purposively selected as the participants. Semi-structured interviews and focused group discussions (FGDs) were conducted to collect the data. After transcription of the interviews and FGDs, the data were analyzed using content analysis.Results:In this package, community-based spiritual health services are offered in three forms of spiritual lifestyle education, introducing social facilities, and collaborating with the related organizations. Hospital services are offered in four forms of assessment of the spiritual status and referral, spiritual care, spiritual counseling, and providing a spiritual environment in the hospital.Conclusion:According to the results of the study, it is suggested that a strategic committee be established at the MOH level for establishment of these training courses as well as another strategic committee for evaluation, review, and service package promotion, and its training courses should be formed. In addition, a set of skills for spiritual assessment of patients and the related interventions should be designed for clinical skill centers of the country in the form of skill training packages.

International teleconsultation on conjoined twins leading to a successful separation: a case report

Conjoined twins are identical twins that have incompletely separated in utero. The prognosis for conjoined twins is poor and management in a skilled tertiary care centre is paramount for definitive care. We describe our experience with a telemedical consultation on conjoined twins in The Dominican Republic from our eHealth centre in Valhalla, NY. The patients were two month old, female, pygopagus conjoined twins. A multidisciplinary teleconference was initiated with the patients, their family, the referring paediatrician and our team. Based on this teleconsultation, the team felt as though the twins may be amenable to a surgical separation. They presented to our centre in Valhalla, NY, for a detailed physical examination and series of imaging studies. Soon after, the patients underwent a successful 21 h separation procedure and were discharged 12 weeks later. To our knowledge, this is one of the first reports of an international teleconsultation leading to a successful conjoined twin separation procedure.

Perspectives on rehabilitation of children with cerebral palsy: exploring a cross-cultural view of parents from India and Canada using the international classification of functioning, disability and health

Purpose: To explore parents’ perspectives on rehabilitation of their child with cerebral palsy and their information needs.Methods: Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework.Results: Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the barriers experienced by Indian parents. Information needs: both groups needed information to make their child more functional.Conclusion: Canadian parents experience a more enabling environment and express a more social view of their child’s health, suggesting both education on the International Classification of Functioning, Disability and Health principles and services are needed to better enable and empower Indian parents. There remains a need for healthcare professionals and services in both countries to be more family-centered.Implications for rehabilitationTo help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children.Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation.Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process.

The construction of clinical skills center under the mode of informatization

Taking an actual case as an example, this paper discusses how to integrate the informa-tization concept into the actual construction of the clinical skill center, and introduces the two aspects of the construction and management of the site and the daily business management. The design concept of multimedia standard has been proposed, and the necessary teaching auxiliary facilities are chosen according to local conditions, all of which ensure the versatility and high cost performance of teaching units. Through the concept of information remote management, the problem of multimedia teaching terminal management is solved. Besides, through the information process reengineering, the daily business problems such as room management, multi-station examination and asset management have been solved, and syn-chronously a multimedia network learning platform has been built. The scheme has highlighted the charac-teristics of practical, efficient and management science and has achieved remarkable results, so it has cer-tain reference and promotion value. Key words: Informatization; Mode; Clinical skills training center; Construction

Nuclear family [Hinkley Point C power station construction

The development of Hinkley Point C puts essential UK energy infrastructure-as well as contracts worth over £30bn - in the hands of French and Chinese engineers and developers. It has led to inevitable questions over whether the project could have been managed by UK engineers. Andy Berry, vice principal at Bridgwater College, claims that, because the UK hasn't built a nuclear power plant in more than 25 years, it has lost the requisite skills. Many of our qualifications, skills and standards are either out of date, or don't exist, he says. In order to get the plant up and running, these skills need to be revived. As part of the creation of the new power plant, Bridgwater College is helping to kick-start the UK's nuclear renaissance. French firm EDF itself has committed to creating over 1,000 apprenticeships over the course of the project, with suppliers adding many more to that number. The college has seen the building of a new construction skills and engineering facility that will help train the thousands of construction workers needed for the site. The Advanced Energy Skills Centre being built will help develop the skills and capacity of the UK nuclear engineering industry after a 20-year hiatus. Together, suppliers, educators and partners need to work together to develop the UK's nuclear capabilities. Indeed, the development of similar power stations across Europe could help develop a whole new area of expertise, potentially an opportunity for engineers throughout the continent.

Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers?

ABSTRACTPhenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. Approach: This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. Findings: Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important point was that sufficient tutor training and preparation was crucial for the success of models.

“Take-home” box trainers are an effective alternative to virtual reality simulators

BackgroundPractice on virtual reality simulators (VRSs) has been shown to improve surgical performance. However, VRSs are expensive and usually housed in surgical skills centers that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers (BT) are inexpensive and can be used anywhere at anytime. This study assesses “take-home” BTs as an alternative to VRS. MethodsAfter baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT), 25 surgical trainees were randomized to two groups. Trainees were asked to practice three basic laparoscopic tasks for 6 wk (BT group using a “take-home” box trainer; VR group using VRS in clinical skills centers). After the practice period, all performed two laparoscopic cholecystectomy, one on a VRS and one on a BT; (i.e., posttraining assessment). VRS provided metrics (total time [TT], number of movements instrument tip path length), and expert video assessment of cholecystectomy in a BT (Global Operative Assessment of Laparoscopic Skills [GOALS] score) were recorded. Performance during pretraining and posttraining assessment was compared. ResultsThe BT group showed a significant improvement for all VRS metrics (P = 0.008) and the efficiency category of GOALS score (P = 0.03). Only TT improved in the VRS group, and none of the GOALS categories demonstrated a statistically significant improvement after training. Finally, the improvement in VRS metrics in the BT group was significantly greater than in the VR group (TT P = 0.005, number of movements P = 0.042, path length P = 0.031), although there were no differences in the GOALS scores between the groups. ConclusionsThis study suggests that a basic “take-home” BT is a suitable alternative to VRS.

Formación, educación, acreditación y desarrollo profesional en cirugía en Europa: perspectiva de la Unión Europea de Médicos Especialistas (UEMS)

The European Union of Medical Specialists, founded in 1958, is the largest and oldest european medical organization. It includes 39 member states (of the European Union and others), and represents a total of 1.600.000 medical specialists. The main objective of the UEMS is to influence european healthcare politics by promoting the interests of the european medical specialists, establishing high standards in practice and training, as well as continuing medical education and professional development, and guaranteeing quality in specialist practice. The UEMS is developing several projects to face current and future challenges related to surgical training, education, acreditation, revalidation and professional development: i.- First, the UEMS is developing homogeneous requisites for European Training (ETRs), ii.- To manage the quality control process of the ETRs and evaluation of the organization, the UEMS has created the Council of european specialized medial evaluations (CESMA), iii.- The UEMS has been greatly involved in the acreditation process of training centres in all of Europe, iv.- in relation to continuing medical education, the European Accreditation Council for Continuing Medical Education (EACCME) is the main project of the UEMS for the accreditation of educational events and v.- the UEMS has established the Network of Accredited Clinical Skills Centres of Europe (UEMS-NASCE), that facilitates the accreditation and cooperation of training centres in Europe. In conclusion, with the great support of National Surgical Societies of the UEMS and the Surgery Section a series of solid projects have been established to support the professional development of the collective in Europe. This process constitutes a continuous effort that is very gratifying, with the aim to set the standards for a brilliant future for surgery students and specialized surgeons.

Personalized Outreach to University Students With a History of Reading Difficulties: Early Screening and Outreach to Support Academically At-Risk Students

We examined whether identification of and personalized outreach to a group of students with a history of reading difficulties would impact their use of support services and academic outcomes. Using a brief self-report questionnaire, we identified students with a history of reading difficulties ( n = 175) and a comparison group of university students without a history of reading difficulties ( n = 100). One half of the students with a history of reading difficulties were individually invited to visit the Academic Advising Centre; the other students received standard university communications about and access to university support services. Students with a history of reading difficulties who received personalized outreach in the first semester of their studies were more likely to use the Academic Advising Centre both in the weeks directly following outreach and in their second year of study. Outreach also increased use of the Study Skills Centre, but not the Writing Centre. Further, there was evidence of a positive effect of personalized outreach on the number of credits earned. Finally, the effect of first-semester personalized outreach on use of Academic Advising Centre in the second year was especially prominent for students who experienced serious academic difficulties in their first year. Overall, our results show promising outcomes for a simple, proactive, cost-effective approach to identify and provide personalized outreach to academically at-risk students.

Systematic review of the implementation of simulation training in surgical residency curriculum.

We reviewed the literature regarding the specific methods and strategies for implementing simulation-based training into the modern surgical residency curriculum.Residency programs are still struggling with how best to implement it into their curricula from a practical viewpoint. A systematic review was performed using Ovid MEDLINE, EMBASE, PubMed, PsycINFO, Web of Science, and other resources for studies involving the use of simulation for technical skills training in the surgical residency curriculum. Studies were selected based on the integration of simulation into the curriculum and/or a description of the details of implementation and the resources required. In total, 2533 unique citations were retrieved based on this search, and 31 articles met the inclusion criteria. Most simulators were focused on laparoscopic procedures, and training occurred most often in a skills lab. The assessment of skills consisted mostly of speed of task completion. Only 4 studies addressed issues of cost, and 6 programs mentioned human resources without any mention of skills center personnel or administrative support. All of the studies described the nature of the simulation training, but very few commented on how it was actually implemented and what was needed from organizational, administrative and logistical perspectives.

Comparison of the Effects of Concept Mapping and Conventional Teaching Methods on Critical Thinking of Nursing Students

Introduction: Development of critical thinking and Procedural skills has remained a serious and considerable challenge throughout the nursing educational system in Iran. Conventional methods of teaching such as lecture, as the dominant method used in higher educational systems, is a passive style which ignores critical thinking. Therefore, the aim of this study was to compare the effects of instruction by concept-mapping and conventional methods in fundamentals of nursing on critical thinking skills in Tehran nursing students in 2014. Methods: This quasi-experimental study was carried out on 70 nursing students, who were selected through convenient sampling method, then divided randomly into two equal experimental and control groups, in the Clinical Skills Center of Tehran Nursing and Midwifery School. Educational content was presented in the forms of concept-mapping for the experimental group and lecture in the control group. Data collection included a demographic information and California Critical Thinking Skills (form B) questionnaire; They were filled at the beginning and end of the fourth week of the Instructional period. Data were analyzed using SPSS software (v. 21), using descriptive and analytical statistics, at the significance level of 0.05. Results: Before the intervention, the mean of the total critical thinking skill score was 9.71 ± 2.66 in the concept mapping group and 9.64 ± 2.14 in the lecture group, and the difference was not significant (P = 0.121); but, after the intervention, the critical thinking skill score was 15.20 ± 2.71 in the intervention group and 10.25 ± 2.06 in the control group, which had a significant difference (P = 0.003). Conclusions: Using concept mapping strategy in the education of nursing students may lead to developing critical thinking skills as one of the important missions of higher level education. Therefore, it is recommended to employ this method in clinical nursing education. Keywords: Concept mapping, Critical Thinking Skills, Fundamentals of Nursing, Nursing Students

Robot assisted retroperitoneal lymph-node dissection after adjuvant therapy: different indications.

Today, access to technology through robotic surgery has allowed urologists to have a valuable tool in order to perform various robot -assisted laparoscopic procedures. Robotic surgery allows reproducing complex techniques such as retroperitoneal or extended pelvic lymphadenectomy. The aim of the study was to report our series of robot assisted retroperitoneal lymphadenectomy and to demonstrate its technical and oncological feasibility. A retrospective analysis on 7 patients (four cases of testicular tumors, one prostate adenocarcinoma, and two bladder urothelial carcinomas), who underwent retroperitoneal para-aortic, interaorto-cava and extended pelvic lymphadenectomy by robot assisted laparoscopic surgery, was conducted. We analyzed demographic, oncologic and operative data (surgical time, blood loss, and hospital stay). Demographic and operative data showed a mean age of 49 years (18-65), mean BMI of 26.1 kg/m2(23.7-29.1), mean operative time of198 minutes (180-220), mean estimated blood loss of 88 mL, and mean hospital stay of 3.6 days (3-5). No intraoperative complications occurred. Themean number of dissected nodes was 12 (3-20). Histopathology findings showed one case of postchemotherapy recurrenceof seminoma and six cases of fibrosis. At a mean postoperative follow-up of 39 months (7-75) no patients showed disease recurrence. Our case series demonstrated that the robot assisted approach isa feasible and reproducible option in skilled robotic surgical referral centers. The surgeons' experience and the optical magnification, associated to the degree of freedom offered by robotic assisted laparoscopy allow achievinga precise lymph node dissection, also in advanced oncologic patients.

Does video feedback analysis improve CPR performance in phase 5 medical students?

BackgroundThe use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen’s University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen’s University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance.MethodsFinal year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen’s University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using ‘StudioCode’ software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation.ResultsOne hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8–15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3–15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3–7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7–3.8) of cohort B participants, from session one to session two.ConclusionsThere is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0726-x) contains supplementary material, which is available to authorized users.

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery.

Purpose To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.MethodsFollowing a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.Results 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4–0.8 %) and 1 % (95 % CI 0.2–1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8–18.2 %) and 10.5 % (95 % CI 5.0–15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 % (95 % CI 5.5–8.5 %) and radiological incidence of 35.3 % (95 % CI 26.4–44.3 %).ConclusionIsolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.Level of evidenceII.

Developing academic literacy through self-regulated online learning

This study explores the self-regulated learning (SRL) experiences of international students in developing English language academic literacy essential for successful transition to university. The participants in this study were a small, diverse group of first year undergraduate students who sought academic support from the Academic Skills Centre at an Australian university. They were given the opportunity to independently access an online program, Study Skills Success, over the duration of one semester to develop their academic literacy in English. Data for this study were collected from a pre- and post-program questionnaire, interviews, a focus group discussion, and reflective online learning logs. These sources gathered information regarding the participants’ motivation and attitudes, their online learning experiences and strategy use, and the perceived benefits of SRL online. The findings from this study have implications for supporting the transition of first year students to university by developing essential academic skills through independent online learning.

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The paper provides practical experience on teaching the �Vital Activity Secure Safety� course at the Department of Vital Activity Secure and Disaster Medicine&#x0D; of Chita State Medical Academy in accordance with the requirements, stipulated by the Federal State Educational Standard of the 3rd generation&#x0D; (FGOS-3). Pressing aspects of teaching and professional skills are considered; the teaching course content, new educational technologies and innovative&#x0D; teaching techniques are analyzed. Within the Academy�s Practical Skills Center and the simulation class at Transbaikalia Regional Disaster Medicine&#x0D; Centre the correspondent classes are conducted, using dummies and phantoms. As one of the interactive teaching method the role play on the discipline&#x0D; concerned has been successfully pioneered. Also the paper features the role of special tactical training exercises and research work, conducted by students,&#x0D; as necessary to help them to master the required professional competencies.

Participant evaluation of simulation training using crew resource management in a hospital setting in Hong Kong.

A simulation team-based crew resource management training programme was developed to provide a unique multidisciplinary learning experience for health care professionals in a regional hospital in Hong Kong. In this study, we evaluated how health care professionals perceive the programme. A cross-sectional questionnaire survey was conducted in the Multidisciplinary Simulation and Skills Centre at Queen Elizabeth Hospital in Hong Kong. A total of 55 individuals in the departments of Obstetrics and Gynaecology, Anaesthesiology and Operating Theatre Services, Intensive Care Unit, and Accident and Emergency participated in the study between June 2013 and December 2013. The course content was specially designed according to the needs of the clinical departments and comprised a lecture followed by scenarios and debriefing sessions. Principles of crew resource management were introduced and taught throughout the course by trained instructors. Upon completion of each course, the participants were surveyed using a 5-point Likert scale and open-ended questions. The participant's responses to the survey were related to course organisation and satisfaction, realism, debriefing, and relevance to practice. The overall rating of the training programme was high, with mean Likert scale scores of 4.1 to 4.3. The key learning points were identified as closed-loop communication skills, assertiveness, decision making, and situational awareness. The use of a crew resource management simulation-based training programme is a valuable teaching tool for frontline health care staff. Concepts of crew resource management were relevant to clinical practice. It is a highly rated training programme and our results support its broader application in Hong Kong.