Tool In Clinical Training Research Articles

Online Simulation Education for Audiometry Training.

The purpose of this clinical focus article was to describe a new online simulation program for pure-tone audiometry. Fictional but realistic patient profiles and testing environments were created to teach students about hearing screening protocols and pure-tone audiology. The diversity of the demographics of the United States is represented throughout the program. The web app was created using HTML/JS/CSS with a Flask server backend and MySQL database. The program allows students to learn the process of conducting a hearing screening and measuring audiometric thresholds using a web-based virtual clinical audiometer. The virtual audiometer includes standard audiometer features and allows for instruction based on standard guidelines. The diversity of the patients within the simulation program allows for discussions of diversity to be woven throughout the curriculum. The new simulation program is designed for use as a clinical training tool enabling undergraduate and graduate students to actively participate in hearing screening testing and pure-tone audiometry using any web browser. The program is also designed with the intent to improve pedagogical outcomes at the undergraduate and graduate level for communication sciences and disorders education for pure-tone audiometry by providing instructors with content that focuses on the diversity that is represented in the demographics of the United States.

The Effect of an Ovariohysterectomy Model Practice on Surgical Times forFinal-Year Veterinary Students' First Live-Animal Ovariohysterectomies.

This study evaluated whether one supervised simulated ovariohysterectomy (OVH) using a locally developed canine OVH model, decreased surgical time for final-year veterinary students' first live-animal OVH. We also investigated student perceptions of the model as a teaching aid. Final-year veterinary students were exposed to an OVH model (Group M, n = 48) and compared to students without the exposure (Group C, n = 58). Both groups were instructed similarly on performing an OVH using a lecture, student notes, a video, and a demonstration OVH performed by a veterinary surgeon. Students in Group M then performed an OVH on the model before performing a live-animal OVH. Students in Group C had no exposure to the OVH model before performing a live-animal OVH. Surgical time data were analyzed using linear regression. Students in Group M completed a questionnaire on the OVH model after performing their first live-animal OVH. The OVH model exposure reduced students' first canine live-animal OVH surgery time (p = .009) for students without prior OVH experience. All students (n = 48) enjoyed performing the procedure on the mode; students practicing an OVH on the model felt more confident (92%) and less stressed (73%) when performing their first live-animal OVH. Results suggest that the canine OVH model may be helpful as a clinical training tool and we concluded that the OVH model was effective at decreasing students' first OVH surgical time.

Pimping as a Practice in Medical Education—Reply

EnglishPimping in medical education, as both a term and an activity, has long been a subject of controversy.1,2 Pimping often polarizes physicians and medical educators into 2 opposing camps; those who think that pimping is a time-honored tool in clinical training and those who think it is a harmful vestige of the past that should be retired to the medical education museum.2 Ms Crosby provides an outsider’s view of pimping, finding the practice both “startling and demeaning” and comparing it to “hazing.” She suggests that “students learn best when they have the emotional support of their teachers and peers.” We agree. Our Viewpoint was motivated not as a defense of pimping, but rather as a call to action to develop more evidence either for or against it. Specifically, although Crosby argues that pimping hinders students from reaching their full potential, the opposite may also be true. The pressurized environment cultivated by pimping may prepare medical students for the stress of making life and death decisions; therefore, the benefit of this educational modality may be unique to the medical profession.3 EnglishBoth Ms Crosby and Dr Ravi take issue with the use of the term pimping in medical education. Whereas Ravi objects on the basis of the linguistic association of the word with exploitive and violent sex practices, Crosby focuses on the damage inflicted when future physicians are routinely humiliated. Writing as a teacher who is outside the medical profession, Crosby reacts to McCarthy and McEvoy’s1 definition of pimping, which was drawn from the 1989 article by Brancati, “The Art of Pimping.”2 But when Brancati extolled unanswerable questions and “ridding the intern of needless self-esteem,” his tongue was planted firmly in his cheek. Brancati used irony to critique, not endorse, this practice. More recent descriptions of such behavior might use the expression “malignant” pimping, which has become indefensible if not yet extinct. Medical education must show compassion and promote well-being in students, and educators must continue to improve in this regard.

The Clinician Directed Hierarchy: A Clinical Training Tool

Abstract Clinical supervisors in university based clinical settings are challenged by numerous tasks to promote the development of self-analysis and problem-solving skills of the clinical student (American Speech-Language-Hearing Association, ASHA, 1985). The Clinician Directed Hierarchy is a clinical training tool that assists the clinical teaching process by directing the student clinician’s focus to a specific level of intervention. At each of five levels of intervention, the clinician develops an understanding of the client’s speech/language target behaviors and matches clinical support accordingly. Additionally, principles and activities of generalization are highlighted for each intervention level. Preliminary findings suggest this is a useful training tool for university clinical settings. An essential goal of effective clinical supervision is the provision of support and guidance in the student clinician’s development of independent clinical skills (Larson, 2007). The student clinician is challenged with identifying client behaviors in the therapeutic process and learning to match his or her instructions, models, prompts, reinforcement, and use of stimuli appropriately according to the client’s needs. In addition, the student clinician must be aware of techniques in the intervention process that will promote generalization of new communication behaviors. Throughout the intervention process, clinicians are charged with identifying appropriate target behaviors, quantifying the progress of the client’s acquisition of the targets, and making adjustments within and between sessions as necessary. Central to the development of clinical skills is the feedback provided by the clinical supervisor (Brasseur, 1989; Moss, 2007). Particularly in the early stages of clinical skills development, the supervisor is challenged with addressing numerous aspects of clinical performance and awareness, while ensuring the client’s welfare (Moss). To address the management of clinician and client behaviors while developing an understanding of the clinical intervention process, the University of the Pacific has developed and begun to implement the Clinician Directed Hierarchy.

Virtual Patient Training to Improve Reproductive Health Care for Women With Intellectual Disabilities

A multimedia virtual patient module, involving the case of a young woman with mild intellectual disabilities with a complaint of diffuse abdominal pain, was developed as a clinical training tool for students in health care professions. Primary objectives following use of the module included improved knowledge and reduced perception of difficulty in treating women's health patients with intellectual disabilities. The module was developed using an iterative, collaborative process of a core development team that included medical professionals, multimedia specialists, the parent of a child with intellectual disability, and a disability advocate. Over the course of the module, students were required to identify appropriate and effective clinician-patient interactions in addition to relevant medical and developmental concerns for this patient population. Pilot data from a sample of nursing, physician assistant, and medical students suggest that the module is an effective tool for both improving students' knowledge and reducing their perception of difficulty in providing care to women's health patients with intellectual disabilities.

Application of three-dimensional digitalized reconstruction of latissimus dorsi myocutaneous flap

Developments of digital technology and three-dimensional (3D) reconstruction allowed a precise description of anatomic structures. With the introduction of Visible Human Project and Virtual Chinese Human (VCH) techniques, more detailed anatomic images could be obtained. Digitized visible models of these structures can be applied as a useful tool in clinical training. The aim of this study was to reconstruct the normal structures of thoracodorsal artery in 3D images and to establish the digitized visible models of latissimus dorsi myocutaneous (LDM) flap. The cross-sectional images from the four VCH datasets were reviewed to study LDM and thoracodorsal artery structures on a section-by-section basis. Next, two adult fresh cadaver specimens were perfused with lead oxide-gelatine mixture and subject to radiographic CT scanning on their torsos. The cross-sectional images from the CT images were reviewed to study thoracodorsal artery structures. Three-dimensional computerized reconstructions of LDM flap structures were conducted from these datasets by using Amira 3.1 (TGS) software respectively. The 3D reconstructed visible models established from these datasets perfectly displayed the anatomic characteristics of LDM flap.

Three-dimensional reconstructive methods in the visualization of anterolateral thigh flap

Developments in the field of digitalized technique and three-dimensional (3D) reconstruction methods allowed a precise description of anatomy structures. With the development of computer reconstructive techniques, we could get more precise anatomic images. Digitized visible models of these structures can be as a useful tool in clinical training. The purpose of this study was to observe the anatomy of arteria circumflexa femoris lateralis (ACFL) flap and to discuss the methods in the visualization of anterolateral thigh (ATL) flap by digitalized technique. Six adults volunteer underwent contrast-enhanced CT angiography of pelvic and lower limbs utilizing a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist (3.5 ml/s). 2D images from these data in Dicom format were transformed into computer. Next two adult fresh cadaver specimens, one male and one female, were subject to radiographic CT scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0.5 mm (120 kV, 110 mA, 512 x 512 matrix). Through Amira 3.1 (TGS) software, the 2D images in Dicom format were transformed into the 3D models of the entire region. The structures of arteria circumflexa femoris lateralis (ACFL) were observed and the digitized visible models of ALT flap were established through 3D computerized reconstructions methods from these data using Amira 3.1 software. Then merging volume rendering with surface rendered reconstruction from lead oxide-gelatine mixture perfusion database. The 3D reconstructed visible models established from these datasets perfectly displayed the characteristic of ACFL and ALT flap anatomy. The digitized models could offer the anatomy of ALT flap perfectly, and the reconstructed methods may be used in other flap reconstruction with 3D demonstration.

Application of three‐dimensional digitalized reconstruction of an anterolateral thigh flap and an arterial dorsalis pedis flap

Developments in the field of digitalized technique and three-dimensional (3D) reconstruction methods allowed a precise description of anatomy structures. With the development of Visible Human Project (1989) and Virtual Chinese Human (VCH) techniques, we could get more precise anatomic images. Digitized visible models of these structures can be a useful tool in clinical training. Combining modern radiology and VCH techniques, we designed a method to establish digitized visible models of anterolateral thigh (ALT) flap and arteria dorsalis pedis (ADP) flap from adult fresh cadaver specimens perfused with lead oxide-gelatine mixture and VCH Male III dataset. The 3D reconstructed visible models established from these datasets perfectly displayed the anatomic structures of ALT flap and ADP flap. This is the first report on the ACFL and ADP structures which were reconstructed digitally.