Untrained Medical Students Research Articles

Teaching medical students the QT interval and its autonomous regulation in a practical ECG course in physiology

Background: The QT interval is a well established marker for ventricular repolarization. As the QT interval is inversely regulated with the heart rate, several correction formula are established to calculate corrected QT intervals (QT c ). In practical courses of physiology, medical students learn the correct measurement of the QT interval and its autonomous regulation. For this, students record and analyse ECGs under resting conditions and during/following a workout. However, little is known about teaching QT/QT c skills in students. In particular, it is not established whether untrained medical students can determine the length of the QT interval in rest and following an exercise with sufficient accuracy to allow discussion of its physiological regulation. Methods: A full cohort of 3rd year medical students (n=380) participated in a practical ECG course. In each course (20 students), ECGs of volunteers were recorded in small groups (2-4 students) under resting conditions and immediately following standardised physical exercise (squats and push-ups). Students calculated HR, QT intervals and QT c intervals using Bazett’s exponential correction. Automatically calculated QT intervals were retrieved from the ECG devices. Following the course, QT intervals of the same ECG passages were measured by experienced physiology teachers and expert clinical electrophysiologists. To compare effects of established QT c correction formulas, QT c was calculated for all retrieved intervals using Bazett, Framingham, Fridericia and Hodges. Data were analysed on the level of individual experiments and as pooled data of student groups. Results: In 117 experiments, students reported resting HRs of ~70 bpm and corresponding QT intervals of ~360 ms. Following exercise, students found an average increase of the HR by ~75% and a decrease of the QT interval by ~25%. Using pooled data sets of each course, the overall efficacy of the Bazett formula could well be demonstrated. Students HR data were highly concordant with the data generated by the automated ECG routines, the experienced physiologists and the clinical electrophysiologists. While average QT and QT c intervals were also comparable between the groups, the variance was substantially higher in students data than in the other groups, especially in the exercise ECGs. In the HR ranges generated in the course, QT correction by Fridericia and Framingham was more efficient than by Bazett and Hodges. Conclusions: Untrained students can determine QT intervals from ECGs recorded under resting conditions and following a workout with sufficient accuracy to demonstrate the autonomous regulation of this important (bio)marker on the level of individual data sets. Due to the high individual variance of the QT c , however, we recommend QT c correction based on data pooled within each student group to discuss the relevance of the QT correction formulas. The study was financed by institutional budget. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Knowledge retention regarding First Aid: A comparison between trained and untrained medical students in Peshawar.

Objective: To compare the impact of formal training in terms of knowledge retention regarding First Aid among medical students of selected medical colleges in Peshawar, Pakistan. Study Design: Cross-sectional study. Setting: Three Selected Public and Private Medical Colleges in Peshawar. Period: November 2018 to June 2019. Material & Methods: A total of 150 students out of whom 75 had received formal training of first aid program one year back and 75 were selected as a comparative group who had no training in this regards. Data were collected on an indigenous questionnaire which incorporates the knowledge about basic terminology and important step taken for dealing with the different medical emergencies as first aid providers. Data were analyzed in SPSS version 20. Chi-square test was used for comparing the frequency of correct answers and p-value <0.05 was significant. Results: Among 150 students 52(34.7%) were male and 98(65.3) female. A comparatively high proportion of 54 (72.0%) of trained medical students correctly marked the meaning of “First Aid” and “CPR” as compared to 38 (50.7%) of untrained students (p=0.042). however, there was no significant difference in terms of knowledge regarding important step taken for patients with cardiac arrest, bleeding, burn emergency, fracture, and frostbite (p>0.05). Conclusion: The regarding knowledge of first aid program were more or less similar among trained and untrained medical students. However, comparatively higher proportions of trained medical students were able to correctly define the term first aid and CPR.

Machine Learning Creates a Simple Endoscopic Classification System that Improves Dysplasia Detection in Barrett's Oesophagus amongst Non-expert Endoscopists.

Introduction Barrett's oesophagus (BE) is a precursor to oesophageal adenocarcinoma (OAC). Endoscopic surveillance is performed to detect dysplasia arising in BE as it is likely to be amenable to curative treatment. At present, there are no guidelines on who should perform surveillance endoscopy in BE. Machine learning (ML) is a branch of artificial intelligence (AI) that generates simple rules, known as decision trees (DTs). We hypothesised that a DT generated from recognised expert endoscopists could be used to improve dysplasia detection in non-expert endoscopists. To our knowledge, ML has never been applied in this manner. Methods Video recordings were collected from patients with non-dysplastic (ND-BE) and dysplastic Barrett's oesophagus (D-BE) undergoing high-definition endoscopy with i-Scan enhancement (PENTAX®). A strict protocol was used to record areas of interest after which a corresponding biopsy was taken to confirm the histological diagnosis. In a blinded manner, videos were shown to 3 experts who were asked to interpret them based on their mucosal and microvasculature patterns and presence of nodularity and ulceration as well as overall suspected diagnosis. Data generated were entered into the WEKA package to construct a DT for dysplasia prediction. Non-expert endoscopists (gastroenterology specialist registrars in training with variable experience and undergraduate medical students with no experience) were asked to score these same videos both before and after web-based training using the DT constructed from the expert opinion. Accuracy, sensitivity, and specificity values were calculated before and after training where p < 0.05 was statistically significant. Results Videos from 40 patients were collected including 12 both before and after acetic acid (ACA) application. Experts' average accuracy for dysplasia prediction was 88%. When experts' answers were entered into a DT, the resultant decision model had a 92% accuracy with a mean sensitivity and specificity of 97% and 88%, respectively. Addition of ACA did not improve dysplasia detection. Untrained medical students tended to have a high sensitivity but poor specificity as they “overcalled” normal areas. Gastroenterology trainees did the opposite with overall low sensitivity but high specificity. Detection improved significantly and accuracy rose in both groups after formal web-based training although it did it reach the accuracy generated by experts. For trainees, sensitivity rose significantly from 71% to 83% with minimal loss of specificity. Specificity rose sharply in students from 31% to 49% with no loss of sensitivity. Conclusion ML is able to define rules learnt from expert opinion. These generate a simple algorithm to accurately predict dysplasia. Once taught to non-experts, the algorithm significantly improves their rate of dysplasia detection. This opens the door to standardised training and assessment of competence for those who perform endoscopy in BE. It may shorten the learning curve and might also be used to compare competence of trainees with recognised experts as part of their accreditation process.

Preliminary evaluation of the efficacy of an intervention incorporating precision teaching to train procedural skills among final cycle medical students

IntroductionA lack of preparedness for practice has been observed among new medical graduates. Simulation technology may offer one means of producing competency. This paper describes the application of a simulation-based...

Sensorimotor Learning of Acupuncture Needle Manipulation Using Visual Feedback.

ObjectiveHumans can acquire a wide variety of motor skills using sensory feedback pertaining to discrepancies between intended and actual movements. Acupuncture needle manipulation involves sophisticated hand movements and represents a fundamental skill for acupuncturists. We investigated whether untrained students could improve their motor performance during acupuncture needle manipulation using visual feedback (VF).MethodsTwenty-one untrained medical students were included, randomly divided into concurrent (n = 10) and post-trial (n = 11) VF groups. Both groups were trained in simple lift/thrusting techniques during session 1, and in complicated lift/thrusting techniques in session 2 (eight training trials per session). We compared the motion patterns and error magnitudes of pre- and post-training tests.ResultsDuring motion pattern analysis, both the concurrent and post-trial VF groups exhibited greater improvements in motion patterns during the complicated lifting/thrusting session. In the magnitude error analysis, both groups also exhibited reduced error magnitudes during the simple lifting/thrusting session. For the training period, the concurrent VF group exhibited reduced error magnitudes across all training trials, whereas the post-trial VF group was characterized by greater error magnitudes during initial trials, which gradually reduced during later trials.ConclusionsOur findings suggest that novices can improve the sophisticated hand movements required for acupuncture needle manipulation using sensorimotor learning with VF. Use of two types of VF can be beneficial for untrained students in terms of learning how to manipulate acupuncture needles, using either automatic or cognitive processes.

Three-dimensional motion tracking correlates with skill level in upper gastrointestinal endoscopy.

Feedback is an essential part of training in upper gastrointestinal endoscopy. Virtual reality simulators provide limited feedback, focusing only on visual recognition with no feedback on the procedural part of training. Motion tracking identifies patterns of movement, and this study aimed to explore the correlation between skill level and operator movement using an objective automated tool. In this medical education study, 37 operators (12 senior doctors who performed endoscopic retrograde cholangiopancreatography, 13 doctors with varying levels of experience, and 12 untrained medical students) were tested using a virtual reality simulator. A motion sensor was used to collect data regarding the distance between the hands, and height and movement of the scope hand. Test characteristics between groups were explored using Kruskal-Wallis H and Man-Whitney U exact tests. All motion-tracking metrics showed discriminative ability primarily between experts and novices in specific sequences. Motion tracking can discriminate between operators with different experience levels in upper gastrointestinal endoscopy. Motion tracking can be used to provide feedback regarding posture and movement during endoscopy training.

2073972 Ultrasound Integration into Medical School Curriculum: A Comparison Between Trained and Untrained Medical Students

2073972 Ultrasound Integration into Medical School Curriculum: A Comparison Between Trained and Untrained Medical Students

Assessment of medical student laparoscopic camera skills and the impact of formal camera training

Background In laparoscopic surgery, the role of camera holder often falls to untrained medical students. Laparoscopic-naive students can easily acquire laparoscopic camera navigation (LCN) skills, yet it is unclear whether this translates into improved LCN performance in the operating room and whether students retain these skills over time. The purpose of this study was to evaluate whether preclinical laparoscopic camera simulator training would result in improved LCN skills, efficiency, and comfort level over the course of a 6-week surgery clerkship. Methods A randomized, controlled study was designed to compare students' preclerkship and postclerkship LCN skills on a previously validated box trainer model. The students (n = 70) were randomized via a computer-generated table of random numbers into study and control groups. The study group (n = 36) received a brief laparoscope training session before the clerkship, while the control group (n = 36) did not. All students also completed a preclerkship and postclerkship questionnaire detailing their experience and comfort level. Results Statistical analysis using Wilcoxon's signed-rank test demonstrated that all students improved in skill level (total score, 4 vs 7; P < .0001), efficiency (time, 76 vs 33 seconds; P < .0001), and comfort level (Likert scale score, 2 vs 4; P < .0001), with no statistically significant difference between the control and study groups. Conclusions This study demonstrates that novice medical students are able to gain laparoscopic camera skills from “hands-on” experience, with no added benefit or retention of skills learned in a preclinical camera simulator training session.

Interpretation of evidence in data by untrained medical students: a scenario-based study.

BackgroundTo determine which approach to assessment of evidence in data - statistical tests or likelihood ratios - comes closest to the interpretation of evidence by untrained medical students.MethodsEmpirical study of medical students (N = 842), untrained in statistical inference or in the interpretation of diagnostic tests. They were asked to interpret a hypothetical diagnostic test, presented in four versions that differed in the distributions of test scores in diseased and non-diseased populations. Each student received only one version. The intuitive application of the statistical test approach would lead to rejecting the null hypothesis of no disease in version A, and to accepting the null in version B. Application of the likelihood ratio approach led to opposite conclusions - against the disease in A, and in favour of disease in B. Version C tested the importance of the p-value (A: 0.04 versus C: 0.08) and version D the importance of the likelihood ratio (C: 1/4 versus D: 1/8).ResultsIn version A, 7.5% concluded that the result was in favour of disease (compatible with p value), 43.6% ruled against the disease (compatible with likelihood ratio), and 48.9% were undecided. In version B, 69.0% were in favour of disease (compatible with likelihood ratio), 4.5% against (compatible with p value), and 26.5% undecided. Increasing the p value from 0.04 to 0.08 did not change the results. The change in the likelihood ratio from 1/4 to 1/8 increased the proportion of non-committed responses.ConclusionsMost untrained medical students appear to interpret evidence from data in a manner that is compatible with the use of likelihood ratios.

The power-duration product--evaluation of a new reference system for cardiopulmonary exercise testing.

The aim of this study was to assess the discriminatory power of the new reference system, power-duration product (PDP), for the analysis of haemodynamic and metabolic variables derived from cardiopulmonary exercise tests. The PDP was calculated as the cumulative index of the product of power (W) times the duration (minutes) of each individual exercise step. The study comprised 30 healthy male volunteers, who were classified into three groups with respect to their regular physical activity: 10 untrained medical students (students), 10 sprinters and long-jumpers (athletes) and 10 endurance athletes performing triathlon (triathletes). Twenty metabolic and haemodynamic variables were recorded throughout exhaustion-limited cycling ergometry. The data were analysed with respect to five reference systems (heart rate, relative and absolute oxygen consumption/body surface area, power, and PDP). A total of 14 differences between modified time courses of haemodynamic and metabolic variables in the three groups of volunteers were observed by reference to PDP, 12 by reference to relative oxygen consumption/body surface area, 11 by reference to heart rate, 8 by reference to absolute oxygen consumption/body surface area, and 7 by reference to power. When using PDP as the reference, the time courses of 8 parameters differed significantly between students and triathletes, 5 between students and athletes, and 1 between athletes and triathletes. In addition to its discriminatory superiority for the comparison of different groups characterized by different cardiopulmonary training and endurance, it was found that PDP permitted a better characterization of the individually performed exercise than the consideration of power per se.