Use Of Human Patient Simulation Research Articles

Human Patient Simulation: Occupational Therapy Student Perceptions

Human patient simulation uses technology to add advancements to learning that traditional learning methods cannot. Many programs are fast-paced and do not provide students with many hands-on experiences before clinical experiences. The literature notes the benefits of human patient simulation in other healthcare programs, yet limited studies exist in occupational therapy. This study examined student perspectives on the use of human patient simulators in occupational therapy curriculum. 146 first year master of occupational therapy students completed an open-ended survey after an evaluation experience with a physiologically based human patient simulator. Responses were collected during four consecutive years. Transcripts were analyzed using qualitative content analysis. Four themes emerged and centered on the value of hands-on learning, team and family dynamics, the human experience, and relevance of clinically applicable skills. Findings indicate that students perceive this type of learning as beneficial before taking the next step towards fieldwork, and programs should consider offering a variety of simulated patient cases throughout the curriculum.

Mechanical Ventilation Boot Camp Curriculum.

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased morbidity and mortality. A three-day simulation-based boot camp serves to provide one-on-one instruction with a critical care provider. These intensivists may dispense personalized immediate feedback as learners engage in hands-on practice with a real mechanical ventilator. Multiple different pathologies can be reviewed that may not be encountered in the clinical setting. Learners can visualize immediate consequences of their actions and may troubleshoot and ask questions, all while in a safe learning environment. We describe the use of human-patient simulators connected to breathing simulators and mechanical ventilators. Potential curriculum executors should be aware of the cost of the equipment and the time needed to dedicate to boot camp execution; however, this intensive interactive training has been shown to increase provider competency, knowledge, and confidence in ventilator management. This curriculum outline provides guidance on how to execute a simulation-based boot camp to train providers on the management of mechanically ventilated patients.

Transforming the Nursing Classroom into a Clinical Setting.

Providing clinical opportunities for students to gain experience in managing cardiac dysrhythmias is a challenge for nursing faculty. High-risk experiences are often not available for all students or are too life-threatening to entrust to students. Faculty shortages and increasing enrollments add to declines in clinical opportunities. The use of human patient simulation (HPS) has added opportunities to experience high-risk, low-frequency clinical situations. HPS may be employed in the classroom setting to teach content related to dysrhythmia treatments. This innovative approach to HPS utilization engages students and helps them apply theory into clinical nursing practice.

Cross-Cultural Validation and Psychometric Testing of the Questionnaire: Debriefing Experience Scale

BackgroundIn the use of human patient simulation, there is a need for standardized and validated instruments across both national boundaries and cultural conditions. The aim of the present study was to translate and validate the Debriefing Experience Scale in a Norwegian context. MethodThe study was conducted as a survey of 146 bachelor's nursing undergraduates. An expert group, conventional content analysis, the known-group technique, and psychometric testing were all used. ResultsThe scale seemed to hold good potential for evaluating debriefing but would also benefit from reducing the subscales. ConclusionsBecause of testing for validity being an ongoing process, there is a need for more studies to draw conclusions about the properties of questionnaire.

Use of Human Patient Simulation and Validation of the Team Situation Awareness Global Assessment Technique (TSAGAT): A Multidisciplinary Team Assessment Tool in Trauma Education

Situation awareness (SA) is a vital construct for decision making in intense, dynamic environments such as trauma resuscitation. Human patient simulation (HPS) allows for a safe environment where individuals can develop these skills. Trauma resuscitation is performed by multidisciplinary teams that are traditionally difficult to globally assess. Our objective was to create and validate a novel tool to measure SA in multidisciplinary trauma teams using a HPS--the Team Situation Awareness Global Assessment Technique (TSAGAT). Memorial University Simulation Centre. Using HPS, 4 trauma teams completed 2 separate trauma scenarios. Student, junior resident, senior resident, and attending staff teams each had 3 members (trauma team leader, nurse, and airway manager). Individual SAGATs were developed by experts in each respective field and contained shared and complimentary knowledge questions. Teams were assessed with SAGAT in real time and with traditional checklists using video review. TSAGAT was calculated as the sum of individual SAGAT scores and was compared with the traditional checklist scores. Shared, complimentary, and TSAGAT scores improved with increasing team experience. Differences between teams for TSAGAT and complimentary knowledge were statistically significant (p < 0.05). Mean checklist differences between teams also reached statistical significance (p < 0.05). TSAGAT scores correlated strongly with traditional checklist scores (Pearson correlation r = 0.996). Interrater reliability for the checklist tool was high (Pearson correlation r = 0.937). TSAGAT is the first valid and reliable assessment tool incorporating SA and HPS for multidisciplinary team performance in trauma resuscitation. TSAGAT could compliment or improve on current assessment methods and curricula in trauma and critical care and provides a template for team assessment in other areas of surgical education.

Pilot Study in the Use of Human Patient Simulator (HPS) as a Novel Approach to COPD Self-Management

Pilot Study in the Use of Human Patient Simulator (HPS) as a Novel Approach to COPD Self-Management

The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

Providing high-quality clinical experiences for students has been a perennial challenge for nursing programs. Short patient length of stays, high patient acuity, disparities in learning experiences, and the amount of time instructors spend supervising skills have long been issues. More recently, other challenges have emerged: more programs competing for limited clinical sites, faculty shortages, facilities not granting students access to electronic medical records, and patient safety initiatives that decrease the number of students allowed on a patient unit or restrict their activity to observing care. With high-fidelity simulation, educators can replicate many patient situations, and students can develop and practice their nursing skills (cognitive, motor, and critical thinking) in an environment that does not endanger patients. As the sophistication of simulation has grown over the last 10 years, the number of schools using it has increased as well, and boards of nursing (BONs) have received requests from programs for permission to use simulation to replace some traditional clinical experience hours. However, the existing literature does not provide the level of evidence that BONs need to make a decision on simulation as a replacement strategy. Though studies indicate that simulation is an effective teaching pedagogy, they lack the rigor and generalizability to provide the evidence needed to make policy decisions. The NCSBN National Simulation Study, a large-scale, randomized, controlled study encompassing the entire nursing curriculum, was conducted to provide the needed evidence. Incoming nursing students from 10 prelicensure programs across the United States were randomized into one of three study groups: ●Control: Students who had traditional clinical experiences (no more than 10% of clinical hours could be spent in simulation) ●25% group: Students who had 25% of their traditional clinical hours replaced by simulation ●50% group: Students who had 50% of their traditional clinical hours replaced by simulation. The study began in the Fall 2011 semester with the first clinical nursing course and continued throughout the core clinical courses through graduation in May 2013. Students were assessed on clinical competency and nursing knowledge, and they rated how well their learning needs were met in both the clinical and simulation environments. A total of 666 students completed the study requirements at the time of graduation. At the end of the nursing program, there were no statistically significant differences in clinical competency as assessed by clinical preceptors and instructors (p=0.688); there were no statistically significant differences in comprehensive nursing knowledge assessments (p=0.478); and there were no statistically significant differences in CLEX® pass rates (p=0 737) among the three study groups The study cohort was also followed for the first 6 months of clinical practice There were no differences in manager ratings of overall clinical competency and readiness for practice at any of the follow-up survey time points: 6 weeks (p=0 706), 3 months (p=0.511), and 6 months (p=0.527) of practice as a new registered nurse. The results of this study provide substantial evidence that substituting high-quality simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice.

The Comprehensive Textbook of Healthcare Simulation

The use of human patient simulation for teaching aspects of anesthesiology has grown significantly over the last decade and a half. Anesthesia has been in the forefront of developing this technology and its use in medical education. Simulation has gone from a novelty to being recognized as an important modality for delivering curricula. All Canadian anesthesia residency programs, in varying degrees, incorporate simulation in their postgraduate medical education. The future use of simulation will become even more important. As residents’ duty hours become more limited, there will be heavier reliance on simulation to provide experience with rare life-threatening situations such as malignant hyperthermia or local anesthetic toxicity. The Royal College of Physicians and Surgeons of Canada is moving towards competency-based medical education (CanMEDs 2015 and other initiatives). Integrating simulation in this process is essential for successful transition into a competency-based educational model. As the field of medical simulation has grown, so have the literature, technologies, and accompanying educational theories associated with it. Healthcare simulation is now at a point where a comprehensive textbook is needed. Dr. Levine and his associates identified the absence of a definitive resource and attempted to fill that void. As stated in the text’s introduction, ‘‘Many educators, researchers, and administrators are seeking a definitive up-to-date resource that addresses solutions to their needs in terms of training, assessment, and patient safety. Hence, we present this book The Comprehensive Textbook Of Healthcare Simulation’’. This textbook is very useful for those involved in healthcare simulation. It is an inclusive, current manual. The contributing authors list reads like a ‘‘who’s who’’ of healthcare simulation. It includes many pioneers in the field as well as numerous authors from Canadian universities who have provided chapters in their fields of expertise. There is also a global perspective, with contributors from the United States, Europe, and the Middle East. The textbook is well organized into five sections; Introduction, Simulation Modalities and Technologies, Simulation for Healthcare Disciplines, Professional Development in Simulation, and Program Development in Simulation. The Introduction covers the basics of simulation, including learning theory, simulation environments, and debriefing. It also tackles more complex subject matter such as crisis resource management and patient safety in simulation. I was surprised to see the chapters ‘‘Competency Assessment’’ and ‘‘Simulation for Licensure and Certification’’ in the Introduction. Both of these topics are timely and worthy of discussion within the simulation community. Competencybased medical education is looming on the horizon as CanMEDs 2015 is being developed. Simulation has already been introduced in high-stakes examinations, such as the Royal College examination process for anesthesiology, albeit not yet in a comprehensive fashion. The second section – Simulation Modalities and Technologies – serves as an excellent resource as it provides a detailed view of more than just high-fidelity simulation. There is comprehensive information on standardized patients as well as computerand web-based simulation. It also explores emerging technologies such as virtual reality and haptic simulation (tactile sensation in virtual reality). N. O’Regan, MD (&) Memorial University of Newfoundland, St. John’s, NL, Canada e-mail: noel.oregan@med.mun.ca

Costs of ignorance studies in medical education

British Journal of Hospital MedicineVol. 75, No. 2 RegularsCosts of ignorance studies in medical educationKieran WalshKieran WalshSearch for more papers by this authorKieran WalshPublished Online:20 Feb 2014https://doi.org/10.12968/hmed.2014.75.2.117AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Buchan J, Campbell J (2013) Challenges posed by the global crisis in the health workforce. BMJ 347: 6201 Crossref, Google ScholarByford S, Torgerson DJ, Raftery J (2000) Cost of illness studies. BMJ 320: 1335 Crossref, Medline, Google ScholarCarruthers I, Philip P (2006) Safety First – A report for patients, clinicians and health-care managers. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_064159.pdf (accessed 6 January 2014) Google ScholarCrea KA (2011) Practice skill development through the use of human patient simulation. Am J Pharm Educ 75(9): 188 Crossref, Medline, Google ScholarDepartment of Health (2000) An Organisation with a Memory. The Stationery Office, London Google ScholarGordon M, Bose-Haider B (2012) A novel system of prescribing feedback to reduce errors: A pilot study. Int J Risk Saf Med 24(4): 207–14 Medline, Google ScholarHernandez MB, McDonald CL, Gofman Y et al. (2010) Physician Familiarity with the Most Common Misdiagnoses: Implications for Clinical Practice and Continuing Medical Education. The Internet Journal of Medical Education 1(2) (http://ispub.com/IJME/1/2/6945 accessed 6 January 2014) Google ScholarNational Research Council (2007) Preventing Medication Errors: Quality Chasm Series. The National Academies Press, Washington, DC Google ScholarVan Den Bos J, Rustagi K, Gray T, Halford M, Ziemkiewicz E, Shreve J (2011) The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors. Health Aff 30(4): 596–603 Crossref, Google ScholarWalsh K (2010) Cost effectiveness in medical education. Radcliffe, Oxon Google ScholarWalsh K (2013) Cost and value in medical education. In: Walsh K, ed. The Oxford Textbook of Medical Education. Oxford University Press, Oxford: 601–12 Crossref, Google ScholarWeingart SN, Wilson RM, Gibberd RW, Harrison B (2000) Epidemiology of medical error. BMJ 320(7237): 774–7 Crossref, Medline, Google ScholarWu AW, Folkman S, McPhee SJ, Lo B (1991) Do house officers learn from their mistakes? JAMA 265(16): 2089–94 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 February 2014Volume 75Issue 2ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 20 February 2014 Published in print 2 February 2014 Information© MA Healthcare LimitedPDF download

The use of human patient simulation to improve academic test scores in nursing students

Many technologies that were not yet invented when today's educators went to nursing school are now staples in nursing colleges and schools worldwide. Although there are numerous studies that examine the relationship between simulation and student success, most focus on the affective and psychomotor domains of learning. This article focuses on the cognitive domain of learning and discusses the correlation between the use of high-fidelity human patient simulation and improved academic test scores.

Pharmacy Student Response to Patient Simulation Based Learning

This study was to investigate the effectiveness, satisfaction and acceptance of pharmacy students towards the use of human patient simulator (HPS) in learning acute patient care. A workshop was conducted using HPS to teach pharmacy students on acute patient care. At the end of the workshop, participants were asked to complete a satisfaction survey consisted of 13 statements. HPS-based training received favourable feedback to be incorporated into the pharmacy curriculum. Using HPS in pharmacy curriculum may be a significant contributing factor to produce competent pharmacists.

Using High-fidelity Simulation to Prepare Advanced Practice Nursing Students

BackgroundLimited evidence is available explaining the use of human-patient simulators (HPS) in primary adult advanced practice nursing (APN) programs to enhance clinical performance. The paucity of literature related to using HPS in primary adult APN programs is what led the authors to develop simulations using HPS for such students. MethodsSimulations were used to increase student confidence and knowledge before their Objective Structured Clinical Examination to optimize this costly and important experience. The purpose of this paper was to describe the development of a simulation using a HPS and student perception of using this learning strategy. ResultsStudents reported decreased anxiety after the simulation experience and a better understanding of what to expect during the OSCE experience. ConclusionUsing a HPS in an interactive simulation is a valuable tool that assesses student knowledge, skills, and allows for student reflection. The authors will continue to use this pedagogy, and encourage others to develop such activities in order to prepare future competent APNs.

Use of Simulation to Develop a Medication Administration Safety Assessment Tool

BackgroundThis pilot study describes the use of human patient simulation (HPS) to develop a performance-based competency measure of medication administration safety. MethodThe instrument was developed using a content-validity approach and pilot tested through independent raters (n = 4) evaluating student nurse research participant (n = 14) performance in the HPS. Rating accuracy was evaluated using three HPS-based standard performances. ResultsUsing four raters, interrater reliability was 0.83 to 0.90, Cronbach's alpha was 0.90, and the rating accuracy averaged 95%. ConclusionsHPS provides unique features to facilitate development of performance-based clinical measures. These include an ability to test the measure on both high-consequence behaviors (such as medication errors) and “standard” performances with predetermined errors.

Learning From Mistakes in a Simulated Nursing Leadership Laboratory

Human patient simulation in nursing education has become an accepted and expected form of pedagogy. Research on the use of human patient simulation to evaluate student performance, however, is still at an early stage. The vast majority of these sources report the unit of analysis as the nurse-patient dyad (one nurse-one patient) situated in an infrequently occurring, high-risk, or costly event such as a code blue, and the literature reveals little evidence on the efficacy of the use of simulation for the care of multiple patients. The teaching innovation, discussed herein, involving a simulation, used a leadership scenario of a routine day in an acute-care hospital unit. The aim of the project was to provide a high-fidelity simulation of the competing demands on a nurse's time and attention while caring for multiple patients. Working as a team, using principles of prioritization, delegation, scope of practice, and communication, senior baccalaureate nursing students assumed the various roles of interdisciplinary team members as they moved through staged sequences of changing patient and unit conditions. This was followed by debriefing session that prompted the students to identify their errors in judgment, including sending the wrong patient to the operating room, failing to rescue a patient, and failing to delegate critical tasks to other nursing team members.

Use of high fidelity human patient simulation (HPS) in second year medical pharmacology instruction

This study examined the use of HPS (Laerdal SimMan 3G) in a pharmacology general principles course and its impact on student learning, critical thinking and problem‐solving. Eight simulation cases were developed: six involving the autonomic nervous system and two with pain management. Students were assigned to one of 36 teams consisting of 5–6 members. Each team encountered only one case scenario. Teams were required to take a patient history, perform a physical exam, request laboratory tests, make a diagnosis, administer appropriate pharmacotherapy and monitor treatment outcome. Two different scenarios were performed concurrently and the two teams were then combined for a student led debriefing session that was faculty facilitated. Student survey comments were extremely positive. Results from 195 students included HPS complemented the course objectives (5.0 out of 5.0), promoted higher level, critical thinking (4.9/5.0), was a more effective learning experience than lectures alone (4.9/5.0) and improved student ability to function as a health professional team (4.7/5.0). We conclude that HPS provides an effective learning experience that encourages active learning and problem‐solving skills as a member of a health professional team.

The Use of Human Patient Simulators to Enhance Clinical Decision-making of Nursing Students

One of the newest teaching modalities in health education is the use of human patient simulators (HPS). A simulation scenario creates a software program vignette in which nursing, medical, and other students interact with a manikin to practice caring for patients in a risk-free environment. Although used extensively in schools of nursing, there is little research that examines if these expensive simulators improve the clinical decision-making ability of nursing students. The purpose of this quasi-experimental differentiated treatment study was to assess if HPS technology leads to greater clinical decision-making ability and clinical performance compared to the teaching modality of a paper and pencil case study. Students (n = 133) learning about the care of a patient with a myocardial infarction at four licensed practical nursing programs (LPN) in Pennysylvania, USA were randomly assigned to one of two groups at each site: an HPS simulation group or a paper and pencil case study group. One-tailed, independent t-tests were used to compare learning gains measured by differences in pre- and postclinical decision-making exam scores and clinical performance. Results indicated that students in the simulation groups were significantly more likely to score higher on the clinical decision-making exams and to respond clinically by performing CPR more quickly on the manikin than students in the case study groups. On the 100-point exam, the simulation groups had a 20-point gain, while the case study groups had a 12-point gain (P < 0.001). Students in the simulation groups provided CPR to a manikin 30 seconds faster, on an average (P < 0.001). Results validate the use of HPS technology in nursing education. Ultimately patients may benefit from increased knowledge and speed of care from practical nurses whose training was improved through the use of HPS technology.

The Current Use of Human Patient Simulators in Nursing Schools in Korea

Purpose: This study was conducted to explore the current usage of high integration mannequin human patient simulators (hereafter HPS) in nursing education. Methods: Thirty-two faculty members in 11 nursing schools participated in this survey. the questionnaire consisted of some multiple-choice questions and open questions to collect data on the experience of faculty members with using HPS as well as quantitative information. Results: The faculty members who used HPS in their classes recognized the need to use simulation in nursing education. They identified the advantages of simulation education as promoting adaptation to the clinical environment(46.9%), promoting self-confidence(28.1%), promoting critical thinking(28.15), and making direct nursing skill practice available(28.1%). However, they considered the obstacles to the use of simulation in nursing education to be insufficient manpower(62.5%), insufficient time(40.6%), and difficulty in preparing a teaching strategy(34.4%). Conclusion: HPS is useful in nursing education, but systematic plans and policies regarding on its operation are needed to confirm its effectiveness. The results of this study generally provide a basic information for use of HPS in nursing education.

Improving Clinical Outcomes, with the Use of Simulation Manikins

Simulations Manikins or Human Patient Simulators refer to the use of computer simulations in human form, to support students and healthcare providers in improving clinical decision-making and critical thinking. A major problem faced at our university in Hawaii continues to be the lack of or reduced actual clinical experience for our nursing students. One alternative to address this is the use of Human Patient Simulators and simulation laboratories to better prepare students for their chosen profession. I hypothesized that a competent student nurse can gain a thorough understanding of the basic skills needed in today's complex healthcare arena, by the use of simulation. My research examined the best practices for using simulation to train student nurses by designing a curriculum to address the problem, evaluating curricular interventions, and assessing tools designed to implement and maintain the changes in the clinical environment.

Supporting the lecturer to deliver high-fidelity simulation

In response to a shortage of clinical practice placements for pre-registration nurses and midwives, nursing faculties have been examining alternative ways to support students to develop their clinical skills, with simulation being one of the more popular methods. In a nursing context, simulation is often used to replicate a clinical setting, such as a hospital ward or the patient's home. Some universities have introduced clinical suites that enable replication of clinical environments and offer the use of human patient simulators to mimic patient-focused scenarios. This article describes a small informal review that aimed to identify how lecturers felt about simulation in one faculty using high-fidelity simulated scenarios to inform the development of a subsequent research study. The results indicate that although many staff use simulation and believe it is a beneficial approach to learning, many also lack confidence and do not feel sufficiently prepared in its use. Most participants felt that the development of a simulation module for lecturers would increase their confidence.

Human Patient Simulation for Teaching Medical Emergencies in the Dental Office

OPEN ACCESSFebruary 17, 2011Human Patient Simulation for Teaching Medical Emergencies in the Dental Office Lisa Bilich, RDH, MS, Brenda Bray, BPharm, MPH Lisa Bilich, RDH, MS Eastern Washington University Google Scholar More articles by this author , Brenda Bray, BPharm, MPH Washington State University College of Pharmacy Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8259 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractSimulation in dentistry has been used to guide students through clinical experiences they may encounter in the dental field. Human patient simulation (HPS) utilizes a high-fidelity manikin in a realistic healthcare environment to portray a scenario involving a patient with a specific disease state and/or other medical, social, or behavioral conditions. HPS can benefit dental/dental hygiene curricula through improving communication, making a scenario lifelike and applicable to practice, and allowing students to practice critical thinking and experience low-occurrence, high-risk medical emergencies that may occur in the dental office. HPS can be more effective than case-based study because the situation can be modified to a particular clinic/office. Benefits to the students are that HPS addresses many different learning styles, engages students in active learning, includes prompt feedback through debriefing, and provides interaction and cooperation among students and faculty. The manikin has the ability to speak, answer questions, and respond appropriately to students' handling of the emergency, which addresses visual, auditory, verbal, and kinesthetic learning styles. Active learning is key to HPS due to the fact that students are able to apply what they have learned in a didactic setting and are encouraged to think reflectively during the debriefing portion of the scenario. We have prepared this resource to assist educators in the process of incorporating HPS into their dental/dental hygiene curricula. The included faculty guide focuses on the use of HPS in assessing students' ability to manage a medical emergency. We conduct medical emergency scenarios as part of the curriculum in our dental hygiene program. The purpose of this presentation is to provide information for other faculty based on our experiences. Results include positive feedback from two cohorts of dental hygiene students who have completed the “medical emergencies in the dental office” simulation as a required part of their curriculum. Students reported improved confidence and knowledge of medical emergencies. Educational Objectives By the end of this presentation, learners will be able to: Describe the benefits of utilizing human patient simulation (HPS) scenarios for medical emergencies encountered in the dental office.Explain how to integrate HPS into dental and/or allied dental curricula.Utilize templates provided to design appropriate dental HPS scenarios, including debriefing/grading keys. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Faculty Guide.docx MedEdPORTAL DH.pptx MedEdPORTAL template for scenario- example.docx Debriefing clip.mp4 Dental blur.mp4 To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2011 Bilich and Bray. This is an open-access publication distributed under the terms of the Creative Commons Attribution-Share Alike license.KeywordsIntro to Clinical DentistryCritical ThinkingGraduate Medical Education Disclosures None to report. Funding/Support None to report. Loading ...