Online spaced education to teach urology to medical students: a multi-institutional randomized trial

Background

We investigated whether online spaced education could prospectively improve students' acquisition and retention of knowledge.

Methods

One hundred fifteen third-year medical students at 2 schools were randomized to receive weekly/biweekly spaced education e-mails on 2 of 4 urology topics: prostate cancer (PC) and prostate-specific antigen (PSA) screening, or benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). E-mails began in month 1 of their third year. During their 3-month surgery clerkships, students completed a 28-item validated pre-test on all 4 topics, 8 web-based teaching cases, and a 28-item post-test. This test was administered again a mean of 280 days later to assess long-term retention.

Results

Under an intention-to-treat analysis, students who received the spaced education e-mails demonstrated significant, topic-specific increases in pre-test scores (P < .001 and P = .03 for PC/PSA and BPH/ED, respectively). Spaced education improved long-term retention of PC/PSA (P = .04) but not of BPH/ED (P = .60).

Conclusions

Spaced education delivered prospectively can generate significant, topic-specific learning.     

An early introduction to surgical skills: Validating a low-cost laparoscopic skill training program purpose built for undergraduate medical education

BackgroundMedical student exposure to laparoscopy is limited to observation despite the prevalence of minimally invasive techniques in practice. The high cost of laparoscopic simulation equipment, commonly called “box trainers”, limits undergraduate exposure to skill training.MethodsStudents at a Midwestern medical school were recruited to participate in an experimental laparoscopic skill training program. One cohort (n = 17) used a DIY box trainer design freely available on MedEdPORTAL. A second cohort (n = 17) used a commercially available equivalent. Pre- and post-training attempts for four tasks were scored and the difference was calculated. The average differences for each cohort were then contrasted statistically.ResultsSignificant performance improvements (pre- and post-training) were demonstrated regardless of group allocation. The difference in performance between the cohorts was not significant for any task (p > 0.05).ConclusionsThis low-cost training program using DIY box trainers is as effective as commercially available equivalent box trainers for introducing laparoscopic skills to medical students.     

Predictors of research self efficacy in first-year osteopathic medical students

BackgroundThere has been a decline in the number of physician-scientists which has promoted interest in developing research initiatives for students in medical school. While it is unclear what might promote student success in research endeavors, it has been postulated that research self-efficacy (RSE) may be contribute to student engagement in research. It is thus important to consider what factors contribute to student engagement in research in the early years of medical training.ObjectiveThe purpose of this study was to assess first-year osteopathic medical students’ (OMS) attitudes towards research and identify factors contributing to RSE.MethodsData were collected from 357 first-year OMS via an online questionnaire on attitudes of and opinions towards research. Multiple regression modeling was used to determine if certain attitudinal factors would be associated with RSE. Hypothesis testing was conducted using Pearson correlation coefficients (r) and multiple regression analysis.ResultsRegression modeling successfully explained 33% of the variance in predicting RSE: F(4,350) = 44.475, p < 0.001 with an R² of 0.337 (adj. R² = 0.329). Greater security in understanding research, greater belief in ability to conduct research, feeling research was important in their future career, and wanting more research education and opportunities while in medical school contributed to greater RSE.ConclusionsEvidence-based medicine and the importance of research continue to influence osteopathic education and medical practice. Cultivating RSE should be a goal for medical educators as they design curricular initiatives to facilitate critical thinking and improve chances to apply research skills in residency and beyond.     

Virtual reality and computer-enhanced training devices equally improve laparoscopic surgical skill in novices

BACKGROUND: The study aim was to compare the effectiveness of virtual reality and computer-enhanced videoscopic training devices for training novice surgeons in complex laparoscopic skills. METHODS: Third-year medical students received instruction on laparoscopic intracorporeal suturing and knot tying and then underwent a pretraining assessment of the task using a live porcine model. Students were then randomized to objectives-based training on either the virtual reality (n=8) or computer-enhanced (n=8) training devices for 4 weeks, after which the assessment was repeated. RESULTS: Posttraining performance had improved compared with pretraining performance in both task completion rate (94% versus 18%; P<0.001*) and time [181+/-58 (SD) versus 292+/-24*]. Performance of the 2 groups was comparable before and after training. Of the subjects, 88% thought that haptic cues were important in simulators. Both groups agreed that their respective training systems were effective teaching tools, but computer-enhanced device trainees were more likely to rate their training as representative of reality (P<0.01). CONCLUSIONS: Training on virtual reality and computer-enhanced devices had equivalent effects on skills improvement in novices. Despite the perception that haptic feedback is important in laparoscopic simulation training, its absence in the virtual reality device did not impede acquisition of skill.     

The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial

In children, the pain and anxiety associated with acute burn dressing changes can be severe, with drug treatment alone frequently proving to be inadequate. Virtual reality (VR) systems have been successfully trialled in limited numbers of adult and paediatric burn patients. Augmented reality (AR) differs from VR in that it overlays virtual images onto the physical world, instead of creating a complete virtual world. This prospective randomised controlled trial investigated the use of AR as an adjunct to analgesia and sedation in children with acute burns. Forty-two children (30 male and 12 female), with an age range of 3-14 years (median age 9 years) and a total burn surface area ranging from 1 to 16% were randomised into a treatment (AR) arm and a control (basic cognitive therapy) arm after administration of analgesia and/or sedation. Pain scores, pulse rates (PR), respiratory rates (RR) and oxygen saturations (SaO(2)) were recorded pre-procedurally, at 10min intervals and post-procedurally. Parents were also asked to grade their child's overall pain score for the dressing change. Mean pain scores were significantly lower (p=0.0060) in the AR group compared to the control group, as were parental pain assessment scores (p=0.015). Respiratory and pulse rates showed significant changes over time within groups, however, these were not significantly different between the two study groups. Oxygen saturation did not differ significantly over time or between the two study groups. This trial shows that augmented reality is a useful adjunct to pharmacological analgesia.     

Porcine wet lab improves surgical skills in third year medical students

Background

Medical students desire to become proficient in surgical techniques and believe their acquisition is important. However, the operating room is a challenging learning environment. Small group procedural workshops can improve confidence, participation, and performance. The use of fresh animal tissues has been rated highly among students and improves their surgical technique. Greater exposure to surgical procedures and staff could positively influence students' interest in surgical careers. We hypothesized that a porcine “wet lab” course for third year medical students would improve their surgical skills.

Methods

Two skills labs were conducted for third year medical students during surgery clerkships in the fall of 2011. The students' surgical skills were first evaluated in the operating room across nine dimensions. Next, the students performed the following procedures during the skills lab: (1) laparotomy; (2) small bowel resection; (3) splenectomy; (4) partial hepatectomy; (5) cholecystectomy; (6) interrupted abdominal wall closure; (7) running abdominal wall closure; and (8) skin closure. After the skills lab, the students were re-evaluated in the operating room across the same nine dimensions. Student feedback was also recorded. Fifty-one participants provided pre- and post-lab data for use in the final analysis.

Results

The mean scores for all nine surgical skills improved significantly after participation in the skills lab (P ≤ 0.002). Cumulative post-test scores also showed significant improvement (P = 0.002). Finally, the student feedback was largely positive.

Conclusions

The surgical skills of third year medical students improved significantly after participation in a porcine wet lab, and the students rated the experience as highly educational. Integration into the surgery clerkship curriculum would promote surgical skill proficiency and could elicit interest in surgical careers.     

A surgical skills elective to expose preclinical medical students to surgery

BACKGROUND: Early introduction to surgical skills may serve several valuable purposes; medical students will acquire skills that will reduce their anxiety in approaching clerkships and improve the quality of patient care, and they will possibly become interested in surgery as a career. MATERIALS AND METHODS: We designed an elective called "OR assist" for first and second year medical students based on needs identified from the literature and third year students. The elective comprised three sessions for a total of 6 hours and included instruction in surgical skills and operating room etiquette. We surveyed the students before and after the experience and also surveyed a group of control students. We assessed confidence in surgical skills and OR etiquette and concerns about surgical lifestyle, environment, and enthusiasm. RESULTS: Eight-six students participated and generally had some operating room experience. The 75 students with pre/post match data reported significant improvement in confidence in suturing, knots, and instrumentation (P < 0.001; effect sizes >1.0) and less concern about issues related to enthusiasm for surgery (P < 0.001; effect size = 0.5). The participants and controls did not differ at baseline except for identification of surgical instruments, which was higher for participants. After the experience, the participants were significantly more confident and had less concern about enthusiasm in surgery than the controls. CONCLUSIONS: An elective can be effective in improving students' confidence and reducing their concerns about surgery as a career. This is a unique opportunity for early exposure to surgical role models.     

The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy

Background In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. Methods For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word “error” each time the walls were touched. Group 4 (both) received both the audio buzzer and “error” voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. Results Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). Conclusions The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple MIS task and should be given serious consideration in curriculum design for surgical training using simulation tasks.     

Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents

Background In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance. Methods A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual–spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A). Results After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test). Conclusion The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.     

Perspectives of third-year medical students toward their surgical clerkship and a surgical career

INTRODUCTION: A deficit of surgeons currently exists in the health care workforce. We have designed a study that identifies predictors of students choosing a career in surgery. First, we conducted two feasibility studies, and on the basis of these data, designed a third study for addressing our specific aims. The design and one-year results for the new study are provided here. METHODS: For the feasibility studies, students participating in the third-year surgery clerkship at our institution were asked to complete surveys using two different study designs. For the new study, which began in June 2005, students complete surveys covering domains of interest at the beginning of the clerkship and at weekly intervals throughout the clerkship, and will be providing match results. RESULTS: The feasibility studies offered insight into ways to improve our study design. In the first year of this multi-year study, 93 students participated (response rate = 77%). Forty-five students were women (48%), and the average age was 26.09 (sd 2.85). Proportion of students rating general surgery or a surgery subspecialty in their top three choices for a career increased over the course of the clerkship by 24.7% (n = 32, 34.4% at baseline; n = 55, 59.1% at end of clerkship). Seventy-one students (76.3%) reported having a meaningful experience on the clerkship, and 30 (32.3%) received honors grades. CONCLUSION: Our study design benefitted from the knowledge we gained from our feasibility studies. We look forward to achieving the necessary sample size in the next several years to report the final results of this study.     

Surgical procedure skills of graduating medical students: effects of sex, working, and research experience.

BACKGROUND: Surgical procedures constitute an important part of every physician's daily practice. However, few studies have investigated the surgical skills of graduating medical students and, especially, factors that might be related to their degree of surgical competence. The present study sought to gather information on the basic surgical skills of graduating medical students and to establish whether factors influencing the students' competence could be identified and used to improve the teaching of basic surgical skills at medical schools. METHODS: A questionnaire was sent to all final-year medical students in Finland in 1997. It was returned by 404 (participation rate 80.2%) students. The questionnaire included questions on the theoretical knowledge and successful performance of 10 basic surgical procedures: abdominal paracentesis, application of Sengstake-Blakemoore tube, rubber-band ligation of hemorrhoids, reposition and casting of Colles' fracture, knee arthrocentesis, application of tibial traction, evacuation of subcutaneous abscess, male bladder catheterization, suprapubic catheterization, and nevus excision. RESULTS: Over 90% of the final-year medical students knew the theory of performing reposition and casting of Colles' fracture, knee arthrocentesis, urinary tract catheterization, and nevus excision, but only 32% (124/393) knew the theory of applying the Sengstake-Blakemoore tube. Nevus excision had been successfully performed by over 90% of the students. Of the emergency or duty procedures, application of the Sengstake-Blakemoore tube and abdominal paracentesis had been successfully performed by 1% (4/393) and 8% (32/393) of the students, respectively, whereas Colles' fracture reposition and suprapubic catheterization had been successfully performed by 46% of the students (182/393 and 179/393, respectively). The age-adjusted odds ratios for performing Colles' fracture reposition (OR 1.59; 95% CI 1.01 to 2.50), application of tibial traction (2.00; 1.03 to 3.89), evacuation of subcutaneous abscess (2.13; 1.25 to 3.62), and suprapubic catheterization (2.23; 1.21 to 4.09) were significantly higher among males than females. Students with working experience had higher odds ratios for performing suprapubic catheterization (OR 6.75; 95% CI 1.99 to 22.84), nevus excision (5.69; 2.49 to 13.0), reposition and casting of Colles' fracture (1.72; 1.01 to 2.94), knee arthrocentesis (4.78; 2.67 to 8.53), and evacuation of subcutaneous abscess (12.9; 6.12 to 27.1) than students without such experience. Students who had done extracurricular research had significantly lower odds ratios for performing evacuation of subcutaneous abscess (0.58; 0.34 to 0.99) than students without such experience. When the five medical faculties in Finland were compared, the highest odds ratios for performing procedures were at the university in which a student logbook was systematically used. CONCLUSIONS: Final-year medical students have fairly good theoretical knowledge of basic surgical procedures, but the successful performance rates of these procedures range from 1 to 90%. Males have performed surgical procedures significantly more often than females. Working experience clearly enhanced the surgical skills of medical students. However, research experience may impair the learning of these procedures. The systematic use of logbooks seems to be useful.     

Development and evaluation of a trauma decision-making simulator in Oculus virtual reality

Background

Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the entertainment-industry. We developed an innovative medical-training simulator on the Oculus? Gear-VR platform. This novel application was developed utilising internationally recognised Advanced Trauma Life Support (ATLS) principles, requiring decision-making skills for critically-injured virtual-patients.

A brief private group practice rotation changes junior medical students' perception of the surgical lifestyle

BACKGROUND: Surgical practice is often perceived by students as a stressful and demanding lifestyle in which personal and family issues take low priority. For students to receive a more balanced view of surgical practice, we instituted a private practice preceptorship during the last week of our junior surgery clerkship in 2001. We hypothesized that a 4-day preceptorship with surgeons in private practice would improve student perception of surgery as a valid career choice without compromising student educational performance. METHODS: From January to December 2002, 107 junior medical students were assigned to a brief preceptorship with volunteer private practice surgeons during the surgery clerkship (group 1), while 28 students did not participate in the preceptorship (group 2). We assessed student satisfaction via questionnaire and compared student grade performance between groups. RESULTS: One hundred two questionnaires (95%) were returned. Overall, the preceptor experience was rated positively (9.0+/-0.1) based on a 10-point Likert scale. All students commented on the educational or enjoyment value of the preceptorship, with 44% specifically stating that the lifestyle in private surgical practice appeared pleasant. Interestingly, 9% of students volunteered that the experience had swayed them to consider surgery as a career. Twenty-four percent of questionnaires contained negative comments, mainly concerning not enough "hands-on" participation. Grades for the clerkship did not decrease in group 1 when compared with group 2 or with historic controls (n=113). CONCLUSIONS: A 4-day private practice preceptorship at the end of the junior surgery clerkship favorably alters student perceptions of a surgical career without diminishing student grade performance.     

医学生老年歧视现状及其影响因素分析

目的了解医学生群体的老年歧视现状并分析其影响因素,为培养医学生对老年人的正向态度提供参考。方法应用中文版老年歧视量表(FSA)对707名在校全日制医学生进行问卷调查。结果医学生老年歧视总分为(65.49±6.92)分,其中仇恨言论、逃避、歧视维度得分分别为(23.52±3.09)、(22.56±3.13)、(19.41±2.44);是否有意向从事老年医疗保健相关工作、性别、是否曾与老年人生活是医学生老年歧视的主要影响因素(P0.05,P0.01),可共同解释医学生老年歧视总变异的22.6%。结论医学生存在一定程度的老年歧视,在医学教育工作中,应加强医学生老年相关知识教育及实践机会,促进医学生对老年人的正向态度,以确保为老年人提供优质的医疗保健服务。     

The establishment of a surgical interest society for medical students

With the advent of initiatives by many medical schools to attract students to generalist fields, the curriculum at these institutions has undergone substantial change. In many instances these changes include the abbreviation of exposure to specialty fields such as surgery. Consequently, the exposure of medical students to the surgical discipline and surgeons may be decreased at these institutions. These changes are particularly concerning in light of studies that suggest that these important interactions are the primary influences that lead students to pursue a career in specific fields. It is also interesting to note that these trends in decreasing exposure to surgical fields seem to correlate with recent increases in the number of unfilled categorical residency positions in general surgery. This article focuses on the experiences of a group of students and faculty mentors at the University of Virginia School of Medicine as they set about creating an extracurricular opportunity for students to explore interests in surgical fields. We shall present the thoughts and rationale we used in planning the establishment of our own student surgical interest society, as well as the manner in which we ultimately went about constructing this organization. It is our hope that this information will provide some ideas for the creation of similar societies at other institutions.     

A randomised control trial using soap in the prevention of surgical site infection in Tanzania

BackgroundSurgical site infections (SSIs) are common and serious complications of surgery. Guidelines on preventing SSIs have been developed, but the role of preoperative bathing with plain soap among paediatric population is unclear. We aimed to assess the effectiveness of pre-operative bathing using plain soap in preventing SSIs among paediatric surgical patients.Materials and MethodsAn open-label, randomised trial was conducted at Muhimbili National Hospital in Tanzania. Preoperatively, patients in the intervention group washed their body using plain soap, while those in the control group did not. The primary outcome was SSI postoperatively. Statistical tests included χ2, Wilcoxon rank sum, and univariate and multivariable logistic regression.ResultsOf the 252 patients recruited,114 were randomised to the intervention arm. In the control arm, 40.6% (56/138) of participants developed SSIs compared to 11.4% (13/114) in the intervention arm (p < 0.01). After adjusting for confounding factors in multivariable analysis, the intervention reduced the odds of an SSI by 80% (OR: 0.20 [95% CI: 0.10, 0.41]; p < 0.01). Preoperative antibiotics were deemed to be an effect modifier of the association between the intervention and SSI (p = 0.05). The intervention significantly reduced the odds of an SSI by 88% among participants not given preoperative antibiotics (OR: 0.12 [95% CI: 0.05, 0.30]; p < 0.01).ConclusionThis study has shown that preoperative bathing with soap significantly reduces SSIs in paediatric surgical patients. It is a simple, cost effective and sustainable intervention.Level of EvidenceLevel II     

A focused curriculum in surgical oncology for the third-year medical students

Background

Educating medical students in surgical subspecialty fields can be challenging, and the optimal timing and curriculum remain unknown. Despite advocacy for earlier exposure, competing core clerkship rotations often leave little time for subspecialty fields. We report our experience with a novel, short, and focused curriculum in surgical oncology for the third-year medical students.

Methods

A 2-wk (2009–2010) and a 4-wk (2010–2011) curriculum in surgical oncology were developed for the third-year students at a tertiary-referral cancer center, including formal didactics, rotation in clinical service of students' choosing (breast, gastrointestinal, endocrine, or melanoma), and case-based learning and presentation. Paired pre- and postrotation questionnaires were prospectively completed, including 20 items assessing knowledge and four items assessing experience. Grading was anonymous, and change in score was assessed by Wilcoxon signed-rank test.

Results

Paired questionnaires from 47 students (2-wk rotation, n = 26; 4-wk rotation, n = 21) showed a median improvement of three points (21.4%) from pre- to posttests (P < 0.001). The improvement did not differ by the length of rotation or by the specific clinical service. Nearly all (93%) reported a positive and inspiring experience. The most valuable avenue of learning was reported as the time spent with resident or fellow or attending (92%), followed by self-directed reading (62%) and didactic lectures (28%).

Conclusions

A short and focused curriculum in surgical oncology, including structured didactics and clinical rotation, had positive impact for the third-year students. Given the increasing work-hour limits, it is important to note that the time spent in the clinical setting continues to be ranked as the most educationally valuable by medical students.