Basic and immediate paediatric cardiopulmonary resuscitation training in medical students

BackgroundTo analyse the effectiveness of Paediatric Basic Life Support (PBLS) and Paediatric Immediate Life Support (PILS) courses to train medical students in paediatric cardiopulmonary resuscitation (CPR).MethodsEighteen courses (13 in PBLS and 5 in PILS) were delivered to 1214 medical students. Two theory tests and one practical test were performed. Students filled in an anonymous questionnaire after each course.ResultsThe mean scores (out of 20) in the theory tests of the PBLS course were 11.4 before the course, and 19.2 upon completion (P < 0.0001). Infant BLS skills were achieved by 98.4% of students, and children BLS skills by 97% of them. The mean scores (out of 30) in the PILS courses were 17.3 before the course, and 29.1 at the end of the course (P < 0.0001). PBLS skills were achieved by 99% of students and PILS skills by 98.3% of them. The scores (out of 5) in the anonymous questionnaire were: theory classes, 4.5; teaching methods, 4.5; practice sessions, 4.7; instructor teaching skills, 4.8; and coordination of theory and practice and between instructors, 4.7. There were no significant differences between basic and intermediate CPR courses.ConclusionsPBLS and PILS courses are useful methods for delivering theory and practice training to medical students, and should be mandatory in the paediatric curriculum of medical studies.     

Development and pilot testing of a novel education method for training medical interpreters

ObjectiveThe goal of this study was to determine core competencies by means of a systematic literature review and to design and test an interpreter training program.MethodsCore competencies in medical interpreting were searched using a systematic literature review. An intervention program was developed to improve core competencies. Pretests and posttests were conducted to pilot-test knowledge and interpreting skills in participants aged 22–62 years (n = 43). Results of the tests were compared.ResultsResults of the systematic review indicated five core competencies: (a) maintaining accuracy and completeness; (b) medical terminology and understanding the human body; (c) behaving ethically and making ethical decisions; (d) nonverbal communication skills; and (e) cross-cultural communication skills. Statistical analysis showed a significant improvement in knowledge and interpreting skills in the intervention program compared with the control program.ConclusionPosttest assessment showed that the developed training system can be useful in improving knowledge and quality in medical interpreting.Practice implicationsA 3-day training program for medical interpreters could bridge the gap between medical professionals and patients with limited English proficiency while being amenable to integration into clinical flow.     

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded,randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students.MethodsAll students of the first clinical treatment course (n = 46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically.ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p < 0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p > 0.05).ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students.Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.     

Análisis de la ansiedad en los primeros encuentros clínicos: experiencias utilizando la simulación clínica en estudiantes de pregrado

IntroductionThe first clinical encounters trigger strong feelings and emotions in medical students, when facing complex illnesses, and by feelings of guilt of «using patients’ sufferings» for their learning purposes. Clinical simulation offers them an opportunity for experiencing anxiety in a safe environment prior to being involved in the hospital. The objective of this work was to assess the level of anxiety in the first clinical encounters through clinical simulation experiences in undergraduate students.Material and methodsWe used the Inventory of Anxiety in Clinical Simulation Scenarios in a sample of 49 students. This instrument is made up of 25 items grouped into 7 factors. ANOVA test was considered to evaluate the trends by factor, for the analysis of the data.ResultsWe found an average of 2.67. In considering the gender as a factor, significant difference was obtained by using ANOVA (P = 0.016). The results of trends by factor show significant differences in corporal expressions (P = 0.003), concern about how others perceive me (P = 0.007) and worries about self-image (P = 0.019).DiscussionAssessment is of great value in medical school programs, where it becomes one of the vital elements in designing each activity developed throughout the career. Anxiety is present along the training program, having a positive or negative impact on student learning and performance, according to the way it is handled. Assessing knowledge and skills is imperative, therefore both anxiety and assessment go hand in hand. Different types of assessment can generate different levels and manifestations of anxiety in students.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

Integrative medical education: Educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM)

Objectivesthe development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies.MethodsThe Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI²T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp = 30 h workload), served as a preliminary indicator of student interest.ResultsOf the 412 55%medical students participated in the program: 16% full participation (≥4 ctp/year), 18% partial participation (1–3.99 ctp/year) and 22% occasional participation (0.25–0.99 ctp/year). The amount of additional workload taken on by students was between 7.8 h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants.ConclusionMore than half of medical students were willing to invest a significant amount of additional time in the optional program.Practice implicationsAn integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.     

Shadowing patients: experimentar empatía en estudiantes de Medicina

IntroductionShadowing patients is one of the educational proposals to maintain and experience empathy in medical students. It is about observing, from the sidelines, a patient during a medical visit. The objective of this pilot study is to analyze the perceived and observed patients’ emotions during the experience of shadowing patients, and their relationship with medical empathy.MethodsTwenty-three fifth-year medical students (69.6% women, aged 22.6 ± 1.1 years) participated in the theoretical-practical workshop based on the observation and identification of patients’ emotions in a hospital waiting room. The Jefferson Scale of Physician Empathy (Hojat, 2002) and the Self-Assessment Manikin (Bradley and Lang, 1994) were applied.ResultsMost students experienced sadness (87%), and observed sadness (87%) and impatience (8.7%) in the patients. No statistically significant correlation between medical empathy and valence/arousal of experienced emotions was observed.DiscussionThe workshop of shadowing patient was low cost and easy to implement, stimulated the observation ability to identify the patients’ emotions, helped medical student to be more aware of their empathic skills, and complemented the theoretical training of medical students.     

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial

ObjectivesTo assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group’s experiences and learning preferences.MethodsA single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N = 210) to computer-based learning (N = 211). Primary outcomes: communication scores during repeat interactions with MPathic-VR’s intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. Secondary outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning.ResultsMPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters.ConclusionsMPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation.Practice implicationsMPathic-VR’s virtual human simulation offers an effective and engaging means of advanced communication training.     

Detecting the effects of physician training in self-care interviewing skills: Coding of standardized patient (SP) visit recordings versus SP post-visit ratings

ObjectiveTo compare how coder ratings of standardized patient (SP) visit recordings and SP ratings of the visits detect primary care physician (PCP) training in self-efficacy enhancing interviewing techniques (SEE IT).MethodsAnalyses of data from 50 PCPs who participated in a randomized controlled trial of SEE IT training, which led to increased SEE IT use during three SP visits 1–3 months post-intervention. Untrained SPs rated SEE IT use post-visit. Subsequently, three trained coders generated a consensus SEE IT rating from visit audio recordings. SPs and coders were blinded to provider study arm, and coders to SP ratings.ResultsSP and coder ratings were correlated (r = 0.62). In detecting the intervention effect, the areas under the receiver operating characteristic curve were 0.80 (95% CI 0.74–0.87) and 0.76 (95% CI 0.69–0.84) for consensus coder and SP ratings, respectively (difference 0.04, 95% CI −0.04–0.11; z = 1.04, p = 0.30).ConclusionSP ratings were not significantly different from coder ratings of SP visit recordings in detecting PCP SEE IT training.Practice implicationsIf similar findings are observed in larger studies, it would suggest a greater role for SP ratings in detecting provider interviewing skills training, given the relative simplicity, low cost, and non-intrusiveness of the approach.     

Associations of medical student empathy with clinical competence

ObjectiveEmpathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence.MethodsThis study combined cross-sectional data from four consecutive years of medical students (N = 590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, andObjectiveStructured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity.ResultsJSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests.ConclusionJSPE scores were positively associated with OSCE communication scores in medical students.Practice implicationsThis study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age.     

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial

ObjectiveAppropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills.MethodsFirst-year nursing students (N = 36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example’s correctness) and elaborated feedback (the true explanation).ResultsParticipants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group.ConclusionThe worked example effect was successfully adapted for learning in the provider-patient communication domain.Practice ImplicationsImplementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.     

Type and frequency of healthcare encounters can predict poor surgical outcomes in anterior cruciate ligament reconstruction patients

BackgroundSeveral challenges are associated with collecting clinically meaningful post-operative outcomes. The widespread implementation of electronic medical records (EMR) offers a new opportunity to evaluate surgical outcomes using routinely collected data in these systems. This study evaluated whether surgical outcomes can be ascertained from EMR’s hospital and outpatient encounters. Specifically, we evaluated anterior cruciate ligament reconstructions (ACLR) outcomes.MethodsA retrospective cohort study of 6985 ACLRs performed between 2/2005-9/2012 was conducted. Patient encounters during days 1–90 and days 91–180 after ACLR surgery were the exposures of interest. Nine hospital and eight outpatient encounter types were evaluated. The main endpoint of the study was revision surgery six months after ACLR.ResultsThe cohort was 66.7% male, the mean age was 28 (standard deviation = 11) years-old, and the incidence of revision was 1.5% (n = 105). After adjustments, in days 1–90 post-ACLR, compared to patients with 0–4 orthopedic office visits, patients with 5–9 (hazard ratio (HR) = 9.9, 95% confidence interval(CI), 4.3–23.2) and those with 10 or more (HR = 13.8, 95%CI, 5.6–33.8) visits had a higher risk of revision. In days 91–180, patients with any outpatient hospital encounters (HR = 2.5, 95%CI 1.4–4.5) had a higher risk of revision than patients without visits. Additionally, patients with 4–5 regular office visits (HR = 3.8 times, 95%CI, 2.0–7.0) had a higher risk of revision surgery than those with 0–1 visits.DiscussionThe number of post-operative outpatient visits was associated with ACLR revision surgery. Using EMR encounters to assess surgical outcomes is a viable option for monitoring ACLR patients. The simple assessment of visit types and number of encounters alone can provide valuable information regarding the normal course of rehabilitation of a surgical patient and possible deviation from this normal course. In large cohorts of patients, this type of patient surveillance can assist surgeons with monitoring their patients.     

The role of virtual interactive simulators in medical education: Exploring their integration as an assessment methodology in clinical years

IntroductionAssessment takes a fundamental role in medical education. In Portugal, the main assessment method used is multiple-choice questions (MCQ). The virtual interactive patients (VIP) as an assessment method can be indicated for the development of clinical reasoning for medical students of the clinical years. This study compared the use of MCQ and VIP as assessment methodologies in medical students.MethodsA randomized crossover study carried out, which 35 Portuguese medical students from clinical years evaluated by MCQ and VIP in four medical specialties. In each specialty, students randomized into two groups. One group started being evaluated by MCQ and finished with VIP, the other vice-versa. After the evaluation, students asked to complete a satisfaction questionnaire.ResultsThe final score was higher with the VIP than MCQ method (MCQ: 67.40 ± 8.96 vs. VIP: 73.34 ± 10.8; p < 0.01) with significant differences higher in Clinical History and Physical Examination. The satisfaction quiz showed although both methodologies are adequate and satisfactory, but VIP method allows to improve knowledge.ConclusionVIP is more accurate for clinical reasoning, accepted by medical students and should be integrated into the pre-graduate medical curriculum with other methodologies already used. The COVID-19 pandemic allowed a digital transformation of medical education and VIP will have a crucial role as a knowledge and evaluation method.     

Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

Development of an instrument to measure seniors’ patient safety health beliefs: The Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey

ObjectiveTo develop a survey to measure seniors’ embracement of ambulatory patient safety self-advocacy behaviors, the Senior Empowerment and Advocacy in Patient Safety (SEAPS) survey.MethodsContent was developed by review of published recommendations combined with interviews and focus groups with community members; items were generated for subscales based on the health belief model (HBM). Psychometric characteristics were assessed by cluster and correlation analyses on a pilot test of 143 community dwelling seniors; the ability of the subscales and demographic variables to predict reported behavior was investigated by multiple regression.ResultsThe four subscales of the SEAPS were outcome efficacy (OE), attitudes (ATT), self-efficacy (SE) and behaviors (BEH). Cronbach alphas were 0.74 for ATT, 0.79 for BEH, and 0.91 for OE and SE. Analysis of variance showed that there were no differences in any subscale score by race, education level or frequency of doctor visits, but women were noted to have significantly higher scores (p < .01) on the ATT and SE subscales and for the total of all the scales. Multiple regressions showed that SE significantly predicted self-reported behavior (p < .001). OE was a significant predictor for whites (p < .001) but not for African-Americans (p = .24).ConclusionsWe have developed a short, 21-item self-administered survey to assess seniors’ views about their participation in safety tasks.Practice implicationsWe believe the SEAPS shows promise to be a tool for evaluating interventions and training programs aimed at improving seniors’ self-advocacy skills. Effective interventions may improve the involvement of patients in their own safety in the clinical setting.     

Take the HEAT: A pilot study on improving communication with angry families

ObjectiveOur objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents’ skills in employing this method.Methods33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.ResultsAfter the workshop, residents’ Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z = −3.428, p < 0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.ConclusionFirst-year pediatric trainees’ communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.Practice implicationsThis study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.     

Designing,delivering and evaluating a distance learning nursing course responsive to students needs

Background and purposeThe majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources.MethodsParticipants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured.ResultsThe final sample included 25 students in the distance section and 35 in the hybrid section (N = 60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p < .05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80 ± 8.2) was significantly higher than the hybrid section (72.2 ± 9.5), (t = 3.5, p < .05).ConclusionsThe use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.