Surgical skill acquisition with self-directed practice using computer-based video training

BACKGROUND: Computer-based video training (CBVT) provides flexible opportunities for surgical trainees to learn fundamental technical skills, but may be ineffective in self-directed practice settings because of poor trainee self-assessment. This study examined whether CBVT is effective in a self-directed learning environment among novice trainees. METHODS: Thirty novice trainees used CBVT to learn the 1-handed square knot while self-assessing their proficiency every 3 minutes. On reaching self-assessed skill proficiency, trainees were randomized to either cease practice or to complete additional practice. Performance was evaluated with computer and expert-based measures during practice and on pretests, posttests, and 1-week retention tests. RESULTS: Analyses revealed performance improvements for both groups (all P < .05), but no differences between the 2 groups (all P > .05) on all tests. CONCLUSIONS: CBVT for the 1-handed square knot is effective in a self-directed learning environment among novices. This lends support to the implementation of self-directed digital media-based learning within surgical curricula.     

Core Competence in Fundamental Nursing Practicum Scale: A validity and reliability analysis

AimThis study aimed to develop and examine the psychometric properties of validity and reliability of the Core Competence in Fundamental Nursing Practicum Scale.BackgroundFundamental nursing practicum is an initial practicum required for nursing students; however, no measurement tool is available to assess students’ core competence during their first practicum.DesignCross-sectional design.MethodsNursing students from six nursing colleges in Southern Taiwan who completed their fundamental nursing practicum within 1 month were recruited. The initial 39-item Core Competence in Fundamental Nursing Practicum Scale was drafted and examined for its content, face and factorial validity. The data were randomly assigned into two subgroups and analyzed using exploratory and confirmatory factor analyses. Exploratory factor analysis was performed using principal-axis factoring and direct oblimin rotation and numbers of factors were extracted on the basis of eigenvalues > 1 and a scree plot. The exploratory factor analysis derived structure was then verified by a confirmatory factor analysis using maximum likelihood estimation. Reliability was examined in term of internal consistency.ResultsThe exploratory factor analysis and confirmatory factor analysis samples comprised 405 and 513 students, respectively. Four items were omitted by content validity and another four items were omitted because of the ceiling effect. Six items were removed during the exploratory factor analysis because of their lower factor loadings (< 0.4). The final 25-item Core Competence in Fundamental Nursing Practicum Scale comprised 5 domains, namely communication (3 items), application of nursing process (6 items), basic biomedical science (4 items), nursing skills and ability to perform a care process (7 items), and professional attitude (5 items), which collectively explained 70.14% of total variance. The structure was then verified by a confirmatory factor analysis with satisfactory model fit. The Cronbach’s alpha of the Core Competence in Fundamental Nursing Practicum Scale was 0.94.ConclusionsThe 25-item Core Competence in Fundamental Nursing Practicum Scale reliably and validly measures nursing students’ core competence during their fundamental nursing practicum. Instructors can use the scale to identify students’ weak core competencies and refine their courses for novice nurses.     

早期皮肤接触对剖宫产产妇心理状态及母乳喂养的影响:前瞻性随机对照试验

目的探讨母婴早期皮肤接触(skin-to-skin contact,SSC)对剖宫产产妇心理状态及母乳喂养的影响。方法前瞻性选取2017年8月1日至12月31日在深圳市南山区妇幼保健院行择期足月剖宫产的产妇221例,随机分为早接触组和对照组。对照组产后常规护理;早接触组实施母婴早期SSC,即新生儿娩出后1 h内赤裸全身俯卧于母亲裸露的乳房之间,持续1~2 h。观察指标包括:(1)泌乳启动时间以及首次母乳喂养测量工具评分;(2)产后72 h和42 d的纯母乳喂养率、母乳喂养自我效能量表评分和爱丁堡产后抑郁量表评分。采用两独立样本t检验、χ2检验和二分类logistic回归进行统计学分析。结果最终210例产妇纳入分析,早接触组和对照组各105例。42 d随访时早接触组失访20例,对照组失访17例。与对照组比较,早接触组首次母乳喂养成功率[77.1%(81/105)与59.1%(62/105),χ2=7.913]、首次母乳喂养测量工具评分[(9.5±1.7)与(8.6±1.4)分,t=4.115]、泌乳启动时间≤24 h的比例[41.0%(43/105)与12.4%(13/105),χ2=23.205]、产后72 h和42 d的纯母乳喂养率[36.2%(38/105)与22.9%(24/105);76.5%(65/85)与60.2%(63/88);χ2值分别为4.486和5.261]以及产后72 h和42 d母乳喂养自我效能量表评分[(117.5±12.0)与(111.8±22.3)分;(124.3±11.6)与(113.1±19.0)分;t值分别为2.100和4.710]均提高,差异均有统计学意义(P值均<0.05)。但早接触组产后72 h和42 d的爱丁堡产后抑郁量表评分与对照组差异无统计学意义[(5.4±3.5)与(5.9±4.0)分,t=0.937,P=0.350;(7.0±3.7)与(8.1±4.0)分,t=0.905,P=0.058]。二分类logistic回归分析显示,早期SSC是产后42 d纯母乳喂养成功的保护因素(OR=2.359,95%CI:1.173~4.743,P=0.016)。结论早期SSC可以提高剖宫产产妇母乳喂养自信心,促进泌乳启动,提高首次母乳喂养的成功率和产褥期纯母乳喂养率,是一种值得推广的临床实践。     

Communication skills instruction: An analysis of self, peer-group, student instructors and faculty assessment

Objective

To explore the correlation of student and faculty assessments of, second-year dental students’ (D2s) communicative skills during simulated patient interviews.

Methods

Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1 = poor-5 = excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources.

Results

Mean assessment score and standard error for peer-group (4.14 ± 0.04), was higher than self (3.86 ± 0.06, p < 0.05) yet slightly higher than student instructor (4.07 ± 0.04) and faculty (3.93 ± 0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ = 0.46, p < 0.0001), self and student instructor (ρ = 0.35, p < 0.002), self and peer-group (ρ = 0.28, p < 0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant.

Conclusion

Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments.

Practice implications

Peer, student instructor and faculty assessments of dental students’ communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students.     

Do patients and clinicians differ in their assessment of suicidal intent after self-harm using the same suicide questionnaire scale?

There have been no studies looking at differences in clinicians and patients assessment of suicidal intent in adults after presenting to emergency departments with intentional self-harm. In a non-experimental correlational study patients were asked to complete the objective section of the Beck Suicide Intent Scale whilst clinicians, as part of their routine clinical evaluation, completed the same scale blind to the patients’ ratings. Clinicians rated the suicide attempts consistently less seriously than the patients and there was poor agreement on individual questions (patients mean total score 6.86, clinicians mean total score 3.41, difference 3.45 (95% confidence interval 4.41–2.50) n = 22, t = ?7.52, p < 0.01). The results may be explained by the requirement for clinicians to defend themselves against being overwhelmed by neediness, possibly leading to minimisation of the risk of suicide.     

Self vs expert assessment of technical and non-technical skills in high fidelity simulation

Background

Accurate assessment is imperative for learning, feedback and progression. The aim of this study was to examine whether surgeons can accurately self-assess their technical and nontechnical skills compared with expert faculty members' assessments.

Methods

Twenty-five surgeons performed a laparoscopic cholecystectomy (LC) in a simulated operating room. Technical and nontechnical performance was assessed by participants and faculty members using the validated Objective Structured Assessment of Technical Skills (OSATS) and the Non-Technical Skills for Surgeons scale (NOTSS).

Results

Assessment of technical performance correlated between self and faculty members' ratings for experienced (median score, 30.0 vs 31.0; ρ = .831; P = .001) and inexperienced (median score, 22.0 vs 28.0; ρ = .761; P = .003) surgeons. Assessment of nontechnical skills between self and faculty members did not correlate for experienced surgeons (median score, 8.0 vs 10.5; ρ = −.375; P = .229) or their more inexperienced counterparts (median score, 9.0 vs 7.0; ρ = −.018; P = .953).

Conclusions

Surgeons can accurately self-assess their technical skills in virtual reality LC. Conversely, formal assessment with faculty members' input is required for nontechnical skills, for which surgeons lack insight into their behaviours.