Автор неизвестен - Mededworld and amee 2013 conference connect - страница 31

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Lone N0rgaard (Hiller0d Hospital, Dept. Obstetrics, Hiller0d, Denmark)

Ase Klemmensen (Juliane Marie Centre, Dept. of Obstetrics, Copenhagen, Denmark) Charlotte Ringsted (University of Toronto, Wilson Centre, Toronto, Canada)

Martin Tolsgaard (Juliane Marie Centre, Copenhagen, Denmark)

Background: Preterm birth is one of the major causes of neonatal morbidity and mortality in infants. Transvaginal ultrasound measurement of the cervix-length has become a key to determine the risk of preterm birth. The examination is considered safe but also difficult to learn for novices due to the challenging interpretation of ultrasound scans and equipment handling. The quality of ultrasound examination is highly operator dependent and adequate training is necessary before clinical practice. The aim of this study was to explore the correlation between performances on a Virtual Reality ultrasound simulator and subsequent clinical performances. The research questions were: In a group of midwives training on Virtual Reality ultrasound simulators, I) How does simulator performance-scores correlate to subsequent ultrasound performance in a clinical setting? And II) How many repetitions are needed on the simulator to achieve proficiency and how does it correlate to the number of repetitions needed for clinical proficiency?

Summary of work: In a prospective correlation study the relationship between transvaginal ultrasound performances on a Virtual Reality simulator and ultrasound performances in vivo on gynecological patients is examined. Simulator metrics are used to evaluate numbers of repetitions needed for proficiency,

which is correlated to subsequent number of clinical scans needed for proficiency.

Summary of results: Data collection is in progress and final results will be presented at the AMEE conference. Conclusions: We also hypothesize that midwives who use few attempt to reach proficiency in simulated setting also need fewer repetitions in the clinic before proficiency. However, the opposite situation may also be observed as time spent on a simulator may translate to better clinical performance due to automaticity rather than proficiency.

3BB/8

Arthrocentesis workshop with synthetic knee model improves students' performance for knee arthrocentesis in the 6th year medical students

Praveena Chiowchanwisawakit (Mahidol University, Medicine, Division of Rheumatology, 8th Floor Asdang Building, Siriraj Hospital, Bangkok 10700, Thailand) Ranistha Ratanarat (Mahidol University, Medicine, Bangkok, Thailand)

Varalak Srinonprasert (Mahidol University, Medicine, Bangkok, Thailand)

Background: Knee arthritis is a common clinical problem for which knee arthrocentesis (KA) is essential in the differential diagnosis. The Thai Medical Council has rated KA as a requirement procedure for training medical doctors. However, up until now, medical students (MS) in Thailand only perform the procedure by chance. Workshops were therefore arranged for all sixth-year medical students using synthetic knee model to ensure equity in receiving training. Summary of work: The workshop was divided in 2 parts, first, providing general knowledge in arthrocentesis, and then practicing the procedure under supervision. This is a report of pre-and post-workshop self-evaluation about the confidence in performing KA and benefit (0-10 scales) from attending workshop. Summary of results: There were 170 and 158 MS who attended and evaluated the workshops, respectively. Seventy-nine (50%) MS had experience in KA prior to this workshop. The mean (SD) level of the procedural confidence before and after the workshop were 4.3 (2.4) and 7.5 (1.4), respectively. The mean score of post workshop was more than at least 50% of mean pre-workshop score, significance p < 0.0001. The experienced MS were 30% more confident for KA than pre-workshop, significantly. They rated the mean benefit of this workshop as 9.0 (1.2). Conclusions: A hands-on structured-workshop using synthetic knee model for knee arthrocentesis improved medical students' confidence in performing the procedure even in students who were exposed to KA prior to the workshop.

Take-home messages: Hands-on workshop on synthetic model could improve medical students' confidence and should be arranged for the many essential skillful procedures for medical trainees.

ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230

3BB/9

Do undergraduates find high fidelity simulation as useful as postgraduate medical trainees?

C A Boynton (Royal Brompton Hospital, Anaesthesia, London, United Kingdom)

A Riyat (Chelsea and Westminster Hospital, Anaesthesia, Fulham Road, London SW10 9NH, United Kingdom) C Mason (Addenbrooks Hospital, Geriatrics, Cambridge, United Kingdom)

Background: High-fidelity simulation is regarded as a highly effective tool in postgraduate medical education (Temple 2010, Cook 2011, Issenberg 2005), however its role in undergraduate training is undefined. Summary of work: Undergraduate (UGT) and postgraduate (PGT) trainees received simulation sessions on appropriate clinical scenarios. All trainees completed Likert based questionnaires (1-5, low to high), before and after sessions. Questions covered clinical skills confidence and simulation as a teaching method. Focus groups were conducted, evaluating themes including the effectiveness of simulation and simulation for UGT. Data analysis included the Wilcoxon signed rank test for the questionnaires and coded analysis for the focus groups.

Summary of results: 68 UGTs and 56 PGTs completed simulation training. Both groups rated simulation as educationally valuable, with no statistical difference between group scores (UGT mean 4.76, PGT mean 4.73, p value 0.76) and rated feedback they received as highly valuable (cumulative mean score of 4.54). All trainees rated simulation as a more valuable method of training than others (eg lectures, workplace based assessments) and subjectively useful for improving their clinical skills. Common themes from both groups highlighted simulation training for non-clinical skills eg. interpersonal skills and crisis resource management. Conclusions: Minimal differences exist between UGTs and PGTs evaluation of simulation. Both groups reported it as educationally valuable, feedback was highly rated during the sessions and simulation was the most useful method of teaching. Both groups subjectively reported it addressing clinical and non-clinical skills.

Take-home messages: High fidelity simulation can be used for clinical and non-clinical training in all stages of medical training.

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Redefining the stethoscope of the future: Utilizing simulation technology to teach ultrasound guided physical examination of the abdominal aorta and kidneys to internal medicine residents

Joseph Skalski (Mayo Clinic, Internal Medicine, 200 First Street SW, Rochester 55905, United States) Muhamad Elrashidi (Mayo Clinic, Internal Medicine, Rochester, United States)

Samuel Allen (Mayo Clinic, Education Simulation Center, Rochester, United States)

Darcy Reed (Mayo Clinic, Internal Medicine, Rochester,

United States)

Furman McDonald (Mayo Clinic, Internal Medicine, Rochester, United States)

Anjali Bhagra (Mayo Clinic, Internal Medicine, Rochester,

United States)

Background: Using point-of-care ultrasound to enhance physical examination may improve patient safety. Lack of formal training in point-of-care ultrasound has been identified as a primary barrier to widespread adoption. Summary of work: A workshop was created to instruct PGY-2 and PGY-3 internal medicine residents in point-of-care ultrasound imaging of the abdominal aorta and kidneys. The workshop included didactic instruction and hands-on ultrasound practice with standardized patients. The objectives of the workshop were to review ultrasound operation ("knobology") and teach residents to independently obtain ultrasound images of the abdominal aorta and kidneys. Each resident's ability to independently obtain ultrasound images was assessed using a skills exam with a standardized patient. Resident knowledge and attitudes towards point-of-care ultrasound were assessed using a pre and post-test. Summary of results: Most (34 of 40) residents were able to independently obtain high-quality images of both the abdominal aorta and kidneys on standardized patients after workshop completion. Residents demonstrated a statistically significant increase in their self-reported confidence with ultrasound operation and also indicated that they were more likely to use point-of-care ultrasound in their clinical encounters in the post-test compared to the pre-test.

Conclusions: Focused workshop training can prepare residents to independently obtain point-of-care ultrasound images of the aorta and kidneys. The workshop resulted in increased resident confidence with point-of-care ultrasound and self-reported likelihood of future clinical use.

Take-home messages: A hands-on ultrasound workshop can teach internal medicine residents to perform point-of-care ultrasound while also increasing self-reported likelihood that residents will use ultrasound in their clinical practice.

3BB/11

Exploring the effects of practice scheduling on bronchoscopy skills learning

Anne Sofie Bjerrum (Aarhus University Hospital,

Department of Chest Diseases, Noerrebrogade 44, build

2B, Aarhus 8000, Denmark)

Berit Eika (Aarhus University, Center for Medical

Education, Aarhus, Denmark)

Peder Charles (Aarhus University, Center for Medical

Education, Aarhus, Denmark)

Ole Hilberg (Aarhus University Hospital, Department of Chest Diseases, Aarhus, Denmark)

Background: Prior research on practice scheduling within medical simulation training has shown distributed practice beneficial for learning procedural skills.

ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230

However, principles derived from the study of simple skills may not necessarily generalize to more complex skills learning, and more work is needed to explore the impact of practice scheduling on combined complex cognitive and motor skills learning, like bronchoscopy skills learning. This study examines the most effective schedule for acquiring bronchoscopy skills through simulation training; massed practice (three practice sessions distributed within one day) or distributed practice (one practice session a week for three weeks). Summary of work: Twenty residents from a department of chest diseases were randomly assigned to massed practice or distributed practice. Each training session consisted of an instruction video followed by unsupervised training on three simulator cases. Performance was assessed with pre-test, post-test, and four-week retention test with previously validated simulator metrics.

Summary of results: A significant main effect of test was found for all measures, except for the number of wall collisions, indicating improvement in performance from pre-test to post- and retention test. No interaction was found between test and group, and no main effect of group was found for any of the measures, indicating equal learning curves.

Conclusions: We found massed practice and distributed practice equally effective for learning a combined complex cognitive and motor skill - bronchoscopy skills learning - through simulation training. Principles applying to simple and complex skills training may differ. Take-home messages: Massed practice and distributed practice were equally effective for learning a combined complex cognitive and motor skill.

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Evaluation of the implementation of simulation practice into a postgraduate year-1 residency emergency medicine training curriculum

Yu-Che Chang (Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Department of Medical Education; Department of Emergency Medicine, Chang Gung Memorial Hospital. No. 5 Fushing St., Gueishan Shiang, Taoyuan 333, Taiwan) Chien-Kuang Chen (Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Department of Emergency Medicine, Taoyuan, Taiwan) Jen-Tse Kuan (Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Department of Emergency Medicine, Taoyuan, Taiwan) Jih-Chang Chen (Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Department of Emergency Medicine, Taoyuan, Taiwan) San-Jou Yeh (Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Department of Medical Education; Department of Internal Medicine; Second Section of Cardiology, Taoyuan, Taiwan)

Background: Many junior trainees feel that they are inadequately trained in managing rarely-seen but critical cases in the ED. Medical simulation has been proposed as a technique to bridge the educational gap.

Summary of work: Postgraduate year-1 (PGY1) emergency medicine (EM) training was implemented in Chang Gung Memorial Hospital in August 2009. The curricula and outcomes are well-received, based on feedback from around 110 - 130 trainees annually. The one-month EM training program is reviewed periodically to ensure that it is effective. However, many PGY1 trainees still do not feel competent and confident in managing rarely-seen critical cases at the end of EM training. In December 2012, a short course in a simulation workshop, based on team dynamics, procedure skill training and video-based structured feedback and debriefing, was trialled. PGY1 residents reported their confidence and competence before and after the simulation series and made comments on their perception of the experience. Summary of results: Thirty-five PGY1 residents responded to the survey (97.2% response rate). The perceived effectiveness of simulation training from trainees was identified from the comparison between pre-course and post-course Likert scale (1 to 5) in knowledge (2.5±0.9 vs. 3.9±0.7, p<0.001), procedure skills (2.7±1.0 vs. 3.9±0.7, p<0.001), and confidence (2.4±1.0 vs. 3.9±0.8, p<0.001) in managing simulated critical cases. PGY1 residents feel the lack of knowledge and confidence to manage the simulated poisoning cases as compare to manage others. Conclusions: PGY1 residents need an opportunity to engage in treating rarely-seen but critical cases in EM training. Simulation practice assists them to be more competent and confident.

Take-home messages: Simulation practice assists PGY1 residents to be more competent and confident in EM training.

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Creation of an Ongoing Quality Improvement and Needs Assessment Process for a Clinical Simulation Center

Deborah M. Rooney (University of Michigan, Department of Medical Education, 1114 Towsley Center, 1500 E. Medical Center Dr., Ann Arbor 48104, United

States)

James M. Cooke (University of Michigan, Family Medicine, Department of Medical Education, Ann Arbor,

United States)

Background: Although medical institutions employ simulation-based education (SBE) worldwide, no formal evaluation has been performed to identify optimal resources and services needed by SBE programs. Having an accurate estimate of resources and services used, and a clear understanding of user challenges, allows institutions' administrators to address gaps and continually improve the scope and scale of services provided.

Summary of work: After IRB exemption, we disseminated a 20-item, web-based survey to program directors, undergraduate and graduate faculty, and nursing educators at our institution. The three-part survey consisted of a) resources, b) services, and c)

ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230

challenges. Measures were captured via 3-point rating scales ranging from 1 (I would not use this resource) to 3 (I currently use this resource). We summarized frequencies and ranked challenges. Summary of results: Twenty respondents indicated their preference for smaller (M = 2.28, SD = .57) over larger (M = 1.47, SD = .62) spaces. Participants preferred procedural (M = 2.06, SD = .73) over task trainers (M = 1.82, SD = .73) and computer-based simulators (M = 1.67, SD = .77). Respondents use support for developing clinical scenarios (M = 2.12, SD = .33) over maintenance of certification programs (M = 1.81, SD = .54). Top challenges were "I don't know what simulators/equipment are available to me" (53%), and "I don't have time to develop new curricula" (35%). Conclusions: Using a standardized survey during quality improvement helps administrators adapt their centers to meet educational needs, engage new learners, and demonstrate continued relevance to institutions.

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Stepping-stones at the interface between the medical school curriculum and the interdisciplinary simulation center

Ancuta Stefan (Georgia Regents University, Family Medicine, 1120 15th Street, EB 202, Augusta 30912,

United States)

Background: Experiential learning in general and medical simulation in particular have the potential to augment the instructional process and are effective tools for interprofessional training, evaluation of skills, knowledge and attitudes, reflective practice, and research.

Summary of work: This presentation is based on the author's role as interface between the College of Medicine and the Interdisciplinary Simulation Center for the last two years in implementing or expanding medical simulation activities across the curriculum and promoting interprofessional education. This activity included exploring the clerkship directors' views, assumptions and particular needs, assessing resources, and collaborating in planning and conducting simulation sessions.

Summary of results: The positive results of the collaborative efforts with the Internal Medicine Clerkship, the Pre-matriculation Program and the Department of Family Medicine represent stepping-stones and potential models for developing further activities and programs. The strategies included providing an adequate level of consistency among activities and gradually diversifying the case scenarios to respond to the increasing focus on interprofessional educational activities in a coordinated manner that contributes to a meaningful continuity of learning experiences.

Conclusions: In parallel with addressing specific needs of the learners at a given time and complementing other instructional modalities that are already in use, our goal has been to build a scaffolding continuity among the

simulation activities organized in various phases of the curriculum at departmental and institutional level. Take-home messages: Emphasis has been placed on combining the value of hands-on experience in a safe environment with the opportunity to review and consolidate key basic and clinical science concepts through clinical reasoning and reinforcing the relation between pathophysiology and clinical skills.

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Training nursing care for children with type 1 diabetes using simulation integrated with problem based learning

Min Sohn (Inha University, Nursing, 253 Yonghyun Dong, Incheon 402-751, Korea, Republic of (South Korea)) Youngmee Ahn (Inha University, Nursing, Incheon, Korea, Republic of (South Korea))

Sangwon Suh (Hallym University, Physiology, Chuncheon, Korea, Republic of (South Korea)) Mijin Lee (Inha University, Nursing, Incheon, Korea, Republic of (South Korea))

Namhee Kim (Inha University, Nursing, Incheon, Korea, Republic of (South Korea))

Narae Kang (Inha University, Nursing, Incheon, Korea, Republic of (South Korea))

Background: Although type 1 diabetes is a rare disease in Asian children, nursing students should be trained considering its devastating complications. Summary of work: A two-group nonequivalent quasi-experimental study was taken to evaluate the effectiveness of a simulation integrated with problem based learning (SIM-PBL) module of children with diabetes on self-efficacy (SE), knowledge and clinical performance of undergraduate nursing students. Eight students of the intervention group received a 3-hour SIM-PBL training and seven students in the control group received regular clinical practicum of children's health nursing.

Summary of results: After the SIM-PBL and the regular practicum, the improvements of the intervention group were higher in SE (30.75 ±32.226 vs 1.00±15.695; t=2.216, p=.045), but lower in knowledge (.00±0.756 vs

1.43±3.101; t=-1.267, p=.227) than the control group.

Objective structured clinical examination (OSCE) was also applied to evaluate clinical performance for both groups and the mean scores of OSCE were higher in the intervention group (23.75±2.866 vs 20.29±2.289; t=2.559, p=.024).

Conclusions: The SIM-PBL module of type 1 diabetes improved clinical performance, SE and knowledge of undergraduate nursing students. Take-home messages: The SIM-PBL modules could be used in particularly for clinical conditions students are rarely exposed.

This study was supported by Basic Science Research Program of the National Research Foundation of Korea

(2011-0009627)

ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230

3BB/16

Implementation of simulation test to evaluate core competencies for ED residents

Chien-Kuang Chen (Chang Gung Memorial Hospital, Department of Emergency Medicine, No.28, Gongyuan

Rd.,

Linkou Township, New Taipei City 244, Taiwan) Yu-Che Chang (Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Department of Emergency Medicine; Department of Medical Education, Taipei, Taiwan)

Jih-Chang Chen (Chang Gung Memorial Hospital, Department of Emergency Medicine, Taipei, Taiwan) Sen-Jo Ye (Chang Gung Memorial Hospital, Department of Medical Education, Taipei)

Background: Simulation is a useful tool for residents training. It is appropriate for performance assessment but there is little evidence that supports simulation in the use for summative evaluation. Therefore, we introduce simulation test to evaluate the performance of ED residents in core competencies. Summary of work: The Emergency Department of Chang Gung Memorial Hospital employs medical simulation to accurately judge ED residents by using "patient scenarios" during oral board exams. 34 ED residents participated in the exams at December 15, 2011 and August 9, 2012. Each exam contains 6 stations, including patient care, medical knowledge, clinical-oriented self-learning and sophisticated, interpersonal communication skills, professionalism, and system based practice. Written test was also taken at the same time. 30 attending emergency physicians join the questionnaire surveys about ED resident competency, which was completed in February 2013. Summary of results: There is a close relationship between the questionnaire survey and the simulation test. Residents with good results from questionnaire usually have excellent performance in simulation test. However, written test could not show any relationship. Among the Questionnaire surveys, 3 persons are seemed to have poor performance during the past year. Their simulation results show poor performance of core competencies in patient care, interpersonal communication skills, and system based practice. Conclusions: Application simulation tests offer a better method to evaluate the performance of ED residents. It may help the medical providers to reinforce the simulation-based resident education and training. Take-home messages: Simulation is a useful tool for training residents and in ascertaining competency. The core competencies most conducive to simulation-based training are patient care, interpersonal skills, and systems based practice. It is appropriate for performance assessment of core competencies in ED residents.

3CC Posters: Empathy and Attitudes

Location: South Hall, PCC

3CC/1

Evaluation and Improvement of a Medical Ethics Program in a PBL curriculum: two-year results

Sevgi Timbil (Dokuz Eylul University Faculty of Medicine, Department of Medical Education, Izmir, Turkey) Ahmet Can Bilgin (Dokuz Eylul University Faculty of Medicine, Department of History of Medicine And Ethics, Izmr, Turkey)

Sema Ozan (Dokuz Eylul University Faculty of Medicine, Department of Medical Education, Inciralti, Izmir 35340, Turkey)

Berna Musal (Dokuz Eylul University Faculty of Medicine, Department of Medical Education, Izmir, Turkey)

Background: Medical ethics education has universally become an integral part of undergraduate curricula. For the evaluation of a medical ethics program's effectiveness, which was revised during an outcome-based curriculum development, a study was conducted, starting from the first-year.

Summary of work: Kirkpatrick's model at level 1 and 2 was used for the evaluation of the program's effectiveness: students' satisfaction and opinions regarding each educational activity per module (feedback forms); students' opinions of the effectiveness of the overall medical ethics program (questionnaire) at the end of first and second year and; assessment of students' knowledge levels evaluated by a special pre-and post-test using MCQs in first year. Summary of results: The overall satisfaction level on educational activities was high in both years. Students' opinions on the program's effectiveness was perceived as most effective for the 'acquisition of the skill to discuss ethical problems' in first-year and for 'identifying and describing ethical issues' in second-year. The comparison of pre and post-test results in the first-year showed the highest increase in 'being knowledgeable about appropriate approaches to ethical issues in patient-physician relationships' and 'ethical principles in physician-media interactions'. Individual novel reading assignments were found less effective in teaching/learning ethical issues. Conclusions: Students' opinions were elaborated and used for further improvements. One of the changes was to organize small group discussions, facilitated by faculties, on ethical issues identified during students' individual novel reading assignments. Take-home messages: Effective implementation of a new curriculum requires continuous evaluation to identify issues for adjustments and improvement.

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