Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists

Objective: To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. Methods: The present review was conducted using four national and international databases PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002-2017). Results: Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included. Conclusion: Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training.Laureate Int Univ, Sch Med, Dept Ophthalmol, Rua Doutor Almeida Lima 1-134, BR-03164000 Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Dept Ophthalmol, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Dept Ophthalmol, Sao Paulo, SP, BrazilWeb of Scienc

WEIBULL DISTRIBUTION BASED ON EDUCATION PARTLY INTERVAL CENSORED DATA

The work in this project is concerned with the applying of techniques for the assessment of survival analysis in data that include censored observations. Survival analysis has a lot of achievement in the medical, engineering, economic, education and other fields and it also known as failure time analysis. Partly Interval Censoring (PIC) is one of the techniques of the censoring that used in the survival analysis and it can help to treat many types of data especially the incomplete data. One of the most commonly lifetime distribution used in the reliability applications is Weibull distribution. In this project we use Weibull model based on modified education partly interval censored data as well as medical data and simulation data. Based on the medical data, we found that our model is comparable with Turnbull method. From the education data and simulation study for this particular case, we can conclude that our proposed distribution describes well the nature of the model as compared to the Turnbull method in terms of the value of scale and shape parameter estimates. Plots of survival distribution function against failure time are used to examine the predicted survival patterns for the two types of failures

High-fidelity simulation increases obstetric self-assurance and skills in undergraduate medical students

Objective: Teaching intrapartum care is one of the most challenging tasks in undergraduate medical education. High-fidelity obstetric simulators might support students' learning experience. The specific educational impact of these simulators compared with traditional methods of model-based obstetric teaching has not yet been determined. Study design: We randomly assigned 46 undergraduate medical students to be taught using either a high-fidelity simulator or a scale wood-and-leather phantom. Their self-assessments were evaluated using a validated questionnaire. We assessed obstetric skills and asked students to solve obstetric paper cases. Main outcome measures: Assessment of fidelity-specific teaching impact on procedural knowledge, motivation, and interest in obstetrics as well as obstetric skills using high- and low-fidelity training models. Results: High-fidelity simulation specifically improved students' feeling that they understood both the physiology of parturition and the obstetric procedures. Students in the simulation group also felt better prepared for obstetric house jobs and performed better in obstetric skills evaluations. However, the two groups made equivalent obstetric decisions. Conclusion: This study provides first data on the impact of high-fidelity simulation in an undergraduate setting

Is Professionalism Important in Physician Assistant Education?

Purpose: This study was designed to demonstrate the importance of a formal professionalism curriculum in physician assistant (PA) education. The PA concept arose from the medical profession, and PA education was designed to follow the medical model of education. Courses have been mandated by the Accreditation Council for Graduate Medical Education (ACGME) to include professionalism. Just as in the curriculum in medical schools, PA educators have been allowed to create their own professionalism curricula. The American Academy of Physician Assistants (AAPA) and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) have mandated that professionalism and ethics must be included in PA education. To address this need, a professionalism curriculum for first year PA students was created that combined standards of professionalism that are taught in medical school with those from the PA profession. Method: Sixty-four students enrolled in their first year of a master’s degree PA program were asked to voluntarily participate in a two-part survey to assess their knowledge of professionalism. The initial survey was administered prior to any formal education in professionalism. The same survey was repeated following the completion of the professionalism curriculum. The design of the survey was cross sectional and consisted of close ended questions. A Likert scale was utilized for responses, allowing for statistical analysis and comparison. Results: Sixty-three of 64 students completed both surveys. Results did not demonstrate a statistically significant improvement in knowledge of professionalism. Student evaluations were overwhelmingly positive, as was their participation in group discussions. Conclusions: Professionalism did not significantly improve. The lack of statistical significance may have referred to the lack of reliability in the findings but did not indicate the curriculum was effective or ineffective. It may have been wiser to continue professionalism education throughout the didactic year, incorporating case studies and simulation exercises

Exploration, design and application of simulation based technology in interventional cardiology

Medical education is undergoing a vast change from the traditional apprenticeship model to technology driven delivery of training to meet the demands of the new generation of doctors. With the reduction in the training hours of junior doctors, technology driven education can compensate for the time deficit in training. Each new technology arrives on a wave of great expectations; sometimes our expectations of true change are met and sometimes the new technology remains as a passing fashion only. The aim of the thesis is to explore, design and apply simulation based applications in interventional cardiology for educating the doctors and the public. Chapters 1and 2 present an overview of the current practice of education delivery and the evidence concerning simulation based education in interventional cardiology. Introduction of any new technology into an established system is often met with resistance. Hence Chapters 3 and 4 explore the attitudes and perceptions of consultants and trainees in cardiology towards the integration of a simulation based education into the cardiology curriculum. Chapters 5 and 6 present the “i-health project,” introduction of an electronic form for clinical information transfer from the ambulance crew to the hospital, enactment of case scenarios of myocardial infarction of varied levels of difficulty in a simulated environment and preliminary evaluation of the simulation. Chapter 7 focuses on educating the public in cardiovascular diseases and in coronary interventional procedures through simulation technology. Finally, Chapter 8 presents an overview of my findings, limitations and the future research that needs to be conducted which will enable the successful adoption of simulation based education into the cardiology curriculum.Open Acces

MEANINGFUL USE OF SIMULATION AS AN EDUCATIONAL METHOD IN NURSING PROGRAMS

The purpose of this descriptive study was to examine the use of simulation technology within nursing programs leading to licensure as registered nurses. In preparation for this study the Use of Simulation Technology Inventory (USTI) was developed and based in the structure, processes, outcomes model and the current literature on simulation. The survey was then piloted in one Midwestern state. Total item content validity index reported from the first use was 0.97. The USTI was sent to nursing programs in three Midwestern states, and 23 programs of nursing completed the survey. Data were both quantitative and qualitative in nature. Findings indicated that the majority of the respondents reported that they were or would be using simulation to teach undergraduate students. The courses that simulation technology were most frequently used in were medical-surgical nursing and obstetrics. Respondents described their physical simulation space, how they use simulation within their program, and student evaluation practices. Implications include research implications, educational implications and best practice implications. The most important research implications included the need to develop, pilot, and use methods to assess simulation outcomes for students and against program outcomes. Nursing education has found the gap between academia and practice is increasing. The shortage of nursing faculty, clinical sites in not only medical surgical nursing, but in many specialty areas, and decreasing financial support for nursing education have pushed nursing programs to explore new teaching methodologies. Simulation technology is one of the newer methodologies that has had a positive impact within nursing education. The best practice implication from this study was that nursing programs should develop a plan for the funding, implementation, and use of simulation technology. The plan should include a curricular map so that the simulator is included in all key nursing courses. Finally, this study is unique in that only one other study exists that examines what is occurring with simulation use. More research needs to be completed looking at other regions of the US so that best practices can be established. Key words: simulation technology, best practices, simulated learning environments, nursing education

The Effects of Simulation-Based Training on Critical Thinking

The purpose of this study was to examine the effects of a simulation-based training on the critical thinking skills of 10 graduate medical education trainees to understand the potential of simulation-based training as an innovative tool to improve medical competencies among trainees in a graduate medical training program. The theoretical framework incorporated in this study focused on the Five-Stage Model of Adult Skill Acquisition by Dreyfus and Dreyfus and the Theory of Andragogy by Malcolm Knowles to examine how adults learn in a medical simulation-based training setting. This study utilized a pre-and posttest, the AAC&U VALUE Critical Thinking Rubric, and individual interviews with trainees after the simulation. In analyzing pre/posttest scores, a paired samples t-test revealed that all 10 trainees showed a small growth in critical thinking regarding the management of a patient with cardiogenic shock based on hemodynamics by 0.30. A summary of the rubric study findings reported that third-year trainees received the highest critical thinking scores, while first-year trainees received the lowest critical thinking scores. Participant mean scores on the rubric also showed a correlation in the progression of training year to increased critical thinking in their use of hemodynamics to manage patient with cardiogenic shock. Post-simulation interviews with study participants reflected four major themes that included: (a) discrepancies in frequency and classification of simulation training, (b) the simulation learning environment, (c) from theory to practice, and (d) the impact of simulation training on clinical practice. The results of this study indicated the amount of prior exposure a trainee has to the medical competency that is being addressed in the simulation may have an influence on how the trainee perceives the value of the training. This study also found the amount of interaction that a rater has with the trainee may cultivate a bias in how they evaluate the trainee’s procedural and theoretical knowledge. The researcher recommends the implementation of a cohesive simulation curriculum for graduate medical education training programs. The researcher also recommends providing trainees with adequate exposure to simulation that is meaningful, practical, and relevant to their training to elevate the trainees overall learning experienc

Simulation-Based Interdisciplinary Team Learning—Pilot Study

Background: Currently, interprofessional education (IPE) is becoming widely integrated into healthcare professional education with regulating bodies including IPE as a curricular requirement. Although recent studies have concluded that students value IPE, there are a number of challenges associated with initial engagement. Many schools are unsure how to approach this interdisciplinary integration. In addition to IPE, simulation has become an important tool in the education of health professionals. As the first exercise at Wright State University involving interprofessional groups composed completely of undergraduates, interested students from the Boonshoft School of Medicine, the WSU College of Nursing and Health, and the Cedarville University School of Pharmacy collaborated to conduct a series of IPE cases in the Department of Emergency Medicine’s high-fidelity simulation lab. In order to support a continuous improvement process and identify strengths and weaknesses of the interprofessional simulation, data was collected from all participating students. Methods: This study was approved as an exempt protocol by the University IRB. Repeat surveys were conducted on an interprofessional group of students assessing their attitudes prior to and upon completion of a series of simulations. The survey included 6 Likert scale questions and a comments section. Paired t-test and frequency analysis were utilized for each of the survey questions to determine baseline status and determine any statistically significant change from baseline. Results: Students from all health professions demonstrated positive attitudes toward IPE and simulation training. Results from four of the survey questions demonstrated a statistically significant positive increase in differences between pre-simulation and post-simulation survey. Baseline responses indicate a strongly positive attitude towards IPE. In comparison to pre-simulation survey responses, post-simulation responses demonstrated significant increases in students’ experience and perceived value of high-fidelity healthcare clinical simulation. Additionally, there were statistically significant changes in students’ perceived value of interdisciplinary team training and its importance in the future of medical education. Conclusion: This study found that students from all three participating health professions demonstrated overall positive baseline attitudes toward IPE that could be further enhanced through participation in simulation-based exercises. This study provides a model of one method for integrating IPE into curricula for healthcare professionals

Contextualizing the relevance of basic sciences: small-group simulation with debrief for first- and second-year medical students in an integrated curriculum.

There has been a call for increased integration of basic and clinical sciences during preclinical years of undergraduate medical education. Despite the recognition that clinical simulation is an effective pedagogical tool, little has been reported on its use to demonstrate the relevance of basic science principles to the practice of clinical medicine. We hypothesized that simulation with an integrated science and clinical debrief used with early learners would illustrate the importance of basic science principles in clinical diagnosis and management of patients.Small groups of first- and second-year medical students were engaged in a high-fidelity simulation followed by a comprehensive debrief facilitated by a basic scientist and clinician. Surveys including anchored and open-ended questions were distributed at the conclusion of each experience.The majority of the students agreed that simulation followed by an integrated debrief illustrated the clinical relevance of basic sciences (mean ± standard deviation: 93.8% ± 2.9% of first-year medical students; 96.7% ± 3.5% of second-year medical students) and its importance in patient care (92.8% of first-year medical students; 90.4% of second-year medical students). In a thematic analysis of open-ended responses, students felt that these experiences provided opportunities for direct application of scientific knowledge to diagnosis and treatment, improving student knowledge, simulating real-world experience, and developing clinical reasoning, all of which specifically helped them understand the clinical relevance of basic sciences.Small-group simulation followed by a debrief that integrates basic and clinical sciences is an effective means of demonstrating the relationship between scientific fundamentals and patient care for early learners. As more medical schools embrace integrated curricula and seek opportunities for integration, our model is a novel approach that can be utilized

Leveraging Historical Medical Records as a Proxy via Multimodal Modeling and Visualization to Enrich Medical Diagnostic Learning

Simulation-based Medical Education (SBME) has been developed as a cost-effective means of enhancing the diagnostic skills of novice physicians and interns, thereby mitigating the need for resource-intensive mentor-apprentice training. However, feedback provided in most SBME is often directed towards improving the operational proficiency of learners, rather than providing summative medical diagnoses that result from experience and time. Additionally, the multimodal nature of medical data during diagnosis poses significant challenges for interns and novice physicians, including the tendency to overlook or over-rely on data from certain modalities, and difficulties in comprehending potential associations between modalities. To address these challenges, we present DiagnosisAssistant, a visual analytics system that leverages historical medical records as a proxy for multimodal modeling and visualization to enhance the learning experience of interns and novice physicians. The system employs elaborately designed visualizations to explore different modality data, offer diagnostic interpretive hints based on the constructed model, and enable comparative analyses of specific patients. Our approach is validated through two case studies and expert interviews, demonstrating its effectiveness in enhancing medical training.Comment: Accepted by IEEE VIS 202