Visuo-spatial ability in colonoscopy simulator training

Visuo-spatial ability is associated with a quality of performance in a variety of surgical and medical skills. However, visuo-spatial ability is typically assessed using Visualization tests only, which led to an incomplete understanding of the involvement of visuo-spatial ability in these skills. To remedy this situation, the current study investigated the role of a broad range of visuo-spatial factors in colonoscopy simulator training. Fifteen medical trainees (no clinical experience in colonoscopy) participated in two psycho-metric test sessions to assess four visuo-spatial ability factors. Next, participants trained flexible endoscope manipulation, and navigation to the cecum on the GI Mentor II simulator, for four sessions within 1 week. Visualization, and to a lesser degree Spatial relations were the only visuo-spatial ability factors to correlate with colonoscopy simulator performance. Visualization additionally covaried with learning rate for time on task on both simulator tasks. High Visualization ability indicated faster exercise completion. Similar to other endoscopic procedures, performance in colonoscopy is positively associated with Visualization, a visuo-spatial ability factor characterized by the ability to mentally manipulate complex visuo-spatial stimuli. The complexity of the visuo-spatial mental transformations required to successfully perform colonoscopy is likely responsible for the challenging nature of this technique, and should inform training- and assessment design. Long term training studies, as well as studies investigating the nature of visuo-spatial complexity in this domain are needed to better understand the role of visuo-spatial ability in colonoscopy, and other endoscopic techniques

Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation

BACKGROUND: Independent of efficacy, information on safety of surgical procedures is essential for informed choices. We seek to develop standardized methodology for describing the safety of spinal operations and apply these methods to study lumbar surgery. We present a conceptual model for evaluating the safety of spine surgery and describe development of tools to measure principal components of this model: (1) specifying outcome by explicit criteria for adverse event definition, mode of ascertainment, cause, severity, or preventability, and (2) quantitatively measuring predictors such as patient factors, comorbidity, severity of degenerative spine disease, and invasiveness of spine surgery. METHODS: We created operational definitions for 176 adverse occurrences and established multiple mechanisms for reporting them. We developed new methods to quantify the severity of adverse occurrences, degeneration of lumbar spine, and invasiveness of spinal procedures. Using kappa statistics and intra-class correlation coefficients, we assessed agreement for the following: four reviewers independently coding etiology, preventability, and severity for 141 adverse occurrences, two observers coding lumbar spine degenerative changes in 10 selected cases, and two researchers coding invasiveness of surgery for 50 initial cases. RESULTS: During the first six months of prospective surveillance, rigorous daily medical record reviews identified 92.6% of the adverse occurrences we recorded, and voluntary reports by providers identified 38.5% (surgeons reported 18.3%, inpatient rounding team reported 23.1%, and conferences discussed 6.1%). Trained observers had fair agreement in classifying etiology of 141 adverse occurrences into 18 categories (kappa = 0.35), but agreement was substantial (kappa ≥ 0.61) for 4 specific categories: technical error, failure in communication, systems failure, and no error. Preventability assessment had moderate agreement (mean weighted kappa = 0.44). Adverse occurrence severity rating had fair agreement (mean weighted kappa = 0.33) when using a scale based on the JCAHO Sentinel Event Policy, but agreement was substantial for severity ratings on a new 11-point numerical severity scale (ICC = 0.74). There was excellent inter-rater agreement for a lumbar degenerative disease severity score (ICC = 0.98) and an index of surgery invasiveness (ICC = 0.99). CONCLUSION: Composite measures of disease severity and surgery invasiveness may allow development of risk-adjusted predictive models for adverse events in spine surgery. Standard measures of adverse events and risk adjustment may also facilitate post-marketing surveillance of spinal devices, effectiveness research, and quality improvement

Assessing the Quality of Clinical Teachers: A Systematic Review of Content and Quality of Questionnaires for Assessing Clinical Teachers

BACKGROUND: Learning in a clinical environment differs from formal educational settings and provides specific challenges for clinicians who are teachers. Instruments that reflect these challenges are needed to identify the strengths and weaknesses of clinical teachers. OBJECTIVE: To systematically review the content, validity, and aims of questionnaires used to assess clinical teachers. DATA SOURCES: MEDLINE, EMBASE, PsycINFO and ERIC from 1976 up to March 2010. REVIEW METHODS: The searches revealed 54 papers on 32 instruments. Data from these papers were documented by independent researchers, using a structured format that included content of the instrument, validation methods, aims of the instrument, and its setting. Results : Aspects covered by the instruments predominantly concerned the use of teaching strategies (included in 30 instruments), supporter role (29), role modeling (27), and feedback (26). Providing opportunities for clinical learning activities was included in 13 instruments. Most studies referred to literature on good clinical teaching, although they failed to provide a clear description of what constitutes a good clinical teacher. Instrument length varied from 1 to 58 items. Except for two instruments, all had to be completed by clerks/residents. Instruments served to provide formative feedback ( instruments) but were also used for resource allocation, promotion, and annual performance review (14 instruments). All but two studies reported on internal consistency and/or reliability; other aspects of validity were examined less frequently. CONCLUSIONS: No instrument covered all relevant aspects of clinical teaching comprehensively. Validation of the instruments was often limited to assessment of internal consistency and reliability. Available instruments for assessing clinical teachers should be used carefully, especially for consequential decisions. There is a need for more valid comprehensive instruments

Mechanism of injury predicts outcome in traumatic brain injury

Objective: To determine the independent effect of Mechanism of Injury (MOI) on risk-adjusted survival in Traumatic Brain Injury (TBI).Methods: Patient Population; TBI hospital discharges (N=178,642 identified by ICD-9 head injury diagnosis codes) in the 1991-2001 New York Statewide Planning and Research Cooperative System (SPARCS) dataset. MOI was determined by ICD-9 E-Codes. TBI severity was categorized by the Relative Head Injury Severity Score (RHISS). Statistical Analysis: Stepwise logistic regression was used to predict mortality based on: age, gender, ICD-9 injury severity score (ICISS), RHISS, insurance status and MOI. Results: 10,786 (6.1%) TBI patients died. Area under the Receiver Operating Characteristic Curve for mortality prediction was 0.93. MOI was an independently significant predictor (p\u3c.001). The table shows Odds Ratios (OR) for death for each MOI, with motor vehicle crash (MVC) as the reference group (OR= 1). Relative to MVC, all MOIs except bicycle crashes and sports related injuries were associated with a significantly higher probability of death. Gunshots and Burns were associated with the highest odds of death relative to MVC. Conclusion: Mechanism of injury plays a role in determining the outcome of traumatic brain injury that is independent of injury severity and demographic factors. Greater understanding of mechanism-related prognostic factors may lead to improved outcomes and help guide preventative measure

Coping With the COVID-19 Pandemic: An Adapted Approach to Preclinical Teaching of Pathology-Pathophysiology

Introduction/Objective The COVID-19 pandemic affected all aspects of medicine, from patient care to medical education. Pandemic-related restrictions regarding in-person teaching activities at our medical college required adoption of an online, live, virtual format for all activities in our preclinical Pathology-Pathophysiology (PP) courses. Adaptation of teaching approaches using available technology allowed for uninterrupted learning and may serve to contribute to future innovations in medical education. Methods/Case Report Using Zoom as a platform, all lectures and interactive group exercises were converted to a live virtual format. Live Zoom lectures were also recorded and, subsequently, made available to students, in order to provide additional opportunities for engaged learning. Interactive, case-based and self-directed exercises, and gross specimen reviews were also held using the live virtual format. Fourth year students enrolled in our education concentration helped provide intermittent virtual peer reviews for the 2nd year students. All exams were administered via an electronically monitored virtual format. Results (if a Case Study enter NA) Overall, performance of the 2020-2021 class on in-house, multiple choice question (MCQ) exams in our PP courses was typically at or above the performance of prior classes, while class performance on a standardized national subject exam (NBME) in Pathology was above the national average, which was consistent with prior class performances, and significantly higher (p = 0.01) on average in 2021 than in 2019 (2.28 points) and 2020 (2.27 points). Additional analyses are being conducted on demographic subgroups within each cohort (sex, MCAT score, socioeconomic status, underrepresented in medicine, registered for disability accommodations) to determine if any particular group’s performance was impacted by this change of format. Conclusion Despite the restrictions imposed by the pandemic, student performance on in-house and standardized national exams in the NYMC Pathology-Pathophysiology courses were similar to recent pre-pandemic years. Our endeavors to provide a strong preclinical educational experience in Pathology-Pathophysiology during the pandemic resulted in learning outcomes on a par with those in recent years, despite the rapid transition to a completely online, live virtual format.Our data suggest that continued use of virtual teaching methods is a viable option in on-going medical curricul

Interobserver variability among faculty in evaluations of residents\u27 clinical skills

Objective: To describe interobserver variability among emergency medicine (EM) faculty when using global assessment (GA) rating scales and performance-based criterion (PBC) checklists to evaluate EM residents\u27 clinical skills during standardized patient (SP) encounters. Methods: Six EM residents were videotaped during encounters with SPs and subsequently evaluated by 38 EM faculty at four EM residency sites. There were two encounters in which a single SP presented with headache, two in which a second SP presented with chest pain, and two in which a third SP presented with abdominal pain, resulting in two parallel sets of three. Faculty used GA rating scales to evaluate history taking, physical examination, and interpersonal skills for the initial set of three cases. Each encounter in the second set was evaluated with complaint-specific PBC checklists developed by SAEM\u27s National Consensus Group on Clinical Skills Task Force. Results: Standard deviations, computed for each score distribution, were generally similar across evaluation methods. None of the distributions deviated significantly from that of a Gaussian distribution, as indicated by the Kolmogorov-Smirnov goodness-of-fit test. On PBC checklists, 80% agreement among faculty observers was found for 74% of chest pain, 45% of headache, and 30% of abdominal pain items. Conclusions: When EM faculty evaluate clinical performance of EM residents during videotaped SP encounters, interobserver variabilities are similar, whether a PBC checklist or a GA rating scale is used