Ultrasound skills teaching in UK medical education: A systematic review.

BACKGROUND: Sonography is increasingly integrated into medical curricula to prepare students for clinical practice. In 2022, we conducted a systematic review to explore the degree to which ultrasound skill acquisition is incorporated into undergraduate medial education in the United Kingdom. METHODS: A search of Medline and Embase databases from 2003 to 2022 identified 15 relevant articles. Studies were included if they described ultrasound skills training in UK undergraduate medical education. FINDINGS: A range of teaching methods were reported including didactic demonstrations, hands-on experience and combinations thereof. Portable machines were more common than cart-based machines, and most demonstrators were ultrasound-trained clinicians. Ultrasound teaching is well received, with improvements in confidence using ultrasound, motivation to learn anatomy and retention of knowledge. DISCUSSION: Obstacles to integration were noted including training, cost, curriculum time constraints and the issue of incidental pathology. One study demonstrated that anatomists with appropriate training could provide ultrasound teaching, reducing the need for clinicians or sonographers. Costs may be reduced by renting machines or purchasing portable/hand-held devices. Allowing access to machines during student's free time may address scheduling difficulties. A final recommendation is to pre-scan volunteers prior to the teaching session. CONCLUSION: We have outlined approaches to ultrasound skills teaching and the inherent hurdles to this, as well as potential solutions. This may aid educators wishing to augment their curricula. Although there are relatively few studies from the United Kingdom, there is consensus that students enjoy the incorporation of ultrasound practice and believe it complements existing teaching, especially in a small group setting.

The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access.

BACKGROUND: Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. METHODS AND RESULTS: Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables. CONCLUSIONS: The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.

Regional mechanical and biochemical properties of the porcine cortical meninges.

The meninges are pivotal in protecting the brain against traumatic brain injury (TBI), an ongoing issue in most mainstream sports. Improved understanding of TBI biomechanics and pathophysiology is desirable to improve preventative measures, such as protective helmets, and advance our TBI diagnostic/prognostic capabilities. This study mechanically characterised the porcine meninges by performing uniaxial tensile testing on the dura mater (DM) tissue adjacent to the frontal, parietal, temporal, and occipital lobes of the cerebellum and superior sagittal sinus region of the DM. Mechanical characterisation revealed a significantly higher elastic modulus for the superior sagittal sinus region when compared to other regions in the DM. The superior sagittal sinus and parietal regions of the DM also displayed local mechanical anisotropy. Further, fatigue was noted in the DM following ten preconditioning cycles, which could have important implications in the context of repetitive TBI. To further understand differences in regional mechanical properties, regional variations in protein content (collagen I, collagen III, fibronectin and elastin) were examined by immunoblot analysis. The superior sagittal sinus was found to have significantly higher collagen I, elastin, and fibronectin content. The frontal region was also identified to have significantly higher collagen I and fibronectin content while the temporal region had increased elastin and fibronectin content. Regional differences in the mechanical and biochemical properties along with regional tissue thickness differences within the DM reveal that the tissue is a non-homogeneous structure. In particular, the potentially influential role of the superior sagittal sinus in TBI biomechanics warrants further investigation. STATEMENT OF SIGNIFICANCE: This study addresses the lack of regional mechanical analysis of the cortical meninges, particularly the dura mater (DM), with accompanying biochemical analysis. To mechanically characterise the stiffness of the DM by region, uniaxial tensile testing was carried out on the DM tissue adjacent to the frontal, parietal, temporal and occipital lobes along with the DM tissue associated with the superior sagittal sinus. To the best of the authors' knowledge, the work presented here identifies, for the first time, the heterogeneous nature of the DM's mechanical stiffness by region. In particular, this study identifies the significant difference in the stiffness of the DM tissue associated with the superior sagittal sinus when compared to the other DM regions. Constitutive modelling was carried out on the regional mechanical testing data for implementation in Finite Element models with improved biofidelity. This work also presents the first biochemical analysis of the collagen I and III, elastin, and fibronectin content within DM tissue by region, providing useful insights into the accompanying macro-scale biomechanical data.

Maintaining reading experience continuity across e-book revisions.

E-book reader supports users to create digital learning footprints in many forms like highlighting sentences or taking memos. Nowadays, it also allows an instructor to update their e-books in the e-book reader. However, e-book users often face problems when trying to find learning footprints they made in a new version e-book. Thus, users' reading experience continuity across e-book revisions is hard to be maintained and seems to become a shortcoming within the e-book system. In this paper, in order to maintain users' reading experience continuity, we deal with the transfer of learning footprints such as a marker, memo, and bookmark across e-book revisions on an e-book reader in a coursework scenario. We first give introduction and related works to demonstrate how researchers dedicated on the problem mentioned in this paper and page similarity comparison. Then, we compare three page similarity comparison methods using similarity computing models to compute page pairwise similarity in image level, text level, and image & text level. In the analysis, for each level, we analyze the performance of transferring learning footprint across e-book revisions and also the optimal threshold for similar page determination. After that, we give the analysis results to show the performances of three methods in image level, text level, and image & text level, and then, the error analysis is presented to specify the error types that occur in the results. We then propose page image & text similarity comparison as the optimal method to automatically transfer learning footprints across e-book revisions based on the analysis results and error analysis among three compared methods. Finally, the discussion and conclusions are shown in the end of this paper.

Measuring Behaviors and Identifying Indicators of Self-Regulation in Computer-Assisted Language Learning Courses.

The aim of this research is to measure self-regulated behavior and identify significant behavioral indicators in computer-assisted language learning courses. The behavioral measures were based on log data from 2454 freshman university students from Art and Science departments for 1 year. These measures reflected the degree of self-regulation, including anti-procrastination, irregularity of study interval, and pacing. Clustering analysis was conducted to identify typical patterns of learning pace, and hierarchical regression analysis was performed to examine significant behavioral indicators in the online course. The results of learning pace clustering analysis revealed that the final course point average in different clusters increased with the number of completed quizzes, and students who had procrastination behavior were more likely to achieve lower final course points. Furthermore, the number of completed quizzes and study interval irregularity were strong predictors of course performance in the regression model. It clearly indicated the importance of self-regulation skill, in particular completion of assigned tasks and regular learning.

Telephone referral education, and evidence of retention and transfer after six-months.

BACKGROUND: Effective communication between clinicians is essential for safe, efficient healthcare. We undertook a study to determine the longer-term effectiveness of an education session employing a structured method to teach referral-making skills to medical students. METHODS: All final year medical students received a forty-five minute education intervention consisting: discussion of effective telephone referrals; video viewing and critique; explanation, demonstration and practice using ISBAR; provision of a memory aid for use in their clinical work. Audio recordings were taken during a subsequent standardised simulation scenario and blindly assessed using a validated scoring system. Recordings were taken immediately before (control), several hours after (intervention), and at approximately six months after the education. Retention of the acronym and self-reports of transfer to the clinical environment were measured with a questionnaire at eight months. RESULTS: Referral clarity at six months was significantly improved from pre-intervention, and referral content showed a trend towards improvement. Both measures were lower than the immediate post-education test. The ISBAR acronym was remembered by 59.4% (n = 95/160) and used by the vast majority of the respondents who had made a clinical telephone referral (n = 135/143; 94.4%). CONCLUSIONS: A brief education session improved telephone communication in a simulated environment above baseline for over six months, achieved functional retention of the acronym over a seven to eight month period and resulted in self reports of transfer of the learning into practice.

Learning surgical communication, leadership and teamwork through simulation.

BACKGROUND: In Australia and New Zealand, surgical trainees are expected to develop competencies across 9 domains. Although structured training is provided in several domains, there is little or no formal program for professionalism, communication, collaboration, and management and leadership. The Australian federal Department of Health and Aging funded a pilot course in simulation-based education to address these competencies for surgical trainees. This article describes the course and evaluation. METHODS: Course development: Content and methods drew on best-evidence for teaching and learning these competencies from other disciplines. Course evaluation: Participants completed surveys using rating scales and free text comments to identify aspects of the course that worked well and those that needed improvement. RESULTS: Eleven of 12 participants completed evaluation forms immediately after the course. Participants reported largely meeting learning objectives and valuing the educational methods. High levels of realism in simulations contributed to the ease with which participants immersed themselves in scenarios. CONCLUSIONS: This study demonstrates that a course designed to teach competencies in communication, teamwork, leadership, and the encompassing professionalism to surgical trainees is feasible. Although participants valued the content and methods, they identified areas for development. Limitations of the evaluation are highlighted, and further areas for research are identified.

Simulation-based education for building clinical teams.

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented.

ISBAR for clear communication: one hospital's experience spreading the message.

All health services rely on efficient and accurate communication between health professionals to ensure safe and effective patient care. Our health service introduced a standardised technique, ISBAR (Identify, Situation, Background, Assessment, Request), for telephone communication. We describe and evaluate the implementation of this project; evaluation was undertaken using program logic mapping. Recommendations for other health services planning to introduce communication tools into routine clinical use are also provided.

Review of mannequin-based high-fidelity simulation in emergency medicine.

The spectrum of uses of high-fidelity simulation in emergency medicine has increased in the past 10 years and ranges from teaching isolated skills to improving complex team behaviours in critical situations. This review will describe these published uses and explore the evidence supporting the use of high-fidelity simulation, as well as the future directions and difficulties of using this technology in our specialty.

Effective management of anaesthetic crises: development and evaluation of a college-accredited simulation-based course for anaesthesia education in Australia and New Zealand.

The Effective Management of Anesthetic Crises (EMAC) course is a joint initiative between the Australian and New Zealand College of Anesthetists (ANZCA) and simulation centers. This standardized 2.5-day course has become an integral component of training for Fellowship of ANZCA and as such is an innovative development on the global anesthesia scene.Since its inception in 2002, over 600 anesthetists, with equal numbers of specialists and trainees, have attended EMAC throughout Australia, New Zealand, and Hong Kong. Course evaluations from 499 anesthetists and a follow-up survey showed strong support for the course and its relevance to clinical practice. The course is perceived by participants as changing their practice and improving their management of anesthetic crises.Exposure to the concepts of effective crisis management is now widespread in the anesthetic community in the region and should contribute to improved patient safety.

Making patient safety the focus: crisis resource management in the undergraduate curriculum.

BACKGROUND: This paper examines the role of high fidelity simulation and crisis resource management in bridging the gap between theory and practice. Patient safety is fundamental to healthcare professional practice and is a common goal for healthcare providers. It provides a focus to motivate practitioners. Patient safety issues are not a priority in undergraduate curricula. Raising the profile at this level is crucial to improving the safety and quality of healthcare delivery. This paper explores the role of simulation in providing a realistic, safe environment for participants with different levels of experience to manage evolving crises in the context of their work environment. METHODS: The Southern Health Simulation and Skills Centre uses a patient safety focus in delivering a specialised educational programme adapted from aviation to healthcare. The programme, crisis resource management, enables participants to consolidate knowledge, attitudes and skills to achieve a deeper understanding of how their performance impacts on patient safety and the quality of healthcare provided. Self-reported written evaluation data was collected from participants of three different courses at Southern Health. RESULTS: Participants consistently report that these courses offer unique learning experiences that address aspects of workplace learning in ways that have not previously been possible. A video-assisted reflective process powerfully reinforces learning. CONCLUSION: Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

Interns' perceptions of performance and confidence in participating in and managing simulated and real cardiac arrest situations.

This study attempts to describe the effects of a computerized patient simulator education program on interns' perceptions of their own performance and confidence in managing and/or participating in a cardiac arrest incident during simulated and real events. The study design was qualitative using thematic analysis of debriefing sessions and individual interviews. The setting for the research was an education program for interns working at Southern Health, Victoria, Australia utilising a high-fidelity patient simulator. The participants were junior doctors (n = 30) in the first three-month rotation of their first postgraduate year (interns). The results describe the interns' self-reported experiences and perceptions relating to: (1) cardiac arrest experiences prior to the simulation scenario; (2) a simulated cardiac arrest scenario; (3) real-life cardiac arrest experiences after the simulation scenario. The interns expressed perceptions of improved self-confidence in: managing this particular critical situation; their own decision making during a critical incident; their ability to prioritize tasks. They also reported improved awareness and understanding with regards to: the need for leadership and effective teamwork; and the need for effective communication with senior staff during a critical incident. The interns considered that they had improved their ability to effectively handle a cardiac arrest situation as a result of the simulator program. The interns interviewed expressed decreased levels of anxiety and improved confidence in their decision making and their ability to prioritize tasks during a similar real-world situation as a result of the simulator program.