A novel system for teaching the in-plane vascular access technique: A simulation study.

ABSTRACT: The long-axis in-plane approach is amenable to ultrasound-guided central venous catheterization. However, the long-axis in-plane approach is considered difficult to learn because the needle should remain visible in the ultrasound beam during the procedure. We developed a novel competency-based modular system to acquire the skills for the long-axis in-plane approach. The purpose of this study is to evaluate the efficacy of this system.The study was approved by the local ethics committee. Participants performed ultrasound guided venous catheterization (pre-test), attended a 2-hour hands-on session with the teaching system and were then evaluated again (posttest). The teaching system is a simulator device consisting of an ultrasound probe, a simulated vessel, a needle, and an endoscope connected to a computer to visualize the image inside the simulated vessel. The success rate, visualization of the needle tip, and puncture accuracy were measured before and after training. The puncture accuracy was determined by evaluating the distance of the needle tip and needle shaft from the center of a simulated vessel. Primary outcomes were the success rate and the puncture accuracy. The secondary outcome was needle tip visualization. McNemar test was used to analyze success rate and needle tip visualization. Tukey test was used to analyze puncture accuracy. A P value <.05 was considered statistically significant.Forty-seven participants were enrolled in this study. The success rate was significantly increased (pre-test 79%, posttest 94%, P = .04). Ultrasound images from 42 participants were analyzed for puncture accuracy. Puncture accuracy significantly increased for needle tip distance (P = .03), but not shaft distance (P = .1). The needle tip visualization was significantly improved (P = .02).A novel competency-based teaching system was constructed in a step-by-step manner, which improved needle tip visualization and puncture accuracy, with a higher success rate.

How do deployed general surgeons acquire relevant skill sets and competencies and mitigate skill fade?

There are recognised difficulties internationally with acquisition and retention of skills among deployed military general surgeons. These are compounded by reduced trauma workload in non-deployed roles or during low tempo or limited activity deployments, and the winding-down of combat operations in Iraq and Afghanistan. We summarise the relevant military-run courses, military-civilian collaborations and potential future strategies that have been used to address skill sets and competencies of deployed surgeons. We use examples from the American, British, Danish, French, German and Swedish Armed Forces. There is variation between nations in training, with a combination of didactic lectures, simulation training and trauma placements in civilian settings at home and overseas. Data regarding effectiveness of these techniques are sparse. It is likely that combat surgical skill-set acquisition and maintenance requires a combination of employment at a high-volume trauma centre during a surgeon's non-deployed role, together with military-specific courses and high-fidelity simulation to fill skill gaps. There are multiple newer modalities of training that require further evaluation if they are to prove effective in the future. We aimed to summarise the current methods used internationally to ensure acquisition and retention of vital skill sets for these surgeons.

Impact of COVID-19 on medical education: introducing homo digitalis.

PURPOSE: To determine how members of the Société Internationale d'Urologie (SIU) are continuing their education in the time of COVID-19. METHODS: A survey was disseminated amongst SIU members worldwide by email. Results were analyzed to examine the influence of age, practice region and settings on continuing medical education (CME) of the respondents. RESULTS: In total, 2494 respondents completed the survey. Internet searching was the most common method of CME (76%; all ps < 0.001), followed by searching journals and textbook including the online versions (62%; all ps < 0.001). Overall, 6% of the respondents reported no time/interest for CME during the pandemic. Although most urologists report using only one platform for their CME (26.6%), the majority reported using ≥ 2 platforms, with approximately 10% of the respondents using up to 5 different platforms. Urologists < 40 years old were more likely to use online literature (69%), podcasts/AV media (38%), online CME courses/webinars (40%), and social media (39%). There were regional variations in the CME modality used but no significant difference in the number of methods by region. There was no significant difference in responses between urologists in academic/public hospitals or private practice. CONCLUSION: During COVID-19, urologists have used web-based learning for their CME. Internet learning and literature were the top frequently cited learning methods. Younger urologists are more likely to use all forms of digital learning methods, while older urologists prefer fewer methods.

Toward Practice-Based Continuing Education Protocols: Using Testing to Help Physicians Update Their Knowledge.

INTRODUCTION: Using assessment to facilitate learning is a well-established priority in education but has been associated with variable effectiveness for continuing professional development. What factors modulate the impact of testing in practitioners are unclear. We aimed to improve capacity to support maintenance of competence by exploring variables that influence the value of web-based pretesting. METHODS: Family physicians belonging to a practice-based learning program studied two educational modules independently or in small groups. Before learning sessions they completed a needs assessment and were assigned to either sit a pretest intervention or read a relevant review article. After the learning session, they completed an outcome test, indicated plans to change practice, and subsequently documented changes made. RESULTS: One hundred twelve physicians completed the study, 92 in small groups. The average lag between tests was 6.3 weeks. Relative to those given a review article, physicians given a pretest intervention: (1) reported spending less time completing the assigned task (16.7 versus 25.7 minutes); (2) performed better on outcome test questions that were repeated from the pretest (65.9% versus 58.7%); and (3) when the learning module was completed independently, reported making a greater proportion of practice changes to which they committed (80.0% versus 45.0%). Knowledge gain was unrelated to physicians' stated needs. DISCUSSION: Low-stakes formative quizzes, delivered with feedback, can influence the amount of material practicing physicians remember from an educational intervention independent of perceptions regarding the need to engage in continuing professional development on the particular topic.

Learning With Patients, Students, and Peers: Continuing Professional Development in the Solo Practitioner Workplace.

Conceptualizations of workplace learning have moved from knowledge acquisition to learning as participation in the practices and cultures of the workplace environment. Along with this has come an appreciation of applicability of sociocultural learning theories, which frame learning as occurring within "communities of practice" or learning being "situated" within a workplace environment where collaboration and social interaction are fundamental to the learning process. These conceptualizations of workplace learning are ideally suited to health professions where learners are supervised in clinical work environments and then continue to work in team-based environments as graduates. However, what happens to workplace learning for novice practitioners who have limited periods of clinical supervision and then graduate into solo or small group practices (which may also be in rural or remote locations) and embark on long working careers without supervision? This paper argues workplace learning needs to be scaffolded and supported to reach its full potential in these environments. Drawing on workplace-based learning theory, we highlight the ubiquitous nature of learning in the workplace, the importance of active engagement, reflection, and individual meaning making. Through this reframing of traditional notions of continuing professional development, we emphasize the importance of patients, students, and other practitioners as partners in workplace learning for solo practitioners. We also focus on the role of educators, professional associations, and regulators in helping solo practitioners recognize, access, and maximize the learning opportunities inherent in relatively isolated practice environments.

Clinician-scientist training in New Zealand: historical notes and current trends.

Clinician-scientist training most commonly refers to the concomitant undertaking of dual (medical and PhD) degrees by a medical student. While such training is relatively well-established in the US, Canada and many countries in Europe including the UK, uptake in Australasia has been slower and less successful. This brief piece explores this aspect, with some focus on the history of the intercalated programmes in New Zealand.

Current Practices and Existing Gaps of Continuing Medical Education among Resident Physicians in Abha City, Saudi Arabia.

BACKGROUND: Continuing medical education (CME) is an everlasting process throughout the physician's working life. It helps to deliver better services for the patients. OBJECTIVES: To explore CME among resident physicians in Abha City; their current practices, their opinions, and barriers faced. METHODS: A cross-sectional study was conducted among resident physicians at the Ministry of Health hospitals in Abha City using a validated self-administered questionnaire. It included personal characteristics, current CME practices, satisfaction with CME, and barriers to attendance. RESULTS: The present study included 300 residents from 15 training specialties. Their reported CME activities during the previous year were lectures and seminars (79.7%) followed by conferences (43.7%), case presentations (39.7%), workshops (34.0%), group discussion (29/7%), and journal clubs (27.3%). Astonishingly enough, very few (8%) attended online electronic CME activities. There were significant differences in CME satisfaction scores by different training specialties. Regarding residents' perceptions of the effectiveness of different CME activities (conferences/symposia, workshops/courses, and interdepartmental activities) the results showed that workshops and courses were significantly the most effective method compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in improving practice behaviors. Barriers reported were being busy, lack of interest, high cost, and lack of suitable providers. CONCLUSION: Based on the findings of this study, it is recommended that online learning be promoted as a CME format for trainees. There should be support of residents and clinicians through the provision of protected time for their CME activities outside their daily clinical commitments.

Continuing professional education for general practitioners on chronic obstructive pulmonary disease: feasibility of a blended learning approach in Bangladesh.

BACKGROUND: Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees' and trainers' perspectives towards the blended learning approach. METHODS: We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. RESULTS: Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. CONCLUSIONS: Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.

Academics in Absentia: An Opportunity to Rethink Conferences in the Age of Coronavirus Cancellations.

The COVID-19 pandemic has caused major disruptions to the academic medicine community, including the cancellation of most medical and health professions conferences. In this Perspective, the authors examine both the short- and longer-term implications of these cancellations, including the effects on the professional development and advancement of junior faculty and learners. While the COVID-19 pandemic is new in 2020, impediments to conference attendance and participation are not. Cost, personal responsibilities at home, and clinical duties have always restricted attendance. The authors argue that the unprecedented hardships of this pandemic present a unique opportunity to reimagine how conferences can be conducted and to rethink what it means to be part of an academic community. While there are challenges with this digital transformation of academia, there are also undeniable opportunities: online abstracts and recorded presentations enable wider viewership, virtual sessions permit wider participation and greater interactivity, and the elimination of travel facilitates more diverse expert panel participation. The authors conclude with proposals for how conference organizers and participants can expand access by leveraging available distance learning technology and other virtual tools, both during the COVID-19 pandemic and beyond.

Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM).

Critical care ultrasound (CCUS) is an essential component of intensive care practice. Although existing international guidelines have focused on training principles and determining competency in CCUS, few countries have managed to operationalize this guidance into an accessible, well-structured programme for clinicians training in multidisciplinary intensive care. We seek to update and reaffirm appropriate CCUS scope so that it may be integrated into the international Competency-based Training in Intensive Care Medicine. The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described. Importantly, we discuss the rationale for inclusion but also exclusion of competencies listed. BACKGROUND/AIM: Critical care ultrasound (CCUS) is an essential component of intensive care practice. The purpose of this consensus document is to determine those CCUS competencies that should be a mandatory part of training in multidisciplinary intensive care. METHODS: A three-round Delphi method followed by face-to-face meeting among 32 CCUS experts nominated by the European Society of Intensive Care Medicine. Agreement of at least 90% of experts was needed in order to enlist a competency as mandatory. RESULTS: The final list of competencies includes 15 echocardiographic, 5 thoracic, 4 abdominal, deep vein thrombosis diagnosis and central venous access aid. CONCLUSION: The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described.

Podcasting: A Roadmap to the Future of Medical Education.

Podcasts, portable digital audio files that usually are listened to on a smartphone or MP3 player, have become a potent medium for medical education. Medical podcasting has become more sophisticated over the past decade as the producers of this material experiment and adapt the format. At the same time, production of podcasting has shifted from being a part of traditional medical educational venues such as journals and medical school curricula to organic digital education, individuals operating outside of, or parallel to, the traditional medical educational system. The past several years have seen increasing attempts to evaluate and organize podcasting material into vibrant educational resources. This article describes the history of podcasts, prior work on its efficacy in medical education, research directions for the future, and a vision of a global podcasting curriculum.