The Next Surgical Skills and Technology Elective Program: The "Surgical Skills and Technology Elective Program" Decreases Cognitive Load During Suturing Tasks in Second Year Medical Students.

OBJECTIVE: The Surgical Skills and Technology Elective Program (SSTEP) is a one-week, simulation-based procedural skills bootcamp for preclinical medical students. Using cognitive load (CL) as a useful framework for understanding simulation in medical education, our aims were to (1) examine the ability of SSTEP to decrease medical students' CL during procedural skills training and (2) determine the impact of SSTEP on secondary learning. METHODS: In this prospective cohort study, twenty SSTEP participants and twenty controls were recruited. CL was assessed during a simple suturing task and a clinical vignette multitasking activity, where participants were required to suture and concurrently listen to a clinical vignette. CL was measured using the validated Subjective Rating of Mental Effort (SRME) and its impact on working memory was assessed using a knowledge test about the clinical vignette. RESULTS: Participants reported lower SRME scores while suturing following SSTEP, which persisted at 3 months (p = 0.002) and were significantly lower than controls (p = 0.031). Participants also reported lower SRME scores during the clinical vignette multitasking activity (p = 0.011), despite no improvement among controls (p = 0.63). Participants significantly outperformed controls on the clinical vignette knowledge test (p = 0.02). CONCLUSIONS: Surgical skills training through SSTEP was associated with lower reports of mental effort and increased performance on secondary learning tasks. Procedural skills bootcamps may better prepare students for the complex learning environments encountered during clinical clerkship.

Who is the real team leader? Comparing leadership performance of the team leader and CPR Coach during simulated cardiac arrest.

Purpose: To describe the leadership performance of team leaders and CPR Coaches, and to determine if there is a correlation between leadership scores and CPR performance during management of simulated pediatric cardiac arrest events. Methods: This is a secondary analysis of data from a prior randomized controlled trial. We observed the performance of both team leaders and CPR coaches during the management of an 18-minute simulated cardiac arrest scenario which was run for 20 resuscitation teams comprised of CPR-certified professionals from four pediatric tertiary care centers. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. Two raters were trained to use the Behavioral Assessment Tool (BAT) to assess leadership performance of the team leader and CPR Coach. BAT scores of team leaders and CPR coaches were compared and linked with objective CPR performance. Results: There was no significant difference between the BAT scores of team leaders and CPR coaches (median score 27/40 vs 28.8/40, p = 0.16). Higher BAT scores of team leaders were significantly associated with higher percentage of excellent CPR (r = 0.52, p = 0.02), while higher BAT scores of CPR coaches were significantly associated with higher chest compression fraction (r = 0.48, p = 0.03). Conclusions: Both team leaders and CPR coaches have similarly high leadership performance during the management of simulated cardiac arrest. Leadership behaviors were associated with quality of CPR performance.Clinical Trial Registration: Registration ID: NCT02539238; https://www.clinicaltrials.gov.

Barriers and attitudes reported by Canadian emergency physicians regarding the initiation of buprenorphine/naloxone in the emergency department for patients with opioid use disorder.

OBJECTIVES: The primary objective of this study is to identify emergency physician reported barriers to initiating patients on buprenorphine/naloxone in the emergency department (ED) for treatment of opioid use disorder. Secondary objectives include (1) physician reported attitudes about initiating buprenorphine/naloxone in the ED, and (2) comparison of barriers reported based on urban versus rural practice setting. METHODS: An online survey was distributed to a convenience sample of attending emergency physicians and resident physicians using the Canadian Association of Emergency Physicians (CAEP) research survey email distribution network. RESULTS: The survey was sent to 1299 email accounts registered with the CAEP research survey network. We received 121 responses, which is a response rate of 9.3%. The completion rate was 118/121 (97.5%). Most respondents 113/118 (95.7%) reported at least one barrier that prevents them from initiating buprenorphine/naloxone in the ED. The top three reported barriers were (1) lack of allied health care staff who were trained to assist in starting patients on buprenorphine/naloxone in the ED and to help arrange follow-up, (2) time constraints related to patient education on the appropriate and safe use of buprenorphine/naloxone, and (3) access to follow-up resources. The majority of respondents agreed buprenorphine/naloxone was an evidence-based treatment for opioid use disorder and that it is important to make changes in their ED to better facilitate this practice. There was no statistically significant difference in the number of physicians reporting each barrier based on urban versus rural practice setting. CONCLUSIONS: In this convenience sample of physicians working in urban and rural Canadian emergency departments, most physicians perceive barriers that inhibit their ability to initiate buprenorphine/naloxone for patients with opioid use disorder, but overall there is support for making changes to better facilitate this practice.

"R1 Nightmares": a resident-led on-call medical emergency simulation course for junior residents.

Implication Statement On-call medical emergencies can be a source of anxiety for junior medical residents. Senior resident teachers are well-positioned to teach a safe approach to managing on-call emergencies, and simulation-based training has educational and patient safety advantages. We describe the implementation of a resident-facilitated, on-call emergency simulation course for first-year residents. The course was low-cost, time-efficient, increased residents' self-rated comfort with acutely deteriorating patients and was highly recommended by participants. The "R1 Nightmares" course could be adapted for other residency programs and institutions.

Énoncé des implications de la rechercheLes urgences durant la garde peuvent être une source d'anxiété pour les résidents juniors. Les résidents seniors se trouvent en situation privilégiée pour enseigner une approche sûre de la gestion des urgences sur la garde. De plus, la formation basée sur la simulation présente des avantages sur le plan pédagogique et sur le plan de la sécurité des patients. Nous décrivons la mise en œuvre d'un cours de simulation d'urgences survenant durant le service de garde destiné aux résidents de première année et animé par leurs collègues séniors. Nécessitant peu de temps et de ressources financières, le cours a permis aux résidents d'améliorer leur niveau de confort auprès des patients dont l'état se détériore rapidement et il a été fortement recommandé par les participants. Le cours «Cauchemars de R1¼ peut être adapté à d'autres programmes de résidence et à d'autres établissements.

A technical skills elective program for pre-clerkship medical students reduces levels of high anxiety for performing technical skills.

BACKGROUND: We investigated the effect of a simulation-based technical skills course on rates of high anxiety reported by pre-clerkship medical students for basic and advanced technical skills. METHODS: Twenty-two second year medical students reported levels of anxiety by electronic survey for 21 technical skills before and after the course. A peer group of 75 students were invited to complete the survey for comparison. RESULTS: We received 21 (95.5%) responses before and after the course, and 12 (57.1%) in a three-month follow-up. Rates of high anxiety ranged from 19 to 86% across skills before the course and 0-48% afterward. There was no statistically significant difference in high anxiety reported in a three-month follow-up survey. The rates of high anxiety reported were reduced across all skills for course participants compared to the responding peer group of 32 (42.7%), reaching a statistically significant difference for 15/21 skills (P < 0.05). CONCLUSIONS: Participation in this technical skills course was associated with decreased reports of high anxiety by pre-clerkship medical students regarding the performance of basic and advanced technical skills.

Teaching diagnostic reasoning: using simulation and mixed practice to build competence.

The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the students could consider the impact of the sessions on their clinical clerkship. Students felt that the sessions had assisted them in recognizing the key features of relevant diagnoses during clerkship as well as providing a helpful adjunct to their in-class learning.