Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 Vaccine.

BACKGROUND: The safety and efficacy of the AZD1222 (ChAdOx1 nCoV-19) vaccine in a large, diverse population at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States, Chile, and Peru has not been known. METHODS: In this ongoing, double-blind, randomized, placebo-controlled, phase 3 clinical trial, we investigated the safety, vaccine efficacy, and immunogenicity of two doses of AZD1222 as compared with placebo in preventing the onset of symptomatic and severe coronavirus disease 2019 (Covid-19) 15 days or more after the second dose in adults, including older adults, in the United States, Chile, and Peru. RESULTS: A total of 32,451 participants underwent randomization, in a 2:1 ratio, to receive AZD1222 (21,635 participants) or placebo (10,816 participants). AZD1222 was safe, with low incidences of serious and medically attended adverse events and adverse events of special interest; the incidences were similar to those observed in the placebo group. Solicited local and systemic reactions were generally mild or moderate in both groups. Overall estimated vaccine efficacy was 74.0% (95% confidence interval [CI], 65.3 to 80.5; P<0.001) and estimated vaccine efficacy was 83.5% (95% CI, 54.2 to 94.1) in participants 65 years of age or older. High vaccine efficacy was consistent across a range of demographic subgroups. In the fully vaccinated analysis subgroup, no severe or critical symptomatic Covid-19 cases were observed among the 17,662 participants in the AZD1222 group; 8 cases were noted among the 8550 participants in the placebo group (<0.1%). The estimated vaccine efficacy for preventing SARS-CoV-2 infection (nucleocapsid antibody seroconversion) was 64.3% (95% CI, 56.1 to 71.0; P<0.001). SARS-CoV-2 spike protein binding and neutralizing antibodies increased after the first dose and increased further when measured 28 days after the second dose. CONCLUSIONS: AZD1222 was safe and efficacious in preventing symptomatic and severe Covid-19 across diverse populations that included older adults. (Funded by AstraZeneca and others; ClinicalTrials.gov number, NCT04516746.).

Trained to cut? A literature review of veterinary surgical resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

The Impact of the COVID-19 Pandemic on Veterinary Clinical and Professional Skills Teaching Delivery and Assessment Format.

The limitations posed by the COVID-19 pandemic have been particularly challenging for courses teaching clinical and professional skills. We sought to identify how the COVID-19 pandemic has impacted the delivery of veterinary clinical and professional skills courses, including modifications to teaching and assessment, and to establish educators' perceptions of the efficacy of selected delivery methods. A branching survey was deployed to 35 veterinary schools in North America in March and April 2021. The survey collected data about curriculum and assessment in spring 2020, fall 2020, and spring 2021. Educators at 16 veterinary schools completed the survey (response rate: 46%). Educators quickly adapted curriculum to meet the requirements of their institutions and governments. Early in the pandemic (spring 2020), curriculum was delayed, delivered remotely, or canceled. Assessment methods frequently included virtual objective structured clinical examinations (OSCEs) and video-recorded skills assessments. Later in the pandemic (fall 2020, spring 2021), in-person clinical skills sessions resumed at many schools, often in smaller groups. Professional skills instruction typically remained virtual, as benefits were noted. Assessment methods began to normalize with in-person OSCEs resuming with precautions, though some schools maintained virtual assessments. Educators noted some advantages to instructional methods used during COVID, including smaller group sizes, better prepared students, better use of in-person lab time, more focus on essential course components, provision of models for at-home practice, and additional educators' remote involvement. Following the pandemic, educators should consider retaining some of these changes while pursuing further advancements, including improving virtual platforms and relevant technologies.

Self-Efficacy and Student Satisfaction in a Clinical-Year Diagnostic Imaging Course Using an Online Instruction Format.

Accurate interpretation of radiographic images is critical to diagnosing clinical patients. Remote instruction in radiology has become more common at veterinary colleges as academic institutions struggle to fill open veterinary radiologist positions and as a result of the COVID-19 pandemic. This study sought to gather the feedback of fourth-year veterinary students via pre- and post-study surveys (n = 45) and focus groups (n = 7) about a newly implemented 2-week long radiology rotation. Ninety-eight percent of students reported having taken an online course before, and on both pre- and post-study surveys, students commonly reported feeling interested, determined, and attentive. On average, students reported that they were neither more nor less engaged than they would have been in an in-person course and that they understood the material neither better nor worse than they would have in an in-person course. Students reported that the key to their success was primarily hard work; secondarily, instructor availability and student ability were important. Students did not rate luck as having much influence on their success. Although diagnostic imaging can be a challenging subject to master, students effectively learned this subject through online instruction. They provided feedback for the course's continued improvement; their comments centered around improved interactivity, including providing automated quiz questions' answers and increased instructor availability. Data collected in this study will help to guide further development of the radiology course.

Simulating Ovariohysterectomy: What Type of Practice Promotes Short- and Long-Term Skills Retention?

Simulation-based surgical training allows students to learn skills through deliberate practice without the patient risk and stress of operating on a live animal. This study sought to determine the ideal distribution of training sessions to improve short- and long-term retention of the skills necessary to perform a simulated ovariohysterectomy (OVH). Fourth-semester students (n = 102) were enrolled. Students in the weekly instruction group (n = 57) completed 10 hours of training on the OVH simulator, with sessions held at approximately weekly intervals. Students in the monthly instruction group (n = 45) completed the same training with approximately monthly sessions. All students were assessed 1 week (short-term retention test) and 5 months following the last training session (long-term retention test). Students in the weekly instruction group scored higher on their short-term assessment than students in the monthly instruction group (p < .001). However, students' scores in the weekly instruction group underwent a significant decrease between their short- and long-term assessments (p < .001), while the monthly group did not experience a decrease in scores (p < .001). There was no difference in long-term assessment scores between weekly and monthly instruction groups. These findings suggest that if educators are seeking maximal performance at a single time point, scheduling instructional sessions on a weekly basis prior to that time would be superior to monthly sessions, but if educators are concerned with long-term retention of skills, scheduling sessions either on a weekly or monthly basis would accomplish that purpose.

Multimodal Prehabilitation During Neoadjuvant Therapy Prior to Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass and Quality of Life-A Pilot Randomized Clinical Trial.

BACKGROUND: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion. METHODS: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months. RESULTS: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {-0.4 [95% confidence interval (CI) -0.8 to 0.1] vs. -2.5 [95% CI -2.8 to -2.2] mL/kg/min; p = 0.022}, less muscle loss [-11.6 (95% CI -14.2 to -9.0) vs. -15.6 (95% CI -18.7 to -15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported. CONCLUSIONS: This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.

What's the evidence? A review of current instruction and assessment in veterinary surgical education.

Veterinary surgical education is improved by studying the relevant literature. The aim of this literature review was to report the theory and methods used to provide surgical education to veterinary students; to discuss the training most likely to create a competent general practitioner; and to review assessment methods for simulated and live surgeries. The literature reviewed demonstrates that new graduates are expected to perform small animal sterilization, dental extraction, onychectomy, abscess treatment, aural hematoma repair, and mass removal with little or no supervision. Students require repetitive practice to reach competence; some practice can take place in a clinical skills laboratory on models or cadavers. When training novices, distributing practice over a longer time improves retention, but months without practice causes skills to decay. Suturing skills may be taught on models at a ratio of 1 instructor per 10 students. Veterinary students require 6-10 repetitions of each small animal sterilization surgery to reach competence; however, learning curves for other surgeries have not been established. Assessment of surgical skills has been undertaken using objective structured clinical examinations (OSCEs) and observed model and live surgeries. Additional validated rubrics are needed in the field. Surgical educators are urged to continue to search for innovative ways to foster deliberate practice, assess skill, and provide feedback for students.

If you build it, they will learn: A review of models in veterinary surgical education.

Surgical skills are learned through deliberate practice, and veterinary educators are increasingly turning to models for teaching and assessing surgical skills. This review article sought to compile and review the literature specific to veterinary surgical skills models, and to discuss the themes of fidelity, educational outcomes, and validity evidence. Several literature searches using broad terms such as "veterinary surgery model," "veterinary surgical model," and "veterinary surgical simulator" were performed using PubMed, CAB abstracts, and Google scholar. All articles describing a model created and utilized for veterinary surgical training were included. Other review articles were used as a source for additional models. Commercially available models were found using review articles, internet browser searches, and communication with veterinary clinical skills educators. There has been an explosion of growth in the variety of small animal surgical task trainers published in the last several decades. These models teach orthopedic surgery, ligation and suturing, open celiotomy and abdominal surgery, sterilization surgeries, and minimally invasive surgeries. Some models were published with accompanying rubrics for learner assessment; these rubrics have been noted where present. Research in veterinary surgical models is expanding and becoming an area of focus for academic institutions. However, there is room for growth in the collection of validity evidence and in development of models for teaching large animal surgery, training surgical residents, and providing continuing education to practitioners. This review can assist with evaluation of current surgical models and trends, and provide a platform for additional studies and development of best practices.

Retention of basic surgical skills in veterinary students.

OBJECTIVE: To quantify veterinary students' retention of surgical skills after a 5-month period without practice. STUDY DESIGN: Prospective longitudinal descriptive study. SAMPLE POPULATION: Convenience sample of second year veterinary students (n = 57). METHODS: Students practiced ovariohysterectomy (OVH) on a model during 4 clinical skills laboratories during spring 2021. Students were assessed performing OVH on their model using a validated 22-item rubric. Students not meeting expectations repeated their assessment 2 weeks later. All students had a 5-month period, including summer break, without skills practice. Students were again assessed performing OVH on their model in the fall. Students' rubric scores and pass rates were compared before and after summer break. RESULTS: Students scored lower on their retention test in fall (median = 43) than at the spring assessment (median = 56, P < .001). No difference was detected between lower and higher performing students. Five students (9%) did not meet expectations on their first assessment; more students (17/57, 30%) failed to meet expectations on their retention test (P = .004). CONCLUSION: Students experienced a decay in the surgical skills required to perform OVH after a 5-month period without practice, regardless of the quality of their initial performance. CLINICAL SIGNIFICANCE: Veterinary educators should emphasize the importance of continual practice to maintain skills and should consider assisting students in regaining skills during review sessions on models to improve surgical skill retention after a prolonged break.

Evaluating validity evidence for 2 instruments developed to assess students' surgical skills in a simulated environment.

OBJECTIVE: To gather and evaluate validity evidence in the form of content and reliability of scores produced by 2 surgical skills assessment instruments, 1) a checklist, and 2) a modified form of the Objective Structured Assessment of Technical Skills (OSATS) global rating scale (GRS). STUDY DESIGN: Prospective randomized blinded study. SAMPLE POPULATION: Veterinary surgical skills educators (n =10) evaluated content validity. Scores from students in their third preclinical year of veterinary school (n = 16) were used to assess reliability. METHODS: Content validity was assessed using Lawshe's method to calculate the Content Validity Index (CVI) for the checklist and modified OSATS GRS. The importance and relevance of each item was determined in relation to skills needed to successfully perform supervised surgical procedures. The reliability of scores produced by both instruments was determined using generalizability (G) theory. RESULTS: Based on the results of the content validation, 39 of 40 checklist items were included. The 39-item checklist CVI was 0.81. One of the 6 OSATS GRS items was included. The 1-item GRS CVI was 0.80. The G-coefficients for the 40-item checklist and 6-item GRS were 0.85 and 0.79, respectively. CONCLUSION: Content validity was very good for the 39-item checklist and good for the 1-item OSATS GRS. The reliability of scores from both instruments was acceptable for a moderate stakes examination. IMPACT: These results provide evidence to support the use of the checklist described and a modified 1-item OSAT GRS in moderate stakes examinations when evaluating preclinical third-year veterinary students' technical surgical skills on low-fidelity models.

Teaching veterinary surgical skills: Comparison of massed versus spaced instruction.

OBJECTIVE: To determine the effect of massed instruction (MI) versus spaced instruction (SI) of veterinary surgical skills on students' cognitive load and skill retention. STUDY DESIGN: Prospective randomized cohort study STUDY POPULATION: First-year veterinary students from Louisiana State University (LSU; n = 47) and Lincoln Memorial University (LMU; n = 101). METHODS: Students were randomized to MI (two skills in a single session of twice the duration) or SI (one skill per session on two consecutive days). Instructors, instructional ratio, and total educational time was equivalent. Following instruction, students completed a cognitive load questionnaire and underwent a structured assessment immediately after (LMU only), 1 day after, and 3-4 weeks after learning the second skill. Students completed two supervised practice sessions one and 2 weeks after the initial laboratory session(s). RESULTS: Overall cognitive load did not differ between groups (p > .05), although LMUs MI group reported higher physical and time demands, effort, and frustration. At initial assessment, SI students scored higher than MI students for the first skill at both LSU (mean checklist score = 27.7 vs. mean = 24; p = .004) and LMU (mean global rating score = 4.76 vs. mean = 4.55; p = .029). Differences between groups were no longer evident by 3-4 weeks after instruction. CONCLUSION: SI may lead to improved immediate performance; however, supervised practice was sufficient to overcome the initial disparity. CLINICAL SIGNIFICANCE: SI may be beneficial for initial skill performance. However, SI and MI students had similar performance after 3 weeks, suggesting the more convenient curricular design of MI may be sufficient as long as practice sessions are incorporated.

Remote Assessment of Veterinary Clinical Skills Courses During the COVID-19 Pandemic.

In spring 2020, the COVID-19 pandemic forced educators to adjust the delivery and assessment of curriculum. While didactic courses moved online, laboratory courses were not amenable to this shift. In particular, assessment of clinical skills courses through common methods including objective structured clinical examinations (OSCEs) became inadvisable. This article describes decisions made for first-, second-, and third-year veterinary students (n = 368) with respect to clinical skills at one US college. This includes the remote completion of a surgical skills curriculum using instructional videos and models and the delaying of laboratory sessions deemed impossible to deliver remotely. First- and third-year students were subsequently assessed using modified remote OSCEs. Second-year students were assessed using the standard surgical skills examination, video-recorded. All first- and third-year students successfully passed their OSCE upon either first attempt or remediation. Two second-year students failed their remediation examination and were offered additional faculty tutoring and another remediation attempt at the start of the fall semester. The remediation rate on the surgical skills examination was not different from that of previous years. One incident of suspected academic dishonesty occurred in the first-year OSCE. Students learned surgical skills successfully at home by practicing on models and receiving feedback of their skills on video recordings. While disappointing, one case of academic dishonesty among the 368 total students tested was not surprising. Remote assessment using modified OSCEs and surgical skills exams appears feasible and fair when in-person testing is not possible.

Online Case-Based Course in Veterinary Radiographic Interpretation Generates Better Short- and Long-Term Learning Outcomes than a Virtual Lecture-Based Course.

Accurate interpretation of radiographs is necessary for the correct diagnosis and treatment of patients. Research has shown that active learning methods, including case-based learning, are superior to passive learning methods, such as lectures.1,2 Short-term learning outcomes were compared between two groups by enrolling 80 fourth-semester veterinary students in either an online case-based radiology course (n = 40) or a virtual lecture-based course (n = 40). Long-term learning outcomes were compared among three groups: one group completed case-based instruction in the fourth semester, followed by lecture-based instruction in the fourth semester (n = 19); the second group completed only lecture-based instruction in the fourth semester (n = 22), and the third group completed lecture-based instruction in the fourth semester, followed by case-based instruction in the fifth semester (n = 9). Learning was assessed using a multiple-choice examination and two independently written small animal radiograph reports. In the fourth semester, students completing the case-based course had higher examination scores and radiograph report scores than students who took the lecture-based course. Students completing the lecture-based course in the fourth semester and the case-based course in the fifth semester wrote better radiograph reports than students who completed both courses in the fourth semester; both groups wrote better reports than students who did not take the case-based course. A case-based diagnostic imaging course may be better than a lecture-based course for both short- and long-term retention of knowledge; however, there is a significant loss of knowledge following an instructional gap, and spaced refreshers may boost retention.

Academics' Experiences in Veterinary Educational Research: Results of an International Survey.

Research conducted by the veterinary education community is critical to continual improvement of educational outcomes. Additionally, research productivity is one metric in promotion and tenure decisions. We sought to identify challenges encountered or anticipated when undertaking or planning veterinary educational research (VER), to learn how these challenges might be overcome, and to synthesize tips for success from those who have performed VER. A branching survey was developed and deployed along the authors' worldwide veterinary education contacts in a cascading manner. The survey collected quantitative and qualitative information from participants who had performed VER and those who planned to perform VER in the future. The 258 participants represented 41 countries. Of the participants, 204 had performed VER (79%) and 54 planned to in the future (21%). The median time spent teaching was 14 years, and median time performing VER was 5 years. The most commonly reported challenges in performing VER were lack of funding, lack of time, and difficulties encountered when undertaking a study, including data collection, analysis, and publishing. When asked about overcoming the challenges, a major theme emerged around people, who provided expertise and mentoring. The most commonly reported tip for success was collaboration; 73% of experienced researchers reported people as most helpful upon beginning VER. Collaborators provided diverse help with ideas, study design, statistics, and other aspects. These results suggest that institutions can offer support to academics in the form of small grants, protected research time, writing workshops, and mentorship to assist with the production of meaningful VER.

Validation of a Rubric Used for Skills-Based Assessment of Veterinary Students Performing Simulated Ovariohysterectomy on a Model.

Surgical skills are an important competency for new graduates. Simulators offer a means to train and assess veterinary students prior to their first surgical performance. A simulated ovariohysterectomy (OVH) rubric's validity was evaluated using a framework of content evidence, internal structure evidence, and evidence of relationship with other variables, specifically subsequent live surgical performance. Clinically experienced veterinarians (n = 13) evaluated the utility of each rubric item to collect evidence; each item's content validity index was calculated to determine its inclusion in the final rubric. After skills training, veterinary students (n = 57) were assessed using the OVH model rubric in March and August. Internal structure evidence was collected by video-recording 14 students' mock surgeries, each assessed by all five raters to calculate inter-rater reliability. Relationship with other variables evidence was collected by assessing 22 students performing their first live canine OVH in November. Experienced veterinarians included 22 items in the final rubric. The rubric generated scores with good to excellent internal consistency; inter-rater reliability was fair. Students' performance on the March model assessment was moderately correlated with their live surgical performance (ρ = 0.43) and moderately negatively correlated with their live surgical time (ρ = -0.42). Students' performance on the August model assessment, after a summer without surgical skills practice, was weakly correlated with their live surgical performance (ρ = 0.17). These data support validation of the simulated OVH rubric. The continued development of validated assessment instruments is critical as veterinary medicine seeks to become competency based.

Practical Tips for Setting Up and Running OSCEs.

Objective structured clinical examinations (OSCEs) are used to assess students' skills on a variety of tasks using live animals, models, cadaver tissue, and simulated clients. OSCEs can be used to provide formative feedback, or they can be summative, impacting progression decisions. OSCEs can also drive student motivation to engage with clinical skill development and mastery in preparation for clinical placements and rotations. This teaching tip discusses top tips for running an OSCE for veterinary and veterinary nursing/technician students as written by an international group of authors experienced with running OSCEs at a diverse set of institutions. These tips include tasks to perform prior to the OSCE, on the day of the examination, and after the examination and provide a comprehensive review of the requirements that OSCEs place on faculty, staff, students, facilities, and animals. These tips are meant to assist those who are already running OSCEs and wish to reassess their existing OSCE processes or intend to increase the number of OSCEs used across the curriculum, and for those who are planning to start using OSCEs at their institution. Incorporating OSCEs into a curriculum involves a significant commitment of resources, and this teaching tip aims to assist those responsible for delivering these assessments with improving their implementation and delivery.

Acute Response of Sclerostin to Whole-body Vibration with Blood Flow Restriction.

Blood flow restriction may augment the skeletal response to whole-body vibration. This study used a randomised, crossover design to investigate the acute response of serum sclerostin and bone turnover biomarkers to whole-body vibration with blood flow restriction. Ten healthy males (mean±standard deviation; age: 27±8 years) completed two experimental conditions separated by 7 days: (i) whole-body vibration (10 1-minute bouts of whole-body vibration with 30 s recovery) or (ii) whole-body vibration with lower-body blood flow restriction (10 cycles of 110 mmHg inflation with 30 s deflation during recovery). Fasting blood samples were obtained immediately before and immediately after exercise, then 1 hour, and 24 hours after exercise. Serum samples were analysed for sclerostin, cross-linked C-terminal telopeptide of type I collagen, and bone-specific alkaline phosphatase. There was a significant time × condition interaction for bone-specific alkaline phosphatase (p=0.003); bone-specific alkaline phosphatase values at 24 hours post-exercise were significantly higher following whole-body vibration compared to combined whole-body vibration and blood flow restriction (p=0.028). No significant time × condition interaction occurred for any other outcome measure (p>0.05). These findings suggest that a single session of whole-body vibration combined with blood flow restriction does not significantly affect serum sclerostin or bone turnover biomarkers.

Influence of instructor-to-student ratio for teaching suturing skills with models.

OBJECTIVE: To evaluate the influence of instructor to student ratio on the effectiveness and efficiency of teaching suturing skills to veterinary students. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Second-year veterinary students (N = 121). METHODS: Students were randomly divided into three groups to participate in four 2-hour skills laboratory sessions in which suturing of the subcutaneous tissue was taught by using a simple continuous pattern, suturing of the skin was taught by using continuous patterns, suturing of the skin was taught by using interrupted patterns, and suturing of hollow organs was taught by using inverting patterns. For each laboratory, the groups were taught by using instructor-to-student ratios of 1:6, 1:8, and 1:10 on a rotating basis. Students were surveyed at the end of each laboratory, and underwent individual performance assessments at the end of each laboratory session and again at the end of the semester in an objective structured clinical examination (OSCE). RESULTS: For each of the four in-laboratory assessments and the OSCE, no difference in performance was detected between groups. When they were surveyed, students in all groups reported that there was an adequate number of instructors in the laboratory and that they received help in a timely fashion when help was requested (median for all groups = agree). CONCLUSION: For students with prior surgical skills education and with the use of prelaboratory instructional videos, teaching at the 1:10 instructor-to-student ratio was efficient and effective. CLINICAL SIGNIFICANCE: Good educational outcomes may be reached with a 1:10 instructor-to-student ratio or, potentially, fewer instructors, depending on the educational aids present in the laboratory and students' prior level of experience.

The impact of gel fingernail polish application on the reduction of bacterial viability following a surgical hand scrub.

OBJECTIVE: To determine the effect of gel nail polish application on the reduction of bacterial viability immediately after a surgical hand scrub. STUDY DESIGN: Randomized controlled trial. SAMPLE POPULATION: Ten fingernails each from 40 female health care professionals and students. METHODS: Participants' fingernails were randomized to receive no polish or gel nail polish during a manicure from a licensed manicurist. One day and 14 days after manicure, participants' fingernails were sampled before and after a surgical hand scrub with chlorhexidine gluconate. The samples for each fingernail were serially diluted, plated on a Trypsin sheep blood agar and MacConkey's agar plate, and incubated for 36 h. For each plate, bacterial colony forming units (CFU)/ml were determined. Mixed linear models were used to assess factors associated with the logarithmic reduction of viable bacterial counts from pre- to post-surgical scrub. RESULTS: In the final model, no association was detected between gel nail polish and reduction of viable bacterial count (p = .09). On Day 14, among longer nail lengths (2 to <3-mm and ≥3-mm), surgical scrubs resulted in greater reduction in bacterial counts in left-handed than right-handed participants (p < .01). Increasing nail length was correlated with increased CFU/ml post-scrubbing (p < .001). CONCLUSION: Application of gel nail polish did not seem to affect the ability of surgical scrub to reduce bacterial viability 1 and 14 days after a manicure. CLINICAL IMPACT: This study does not provide evidence to prevent application of gel nail polish on short fingernails in surgeons prior to surgical hand scrub with chlorhexidine gluconate.

Educational Research Report Comparison of Three Canine Models for Teaching Veterinary Dental Cleaning.

Veterinary dental cleaning prevents and treats periodontal disease, one of the most common diagnoses in small animal practice. Students learn to perform dental cleaning through deliberate practice, which can be gained through working on models. This study compared educational outcomes after students (n = 36) were randomized to practice on one of three dental cleaning models: a low-fidelity ceramic tile, a mid-fidelity three-dimensional (3D) printed canine skull model, or a high-fidelity canine head model. Students provided survey feedback about their model and later performed a dental cleaning on a canine cadaver head while being video-recorded. Experts (n = 10) provided feedback on each model. Experts agreed that all models were suitable for teaching dental cleaning, but the 3D skull and full head models were more suitable for assessing student skill (p = .002). Students were also more positive about the realism and features of those two models compared to the tile model. Students practicing on each of the models were equally effective at removing calculus from the cadavers' teeth. Students who learned on the tile model were a median of 4 minutes slower to remove calculus from their cadaver's teeth than students who trained on the canine head model. Although students may be more accepting of the 3D skull and full head models, all three models were equally effective at teaching the skill. Experts approved all models for teaching, but recommended the 3D skull or full head model if student skills were to be assessed. Low-fidelity models remain effective training tools with comparable learning outcomes.