The multiple mini-interview in the U.K. context: 3 years of experience at Dundee.

BACKGROUND: The multiple mini-interview (MMI) is a new interview process that Dundee Medical School has recently adopted to assess entrants into its undergraduate medicine course. This involves an 'objective structured clinical examination' like rotational approach in which candidates are assessed on specific attributes at a number of stations. AIMS: To present methodological, questionnaire and psychometric data on the transitional process from traditional interviews to MMIs over a 3-year period and discuss the implications for those considering making this transition. METHODS: To facilitate the transition, a four-station MMI was piloted in 2007. Success encouraged consideration of desirable attributes which were used to develop a full 10-station process which was implemented in 2009 with assessors being recruited from staff, students and simulated patients. A questionnaire was administered to all assessors and candidates who participated in the 2009 MMIs. Cronbach's alpha and Pearson's r and analysis of variances were used to determine the MMI's psychometric properties. Multi-faceted Rasch modelling (MFRM) was modelled to control for assessor leniency/stringency and the impact of using 'fair scores' determined. Analysis was conducted using SPSS 17 and FACETS 3.65.0. RESULTS: The questionnaire confirmed that the process was acceptable to all parties. Cronbach's alpha reliability was satisfactory and consistent. Graduates/mature candidates outperformed U.K. school-leavers and overseas candidates. Using MFRM fair scores would change the selection outcome of 6.2% and 9.6% of candidates in 2009 and 2010, respectively. Students were less lenient, made more use of the full range of the rating scales and were just as reliable as staff. CONCLUSIONS: The strategy of generating institutional support through staged introduction proved effective. The MMI in Dundee was shown to be feasible and displayed sound psychometric properties. Student assessors appeared to perform at least as well as staff. Despite a considerable intellectual and logistical challenge MMIs were successfully introduced and deemed worthwhile.

Basic life support instructor training: comparison of instructor-led and self-guided training.

In this randomized trial, the authors compared the instructional quality of instructor candidates trained in instructional methods through an Internet-based versus a traditional classroom-led version of the American Heart Association Core Instructor Course. The self-guided, Internet-based group had significantly higher posttest scores than did the traditional instructor-led group (although not when adjusted for pretest scores). The Internet-based group scores changed from 54% to 67%, exceeding the a priori definition of 8% as a minimally practically significant improvement (instructor-led group scores changed from 49% to 53%). The Internet-based course appeared to be a suitable alternative to the traditional course.

Rapid development of interprofessional in situ simulation-based training in response to the COVID-19 outbreak in a tertiary-level hospital in Ireland: initial response and lessons for future disaster preparation.

Introduction: The first case of COVID-19 in Ireland was diagnosed on 29 February 2020. Within the same week, our Department of Anaesthesia and Critical Care at University Hospital Galway began to tackle the educational challenge by developing an  in situ interprofessional simulation programme to prepare staff for the impending outbreak. Principles and approaches used for simulation-based training: We describe principles applied to identify core educational and system engineering objectives to prepare healthcare workers (HCWs) for infection control, personal and psychological safety, technical and crisis resource management skills. We discuss application of educational theories, rationale for simulation modes and debriefing techniques. Development of the simulation programme: 3 anaesthesia (general, obstetric, paediatric) and 1 critical care silo were created. 13 simulated scenarios were developed for teaching as well as for testing workflows specific to the outbreak. To support HCWs and ensure safety, management guidelines, cognitive aids and checklists were developed using simulation. The cumulative number of HCWs trained in simulation was 750 over a 4-week period. Challenges and future directions: Due to the protracted nature of the pandemic, simulation educators should address questions related to sustainability, infection control while delivering simulation, establishment of hybrid programmes and support for psychological preparedness.

Does the UKCAT predict Year 1 performance in medical school?

CONTEXT: The need to identify the best applicants for medicine and to ensure that selection is fair and ethical has led to the development of alternative, or additional, selection tools. One such tool is the United Kingdom Clinical Aptitude Test, or UKCAT. To date there have been no studies of the predictive validity of the UKCAT. OBJECTIVES: This study set out to identify whether UKCAT total score and subtest scores predict Year 1 outcomes in medical school. METHODS: Year 1 students starting in 2007 at the University of Aberdeen or University of Dundee medical schools were included. Data collected were: UKCAT scores; Universities and Colleges Admissions Service (UCAS) form scores; admission interview scores; final Year 1 degree examination scores, and records of re-sitting examinations and of withdrawing from a course. Correlations were used to select variables for multiple regression analysis to predict examination scores. RESULTS: Data were available for 341 students. Examination scores did not correlate with UKCAT total or subtest scores. Neither UCAS form score nor admission interview score predicted outcomes. None of the UKCAT scores were reliably associated with withdrawals (P-values for all comparisons > 0.05). Only the decision analysis subtest was associated with re-sits of examinations, but the difference in means was contrary to the direction anticipated (P = 0.025, 95% confidence interval = 6.1-89.7). DISCUSSION: UKCAT scores did not predict Year 1 performance at the two medical schools. Although early prediction is arguably not the primary aim of the UKCAT, there is some cause for concern that the test failed to show even the small-to-moderate predictive power demonstrated by similar admissions tools.

Assessment of BLS skills: optimizing use of instructor and manikin measures.

BACKGROUND: The primary objective of layperson CPR training is to ensure that learners achieve minimal competence to provide aid that improves the odds of survival of victims of out-of-hospital sudden cardiac arrest. During CPR courses, pronouncement of a learner's competence typically depends entirely on judgments made by an instructor; yet previous research strongly suggests that these judgments - particularly of chest compressions - are not sufficiently precise or accurate to ensure valid assessments. Comparisons of instructors' subjective assessments with objective data from recording manikins provide one means of understanding the magnitude and type of instructor errors in assessment. METHOD: Eight hundred and twenty-six laypersons between 40 and 70 years old participated in CPR training. Performance of five discrete skills was tested in a scenario format immediately afterward: assessing responsiveness, calling the emergency telephone number 911, delivering ventilations of adequate volume, demonstrating correct hand placement for compressions, and delivering compressions with adequate depth. Thirteen AHA-certified instructors assessed these five skills and rendered a global performance rating; sensored Resusci Anne manikins with SkillReporting software recorded ventilation and compression data. RESULTS: Instructors' ratings of the ventilation skills were highly accurate; ratings of compressions were correct about 83% of the time; yet inadequate compression depth was rated adequate 55% of the time, and incorrect hand placement was rated adequate 49% of the time. CONCLUSION: Instructors' judgments alone are not sufficient to determine learners' competence in performing compressions. Assessment, technology, and guidelines must be better aligned so that learners can receive accurate feedback.

Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study.

BACKGROUND: Bystander CPR improves outcomes after out of hospital cardiac arrest. The length of current 4-h classes in cardiopulmonary resuscitation (CPR) is a barrier to more widespread dissemination of CPR training and older adults in particular are underrepresented in traditional classes. Training with a brief video self-instruction (VSI) program has shown that this type of training can produce short-term skill performance at least as good as that seen with traditional American Heart Association (AHA) Heartsaver training, although it is unclear whether there is comparable skill retention. METHODS AND RESULTS: Two hundred and eight-five adults between the ages of 40 and 70 who had no CPR training within the past 5 years were assigned at random to a no-training control group, Heartsaver (HS) training, or one of three versions of brief VSI (i.e., self-trained-ST subjects). Post-training performance of CPR skills was assessed in a scenario format by human examiners and by sensored manikin at Time 1 (immediately post-training) and again at Time 2 (2 months post-training). Performance by controls was assessed only once. Significant (P<.001) decline was observed in the three measures recorded by examiners; assess responsiveness (from 72% to 60% for HS subjects and from 90% to 77% for ST subjects), call 911 (from 82% to 74% for HS subjects and from 71% to 53% for ST subjects), and overall performance (from 42% to 30% for HS subjects and from 60% to 44% for ST subjects). Significant (P<.001) decline was observed in two of three skills measured by a sensored manikin: ventilation volume (from 40% to 36% for HS subjects and from 61% to 41% for ST subjects, with a significant [P=.028] interaction) and correct hand placement (from 68% to 59% for HS subjects and from 80% to 64% for ST subjects). Heartsaver and self-trained subjects generally showed similar rates of decline. At Time 2, examiners rated trained subjects better than untrained controls in all skills except calling 911, where self-trained subjects did not differ from controls; manikin data revealed that trained subjects' performance was better than that of controls for ventilation volume, but had declined to the level of controls for both hand placement and compression depth. CONCLUSIONS: Adults between 40 and 70 years of age who participated in a CPR VSI program experienced performance decline in their CPR skills after a post-training interval of 2 months. However, this decline was no greater than that seen in subjects who took Heartsaver training. The VSI program produced retention performance at least as good as that seen with traditional training. Additional effort is needed to improve both initial performance and retention of CPR skills. CONDENSED ABSTRACT: Retention of CPR skills was compared 2 months post-training for adults between 40 and 70 years old who had taken either a traditional Heartsaver CPR course or a 22-min video self-directed training course. Although performance declines occurred in the 2-month interval, self-trained subjects generally demonstrated CPR skill retention equivalent to that of Heartsaver-trained subjects, although for both groups skill decline on some measures reached the level of untrained controls.

Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study.

BACKGROUND: The length of current 4-h classes in cardiopulmonary resuscitation (CPR) is a barrier to widespread dissemination of CPR training. The effectiveness of video-based self-instruction (VSI) has been demonstrated in several studies; however, the effectiveness of this method with older adults is not certain. Although older adults are most likely to witness out-of-hospital cardiac arrests, these potential rescuers are underrepresented in traditional classes. We evaluated a VSI program that comprised a 22-min video, an inflatable training manikin, and an audio prompting device with individuals 40-70 years old. The hypotheses were that VSI results in performance of basic CPR skills superior to that of untrained learners and similar to that of learners in Heartsaver classes. METHODS: Two hundred and eighty-five adults between 40 and 70 years old who had had no CPR training within the past 5 years were assigned to an untrained control group, Heartsaver training, or one of three versions of VSI. Basic CPR skills were measured by instructor assessment and by a sensored manikin. RESULTS: The percentage of subjects who assessed unresponsiveness, called the emergency telephone number 911, provided adequate ventilation, proper hand placement, and adequate compression depth was significantly better (P<0.05) for the VSI groups than for untrained controls. VSI subjects tended to have better overall performance and better ventilation performance than did Heartsaver subjects. CONCLUSIONS: Older adults learned the fundamental skills of CPR with this training program in about half an hour. If properly distributed, this type of training could produce a significant increase in the number of lay responders who can perform CPR.

With or without an instructor, brief exposure to CPR training produces significant attitude change.

BACKGROUND: A common reason for bystanders' failure to perform CPR in real or hypothetical situations is their lack of confidence in themselves. CPR self-training, which uses learner-operated virtual media rather than a live instructor, has not been assessed for its ability to influence learners' attitudes toward performing CPR in a real emergency. The aim of this study was to compare attitude effects associated with traditional, live instruction versus self-training or no instruction. METHOD: Data from 1069 lay learners were collected. Learners were assigned randomly to a traditional instructor-led course, a video-based self-training course, or a no-training control group. All learners completed pre-training and post-training questionnaires that assessed competence, confidence, and willingness to perform CPR. Learners' objective performance of CPR was also assessed, post-training, via a recording manikin. RESULTS: ANOVA revealed that, in all 3 groups, all 3 attitudes changed significantly from pre- to post-questionnaire; further, the amount of attitude change did not differ reliably among the 3 groups (P<.05). Of the objective measures, ventilation performance was the only one consistently and positively correlated with attitudes (P<.05). Despite focus group comments that suggested self-trained learners' concerns about the rudimentary nature of their training, these concerns did not manifest as a hindrance to positive attitude change. CONCLUSIONS: Live training does not pose any measurable advantage for developing learners' positive attitudes. The counterintuitive finding that controls experienced similar levels of attitude change suggests that mere exposure to CPR testing can have positive effects on attitudes.