A proposed model for a comprehensive virtual subinternship in vascular surgery.

OBJECTIVE: In the present study, we sought to understand the challenges, advantages, and applications of a vascular surgery virtual subinternship (VSI) curriculum. METHODS: Our institution hosted 25 students for two 4-week VSI rotations, one in July 2020 and one in August 2020. The students participated in a curriculum centered around the use of Zoom and telephone interactions with residents and faculty. The curriculum included selected readings, surgical videos, group didactics, and one-on-one mentorship. Anonymous pre- and postrotation self-assessments were used to ascertain the students' achievement of the learning objectives and the utility of the educational tools implemented during the rotation. The faculty and resident mentors were also surveyed to assess their experience. RESULTS: With the exception of knot-tying techniques (P = .67), the students reported significant improvement in their understanding of vascular surgery concepts after the virtual elective (P < .05). The highest ranked components of the course were interpersonal, including interaction with faculty, mentorship, and learning the program culture. The lowest ranked components of the course were simulation training and research opportunities. The rating of the utility of aspects of the course were consistent with the ranking of the components, with faculty interaction receiving the highest average rating. The ideal amount of time for daily virtual interaction reported by the students ranged from 3 to 6 hours (median, 4 hours). Overall, most of the mentors were satisfied with the virtual course. However, they reported limited ability to assess the students' personality and fit for the program. The time spent per week by the mentors on the virtual vascular surgery rotation ranged from 2 to 7 hours (median, 4 hours). Of the 17 mentors completing the surveys, 14 reported that having a virtual student was a significant addition to their existing workload. CONCLUSIONS: Overall, our student and mentor feedback was positive. Several challenges inherent to the virtual environment still require refinement. However, the goals of a VSI are distinct and should be explored by training programs. With changes to healthcare in the United States on the horizon and the constraints resulting from the severe acute respiratory syndrome coronavirus 2 pandemic, implementing a virtual away rotation could be an acceptable platform in our adaptations of our recruitment strategies.

COVID-19 Impact on Surgical Resident Education and Coping.

BACKGROUND: Healthcare systems and surgical residency training programs have been significantly affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A shelter-in-place and social distancing mandate went into effect in our county on March 16, 2020, considerably altering clinical and educational operations. Along with the suspension of elective procedures, resident academic curricula transitioned to an entirely virtual platform. We aimed to evaluate the impact of these modifications on surgical training and resident concerns about COVID-19. MATERIALS AND METHODS: We surveyed residents and fellows from all eight surgical specialties at our institution regarding their COVID-19 experiences from March to May 2020. Residents completed the survey via a secure Qualtrics link. A total of 38 questions addressed demographic information and perspectives regarding the impact of the COVID-19 pandemic on surgical training, education, and general coping during the pandemic. RESULTS: Of 256 eligible participants across surgical specialties, 146 completed the survey (57.0%). Junior residents comprised 43.6% (n = 61), compared to seniors 37.1% (n = 52) and fellows 19.3% (n = 27). Most participants, 97.9% (n = 138), anticipated being able to complete their academic year on time, and 75.2% (n = 100) perceived virtual learning to be the same as or better than in-person didactic sessions. Participants were most concerned about their ability to have sufficient knowledge and skills to care for patients with COVID-19, and the possibility of exposure to COVID-19. CONCLUSIONS: Although COVID-19 impacted residents' overall teaching and clinical volume, residency programs may identify novel virtual opportunities to meet their educational and research milestones during these challenging times.

Online educational materials for appendectomy patients have good quality but poor readability.

BACKGROUND: Guidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials. METHODS: Webpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed quality using the Brief DISCERN tool. RESULTS: Thirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality. CONCLUSIONS: Readability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability.

Evaluation of Available Online Information Regarding Treatment for Vitreous Floaters.

OBJECTIVE: To assess the quality, content, and readability of information available online on vitreous floater information. DESIGN: Cross-sectional study. PARTICIPANTS: Not applicable. METHODS: Websites were generated using a Google search of "vitreous floaters treatment" and "[State]" and were analyzed using a standardized checklist of 22 questions. Readability was assessed using the Flesch Reading Ease score. Websites met qualification criteria if they represented U.S.-based institutions, if they provided clinical care and addressed vitreous floater treatment on their website. RESULTS: Of the 1,065 websites screened, 456 were included. Of these, 406 (89%) were private institutions, 24 (5.3%) were academic, and 26 (5.7%) were a combination of private and academic. The average readability score correlated to a 10th-12th grade reading level. Vitreous floater treatment was discussed on 283 (62.1%) websites and 63 (21.8%) websites discussed potential side effects. Google rank was inversely correlated with the depth of explanation (r = -0.114, p = .016). Observation was the main treatment recommended (55.8%, n = 158), followed by laser treatment (27.6%, n = 78), no specific treatment recommendation (11.3%, n = 32), and vitrectomy (5.3%, n = 15). Centers with vitreoretinal surgeons were 16.43 times more likely to recommend vitrectomy than those without vitreoretinal surgeons (p < .001). CONCLUSIONS: Online information about vitreous floater treatment is variable, and the material is at a higher than recommended reading level for health information. While treatment was discussed by nearly two thirds of websites, less than a quarter mentioned possible complications, and treatment recommendations varied significantly depending on physician training.

Implementation and evaluation of eight virtual surgical electives for medical students during the COVID-19 pandemic.

BACKGROUND: Eight novel virtual surgery electives (VSEs) were developed and implemented in April-May 2020 for medical students forced to continue their education remotely due to COVID-19. METHODS: Each VSE was 1-2 weeks long, contained specialty-specific course objectives, and included a variety of teaching modalities. Students completed a post-course survey to assess changes in their interest and understanding of the specialty. Quantitative methods were employed to analyze the results. RESULTS: Eighty-three students participated in the electives and 67 (80.7%) completed the post-course survey. Forty-six (68.7%) respondents reported "increased" or "greatly increased" interest in the course specialty completed. Survey respondents' post-course understanding of each specialty increased by a statistically significant amount (p-value = <0.0001). CONCLUSION: This initial effort demonstrated that VSEs can be an effective tool for increasing medical students' interest in and understanding of surgical specialties. They should be studied further with more rigorous methods in a larger population.

The lasting footprint of COVID-19 on surgical education: A resident and attending perspective on the global pandemic.

BACKGROUND: The COVID-19 pandemic has impacted surgical training nationwide. Our former curricula will likely not return, and training will need to adapt, so we are able to graduate residents of the same caliber as prior to the pandemic. METHODS: A survey evaluating perceptions of changes made in surgical training was conducted on surgery residents and attendings. RESULTS: Disaster medicine training has become more relevant and 85% residents and 75% attendings agreed it should be incorporated into the curriculum. Safety of family was the most significant concern of residents. Virtual curriculum was perceived to be acceptable by 82% residents and only 22% attendings (p < 0.01). Residents (37%) were less concerned than attendings (61%) of falling behind on their overall training (p = 0.04). Both groups agreed operative skills would be adversely affected (56%vs72%; p = 0.37). CONCLUSIONS: To maintain an effective surgical curriculum, programs will need to implement new educational components to better prepare residents to become surgeons of the future.

Standardized Perioperative Patient Education Decreases Opioid Use after Hand Surgery: A Randomized Controlled Trial.

BACKGROUND: Despite the growing hand surgery literature on postoperative opioid use, there is little research focused on patient-centered interventions. The purpose of this randomized controlled trial was to create a standardized patient education program regarding postoperative pain management after hand surgery and to determine whether that education program would decrease postoperative opioid use. METHODS: Patients scheduled to undergo ambulatory hand surgery were recruited and randomized to standardized pain management education or standard of care. All patients received a webinar with instructions for study participation, whereas the education group received an additional 10 minutes of education on postoperative pain management. All patients completed a postoperative daily log documenting opioid consumption. The total number of opioid pills consumed was compared between groups. The authors constructed a linear regression model to determine risk factors for postoperative opioid use after surgery. RESULTS: A total of 267 patients were enrolled in the study. One hundred ninety-one patients completed the study (standardized education, n = 93; control group, n = 97). Patients in the standardized education group were more likely to take no opioid medication (42 percent versus 25 percent; p = 0.01) and took significantly fewer opioid pills (median, two) than those in the control group (median, five) (p < 0.001). Standardized education predicted decreased postoperative opioid pill consumption, whereas higher number of pills prescribed and a history of psychiatric illness were risk factors for increasing opioid use. CONCLUSION: Perioperative patient education and limitation of postoperative opioid prescription sizes reduced postoperative opioid use following ambulatory hand surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Evaluation of academic integrity of online open book assessments implemented in an undergraduate medical radiation science course during COVID-19 pandemic.

INTRODUCTION: Online open book assessment has been a common alternative to a traditional invigilated test or examination during the COVID-19 pandemic. However, its unsupervised nature increases ease of cheating, which is an academic integrity concern. This study's purpose was to evaluate the integrity of two online open book assessments with different formats (1. Tightly time restricted - 50 min for mid-semester and 2. Take home - any 4 h within a 24-h window for end of semester) implemented in a radiologic pathology unit of a Bachelor of Science (Medical Radiation Science) course during the pandemic. METHODS: This was a retrospective study involving a review and analysis of existing information related to the integrity of the two radiologic pathology assessments. Three integrity evaluation approaches were employed. The first approach was to review all the Turnitin plagiarism detection software reports with use of 'seven-words-in-a-row' criterion to identify any potential collusion. The second approach was to search for highly irrelevant assessment answers during marking for detection of other cheating types. Examples of highly irrelevant answers included those not addressing question requirements and stating patients' clinical information not from given patient histories. The third approach was an assessment score statistical analysis through descriptive and inferential statistics to identify any abnormal patterns that might suggest cheating occurred. An abnormal pattern example was high assessment scores. The descriptive statistics used were minimum, maximum, range, first quartile, median, third quartile, interquartile range, mean, standard deviation, fail and full mark rates. T-test was employed to compare mean scores between the two assessments in this year (2020), between the two assessments in the last year (2019), between the two mid-semester assessments in 2019 and 2020, and between this and last years' end of semester assessments. A p-value of less than 0.05 was considered statistically significant. RESULTS: No cheating evidence was found in all Turnitin reports and assessment answers. The mean scores of the end of semester assessments in 2019 (88.2%) and 2020 (90.9%) were similar (p = 0.098). However, the mean score of the online open book mid-semester assessment in 2020 (62.8%) was statistically significantly lower than that of the traditional invigilated mid-semester assessment in 2019 (71.8%) with p < 0.0001. CONCLUSION: This study shows the use of the online open book assessments with tight time restrictions and the take home formats in the radiologic pathology unit did not have any academic integrity issues. Apparently, the strict assessment time limit played an important role in maintaining their integrity.

Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

[Experience of teaching and training for medical students at gastrointestinal surgery department under COVID-19 epidemic situation].

In hospitals and medical schools as densely populated sites with high risk of coronavirus disease 2019 (COVID-19), it is vital to adjust the teaching and training strategy for medical students to ensure curriculum completion with safety. This article aims to introduce the experience of teaching and training for medical students under the epidemic situation at Department of Surgery, Shanghai Medical College, Fudan University and Zhongshan Hospital. The content includes exploring diversified online teaching models for undergraduate surgery courses and clinical practice, carrying out online graduate education and dissertation plans, and strengthening comprehensive education of medical humanity combined with knowledge of COVID-19 prevention. Through implementation of the above teaching strategies, scheduled learning plans of medical students can be well completed in an orderly, safe and quality-ensured manner. Our experience provides practical solution of medical teaching and could be advisable for other medical colleges and teaching hospitals.

A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

Background: Ultrasonographic features can be used to predict mediastinal lymph node malignancy during endobronchial ultrasonography. Despite the validity of using these features for this purpose, the features are not being widely used in clinical practice. This may be attributable to the absence of educational programs that teach clinicians how to identify the features. To address this knowledge gap, we developed an online educational module to teach clinicians how to correctly interpret ultrasonographic features. Methods: The module was designed using corrective feedback and test-enhanced learning theories and distributed to clinicians in relevant specialties. The efficacy of the program was determined by comparing the percentages of correctly identified ultrasonographic features as each clinician progressed through the module. Participants were also asked to self-rate their confidence during the module. Analysis of variance was conducted, and a learning curve and descriptive statistics were generated. Results: Twenty-two of the 29 participants (76%) completed the module. Analysis of variance indicated that the percentage of correctly identified features increased significantly as clinicians completed the module (p = 0.004); this finding is supported by the positive slope of the learning curve. Even though they initially reported some difficulty with identifying certain features, their confidence increased as they progressed through the module. When asked, 86% of participants reported that they found the educational module helpful and 90% reported that they would recommend it to others. Conclusion: Participating clinicians were receptive to the interactive educational module. It enhances clinician skill and confidence in interpreting ultrasonographic features. The results of this study provide the foundation needed to test the validity of the educational module in clinical settings and to further explore clinician preferences for educational programs.

Contexte: Les caractéristiques échographiques permettent de prédire la malignité des ganglions lymphatiques médiastinaux durant l'échographie endobronchique. Malgré leur validité à cette fin, ces caractéristiques ne sont pas très utilisées dans la pratique clinique. Cela pourrait être attribuable à l'absence de programmes de formation pour enseigner aux médecins comment repérer ces caractéristiques. Pour répondre à cette lacune au plan des connaissances, nous avons conçu un module de formation en ligne pour enseigner aux médecins comment interpréter correctement les caractéristiques échographiques. Méthodes: Le module a été conçu selon les théories de rétroaction corrective et d'apprentissage par test et a été distribué aux médecins des spécialités concernées. L'efficacité du programme a été déterminée en comparant les pourcentages de caractéristiques échographiques correctement identifiées à mesure que chaque médecin progressait d'une étape à l'autre du module. Les participants ont aussi été invités à autoévaluer leur degré de confiance pendant la réalisation du module. On a ensuite procédé à une analyse de la variance et on a généré une courbe d'apprentissage et des statistiques descriptives. Résultats: Vingt-deux participants sur 29 (76 %) ont mené le module à terme. L'analyse de la variance a indiqué que le pourcentage de caractéristiques correctement identifiées augmentait significativement à mesure que les médecins finalisaient leur module (p = 0,004); cette observation est confirmée par la courbe d'apprentissage positive. Même s'ils avaient initialement fait état de certaines difficultés à identifier des caractéristiques, leur degré de confiance a augmenté au fur et à mesure qu'ils avançaient. Quatre-vingt-six pour cent des participants ont indiqué avoir trouvé le module utile et 90 % ont dit qu'ils le recommanderaient. Conclusion: Les médecins participants ont bien accueilli ce module éducatif interactif : il améliore les habiletés et le degré de confiance des médecins en leur capacité d'interpréter les caractéristiques échographiques. Les résultats de cette étude servent de point de départ pour tester la validité du module en milieu clinique et pour continuer d'explorer les préférences des médecins en ce qui concerne les programmes de formation.

Readiness for the epidemic: The adult nonalcoholic fatty liver disease toolkit for primary care nurse practitioners.

BACKGROUND AND PURPOSE: Nonalcoholic fatty liver disease (NAFLD) prevalence has reached epidemic proportions, and the severe form, nonalcoholic steatohepatitis, can result in cirrhosis and liver failure. The growing prevalence requires primary care (PC) providers to be adept at recognition and management; however, they experience significant knowledge gaps that can result in delayed access to interventions that could improve outcomes. This study's aim was to develop and evaluate a toolkit to improve knowledge gaps and support evidence-based practice (EBP) among PC nurse practitioners caring for patients with NAFLD in a midwestern state. METHODS AND INTERVENTION: The Adult NAFLD Toolkit was designed using the Knowledge to Action framework and guidelines from the Agency for Healthcare Research and Quality. The success of the toolkit was evaluated by administering the NAFLD survey for general practitioners in a pre-post evaluation design. RESULTS: Pre-post survey scores (N = 11) were compared for statistically significant change using the Wilcoxon signed rank test for matched pairs and showed improvement in overall knowledge (p = .011), perceived preparedness to care for NAFLD (p = .007), intention to recommend weight loss for management (p = .008), and intention to use the NAFLD fibrosis score for patient monitoring (p = .008). CONCLUSIONS: The results of this pilot study demonstrate successful implementation and positive outcomes of an EBP toolkit and support its expanded use. Continued evaluation on a larger scale is needed. Health care providers can use the process described in this article to develop and implement toolkits to support EBP of other PC issues.

A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials.

The Internet is a major source of health information for gynecologic cancer patients. In this study, we systematically explore common Google search terms related to gynecologic cancer and calculate readability of top resulting websites. We used Google AdWords Keyword Planner to generate a list of commonly searched keywords related to gynecologic oncology, which were sorted into five groups (cervical cancer, ovarian cancer, uterine cancer, vulvar cancer, vaginal cancer) using five patient education websites from sgo.org . Each keyword was Google searched to create a list of top websites. The Python programming language (version 3.5.1) was used to describe frequencies of keywords, top-level domains (TLDs), domains, and readability of top websites using four validated formulae. Of the estimated 1,846,950 monthly searches resulting in 62,227 websites, the most common was cancer.org . The most common TLD was *.com. Most websites were above the eighth-grade reading level recommended by the American Medical Association (AMA) and the National Institute of Health (NIH). The SMOG Index was the most reliable formula. The mean grade level readability for all sites using SMOG was 9.4 ± 2.3, with 23.9% of sites falling at or below the eighth-grade reading level. The first ten results for each Google keyword were easiest to read with results beyond the first page of Google being consistently more difficult. Keywords related to gynecologic malignancies are Google-searched frequently. Most websites are difficult to read without a high school education. This knowledge may help gynecologic oncology providers adequately meet the needs of their patients.

Training Future Leaders: Experience from China-ASEAN Cancer Control Training Program.

Cancer care professionals are pivotal in translating the knowledge into action in the continuum of cancer control process. Unfortunately, in China and the Association of South-east Asian Nations (ASEAN), limited training opportunities are available for health professionals in the area of cancer prevention and control. Therefore, the Cancer Hospital, Chinese Academy of Medical Sciences (CICAMS), and the International Agency for Research on Cancer (IARC) collaboratively designed and held the China-ASEAN Cancer Control and Prevention Training Program to provide continuing education opportunities for cancer professionals from China and ASEAN countries. The aim of this article is to report on the effectiveness and quality of the program and share our experience. A total of 36 participants from 12 countries completed the whole course including 1-month online learning and 1-week face-to-face workshop and cancer control facility tour in October 2017. After completion of the program, all participants were invited to fill out a questionnaire and to provide their comments on the training course. Out of 36 participants, 33 completed the evaluation form and they rated the training course highly in terms of satisfaction, value, and likelihood of recommending it to other colleagues. Additionally, all participants provided very detailed and practical comments on the course. Such an intensive, short-term, and comprehensive training program is expected to help participants establish a broader view of cancer prevention and control within the wider health services and be involved in national cancer control programs in a more efficient way. This training course could serve as a model for other institutes dedicated to nurturing future leaders in cancer control.

Evaluating effects of prenatal web-based breastfeeding education for pregnant mothers in their third trimester of pregnancy: Prospective randomized control trial.

BACKGROUND: Education is the cornerstone supporting breastfeeding practices. However, the traditional oral education method cannot always satisfy the learning needs of mothers. OBJECTIVE: to measure the effectiveness of prenatal web-based breastfeeding education program for Jordanian pregnant mothers in their third trimester of pregnancy on enhancing knowledge, attitude, and self-efficacy of breastfeeding after giving birth. METHODS: prospective randomized control trial design was used with sample consisted of 112 pregnant mothers who were recruited from one antenatal clinic in Irbid Governorate. Data collection instruments were the infant feeding knowledge and attitudes (IIFAS) and Breastfeeding Self-Efficacy Scale (BSES) were used to measure self efficacy, knowledge and attitudes regarding breastfeeding. RESULTS: Participants of the experimental group were at moderate level of BSES in pre and post intervention with increasing the number of mothers in the same level post intervention. Participants were at a neutral level of IIFAS in both groups generally, they were neither positive to breastfeeding nor to bottle feeding. There was no significant difference between the experimental and control groups on post- intervention scores on BSES and IIFAS. CONCLUSION: This study is considered the first trial to use new teaching methodologies as internet and website in teaching mothers about breastfeeding. Despite that there were not differences between intervention and control groups, web-based breastfeeding education program may contribute in improving breastfeeding self efficacy. IMPLICATIONS: Inclusion prenatal web-based breastfeeding education in antenatal clinics at MCHC centers of Ministry of Health. Further research is needed to replicate this study in other Jordanian health settings.

Evaluation of eLearning for the teaching of undergraduate ophthalmology at medical school: a randomised controlled crossover study.

AIM: To compare ophthalmology teaching delivered by eLearning with traditional lectures, in terms of undergraduate performance and satisfaction. METHODS: Randomised controlled crossover study at King's College London Medical School with 245 third year medical students. The ophthalmology syllabus was divided into ten topics. Five topics were randomised to be taught by traditional lectures and five by electronic learning (eLearning). For the second rotation of students the topics were crossed over, so that those topics taught by traditional lectures were taught by eLearning and vice versa. At the end of each rotation the students sat an optional online mock examination containing 100 questions (ten on each topic). Students' examination performance was compared between the two teaching methods. Student satisfaction was assessed using an online satisfaction survey. Outcome measures were the mean percentage of correct answers across all ten topics, student satisfaction and self-assessed knowledge. RESULTS: The mean examination score for questions taught by eLearning was 58% (95% CI, 55.7-59.6), versus 55% (95% CI 53.1-56.8) for traditional lectures (P = 0.047). Across all topics students were more satisfied with eLearning than traditional lectures, with 87% (95% CI 84.5-88.4) rating eLearning as 'excellent' or 'good' versus 65% (95% CI 62.0-67.4) for lectures (p < 0.0001). Overall 180 (75.6%) preferred eLearning compared to traditional lectures, with 166 (69.7%) rating eLearning 'much better' or 'better,' 61 (25.6%) 'neutral' and 11 (4.6%) 'worse' or 'much worse.' CONCLUSIONS: Student satisfaction and examination performance are both enhanced by ophthalmology eLearning. Similar eLearning modules may be suitable for other specialties and postgraduate learning.