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.

Safety and Feasibility Assessment of Repetitive Vascular Occlusion Stimulus (RVOS) Application to Multi-Organ Failure Critically Ill Patients: A Pilot Randomised Controlled Trial.

Muscle wasting is implicated in the pathogenesis of intensive care unit acquired weakness (ICU-AW), affecting 40% of patients and causing long-term physical disability. A repetitive vascular occlusion stimulus (RVOS) limits muscle atrophy in healthy and orthopaedic subjects, thus, we explored its application to ICU patients. Adult multi-organ failure patients received standard care +/- twice daily RVOS {4 cycles of 5 min tourniquet inflation to 50 mmHg supra-systolic blood pressure, and 5 min complete deflation} for 10 days. Serious adverse events (SAEs), tolerability, feasibility, acceptability, and exploratory outcomes of the rectus femoris cross-sectional area (RFCSA), echogenicity, clinical outcomes, and blood biomarkers were assessed. Only 12 of the intended 32 participants were recruited. RVOS sessions (76.1%) were delivered to five participants and two could not tolerate it. No SAEs occurred; 75% of participants and 82% of clinical staff strongly agreed or agreed that RVOS is an acceptable treatment. RFCSA fell significantly and echogenicity increased in controls (n = 5) and intervention subjects (n = 4). The intervention group was associated with less frequent acute kidney injury (AKI), a greater decrease in the total sequential organ failure assessment score (SOFA) score, and increased insulin-like growth factor-1 (IGF-1), and reduced syndecan-1, interleukin-4 (IL-4) and Tumor necrosis factor receptor type II (TNF-RII) levels. RVOS application appears safe and acceptable, but protocol modifications are required to improve tolerability and recruitment. There were signals of possible clinical benefit relating to RVOS application.

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.

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.

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.

Impact of the COVID-19 pandemic: The perceptions of health professions educators.

This article was migrated. The article was marked as recommended. What are health professions educators doing during the COVID-19 pandemic? A search of articles in MedEdPublish on the topics of COVID-19 revealed 39 articles published in the first 3 months of the pandemic. Topics included curriculum adaptation, guidelines for using technology, assessment adaptation, impact on students, faculty and career development, and conference adaptation. There was significant overlap among articles, particularly those discussing teaching, learning, and assessment practices. Common themes were adaptation, innovation, remote delivery, flexibility in the face of a pandemic, and how to continue to educate and graduate competent health professionals. All articles were descriptive, and none included data describing efficacy, likely due to the short timeline since the pandemic's inception. Additional study is necessary to produce evidence for the teaching and assessment adaptations described. Some changes are likely to persist longer-term and may outlast the pandemic itself.

Physiological assessment of isolated running does not directly replicate running capacity after triathlon-specific cycling.

Triathlon running is affected by prior cycling and power output during triathlon cycling is variable in nature. We compared constant and triathlon-specific variable power cycling and their effect on subsequent submaximal running physiology. Nine well-trained male triathletes (age 24.6 ± 4.6 years, [Formula: see text] 4.5 ± 0.4 L · min(-1); mean ± SD) performed a submaximal incremental run test, under three conditions: no prior exercise and after a 1 h cycling trial at 65% of maximal aerobic power with either a constant or a variable power profile. The variable power protocol involved multiple 10-90 s intermittent efforts at 40-140% maximal aerobic power. During cycling, pulmonary ventilation (22%, ± 14%; mean; ± 90% confidence limits), blood lactate (179%, ± 48%) and rating of perceived exertion (7.3%, ± 10.2%) were all substantially higher during variable than during constant power cycling. At the start of the run, blood lactate was 64%, ± 61% higher after variable compared to constant power cycling, which decreased running velocity at 4 mM lactate threshold by 0.6, ± 0.9 km · h(-1). Physiological responses to incremental running are negatively affected by prior cycling and, to a greater extent, by variable compared to even-paced cycling. Testing and training of triathletes should account foe higher physiological cost of triathlon-specific cycling and its effect on subsequent running.

Demographic and health factors associated with enrollment in posttrial studies: the Women's Health Initiative Hormone Therapy Trials.

BACKGROUND: After clinical trials end, continued follow-up of the assembled cohort often is desirable for additional research. Factors influencing participants' decisions to consent to additional follow-up and how these shape posttrial cohorts have not been broadly studied. PURPOSE: We examined how two re-enrollment campaigns and the passage of time altered features of the posttrial cohorts compared with the original Women's Health Initiative (WHI) Hormone Therapy clinical trials. METHODS: We examined associations that markers of sociodemography, health, lifestyle, and on-trial experiences had with re-enrollment and contrasted the characteristics of successive posttrial cohorts with those of the original enrollees. RESULTS: The posttrial enrollment campaigns re-enrolled 81.1% and 82.5% of available women, respectively. Women who re-enrolled tended to have better health characteristics than those not re-enrolled. Compared to women of comparable age in the original cohort, women retained for the second posttrial follow-up less often had a history of cardiovascular disease (odds ratio (OR) = 0.36), hypertension (OR = 0.57), diabetes (OR = 0.59), or measured cognitive deficit (OR = 0.40). These women more often had graduated from high school (OR = 1.72) and had participated in other WHI trials (OR = 1.76). LIMITATIONS: We have examined experience with creating follow-up cohorts from participants in a single study. Thus, our findings may not apply to other cohorts and protocols. CONCLUSIONS: Posttrial enrollment in follow-up studies can be successful; however, the characteristics of the resulting cohort may differ substantially from the originally assembled group of trial participants. Collection during the original trial of potential predictors of differential re-enrollment may strengthen interpretation of findings.

Design and methods of a multi-site, multi-behavioral treatment trial for menopausal symptoms: the MsFLASH experience.

BACKGROUND: Behavioral strategies are recommended for menopausal symptoms, but little evidence exists regarding efficacy. PURPOSE: Describe design and methodology of a randomized controlled 3 by 2 factorial trial of yoga, exercise and omega-3 fatty acids. METHODS: Women from three geographic areas with a weekly average of ≥14 hot flashes/night sweats, who met exclusion/inclusion criteria, were randomized to 12weeks of: 1) yoga classes and daily home practice; 2) supervised, facility-based aerobic exercise training; or 3) usual activity. Women in each arm were further randomized to either omega-3 supplement or placebo. Standardized training, on-going monitoring, and site visits were adopted to ensure consistency across sites and fidelity to the intervention. Participant adherence to the intervention protocol was monitored continuously, and retention was actively encouraged by staff. Information on adverse events was systematically collected. RESULTS: Of 7377 women who responded to mass mailings, 355 (4.8%) were randomized; mean age was 54.7 (sd=3.7), 26.2% were African American, 81.7% were post-menopausal, and mean baseline frequency of daily hot flashes/night sweats was 7.6 (sd=3.8). Adherence of ≥80% was 59% for yoga, 77% for exercise training, and 80% for study pills. Final week 12 data were collected from 95.2% CONCLUSIONS: Conducting a multi-site, multi-behavioral randomized trial for menopausal symptoms is challenging but feasible. Benefits included cost-effective study design, centralized recruitment, and methodologic standardization.

Psychological and social characteristics associated with religiosity in Women's Health Initiative participants.

Measures of religiosity are linked to health outcomes, possibly indicating mediating effects of associated psychological and social factors. We examined cross-sectional data from 92,539 postmenopausal participants of the Women's Health Initiative Observational Study who responded to questions on religious service attendance, psychological characteristics, and social support domains. We present odds ratios from multiple logistic regressions controlling for covariates. Women attending services weekly during the past month, compared with those not attending at all in the past month, were less likely to be depressed [OR = 0.78; CI = 0.74-0.83] or characterized by cynical hostility [OR = 0.94; CI = 0.90-0.98], and more likely to be optimistic [OR = 1.22; CI = 1.17-1.26]. They were also more likely to report overall positive social support [OR = 1.28; CI = 1.24-1.33], as well as social support of four subtypes (emotional/informational support, affection support, tangible support, and positive social interaction), and were less likely to report social strain [OR = 0.91; CI = 0.88-0.94]. However, those attending more or less than weekly were not less likely to be characterized by cynical hostility, nor were they less likely to report social strain, compared to those not attending during the past month.

Recruiting patients with breast cancer and their families to behavioral research in the post-HIPAA period.

PURPOSE/OBJECTIVES: To describe a process for, response rates of, and indicated interest in recruiting patients with breast cancer and their spouses and family members from a clinical setting into behavioral and psychiatric research studies since the Health Insurance Portability and Accountability Act (HIPAA) regulations have taken effect. DATA SOURCES: Published articles, books and book chapters, MEDLINE, government agency information and HIPAA regulatory Web sites, and survey data. DATA SYNTHESIS: Response rates among the three target groups--patients, spouses and partners, and female first-degree relatives--were 77%, 95%, and 88%, respectively. Interest was high in the three target groups, with 77%, 87%, and 65% of responding patients, spouses and partners, and female first-degree relatives, respectively. CONCLUSIONS: Taken together, these data indicate that high participation rates can be expected from patients with breast cancer and their families in clinical settings. IMPLICATIONS FOR NURSING: Regulations pose barriers to patient and family recruitment, but thoughtful systems actually can improve rates of recruitment.

Prevalence and 3-year incidence of abuse among postmenopausal women.

OBJECTIVES: We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women. METHODS: We used a cohort of 91,749 women aged 50 to 79 years from the Women's Health Initiative. Outcomes included self-reported physical abuse and verbal abuse. RESULTS: At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse. CONCLUSIONS: Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health.