Introduction of a formative assessment tool in a post-graduate training program in India: a mixed methods evaluation.

BACKGROUND: Our institution has longstanding post-graduate education and training partnership programs in Emergency Medicine (EM) across India. A programmatic challenge has been the integration and uptake of evidence-based medicine and lifelong learning concepts. Formative assessment (FA) is intended to enable learners to monitor learning, identify strengths and weaknesses, and target areas of growth. As part of a program improvement initiative, we introduced an online FA tool to existing summative assessments. This study investigates how the FA tool was used and perceived by trainees. METHODS: 246 trainees across 19 sites were given access to the FA tool. Usage metrics were monitored over 12 months. Semi-structured interviews were conducted in person with trainees using a purposive sampling methodology. A hybrid thematic analysis approach was used to determine themes. Interviews were coded independently by two blinded researchers using NVivo software. The study was deemed exempt by our institutional review board. RESULTS: There was high variability in trainees' utilization of the FA tool. Trainees who used the FA tool more performed better on summative exams (r = 0.35, p < 0.001). Qualitative analysis revealed that trainees were motivated to learn for improved clinical knowledge and to be a good physician, not only passing exams. Benefits of the tool included the relationship to clinical practice and thorough explanation of answers, while disadvantages included topics unrelated to India. CONCLUSION: The integration of a FA tool has provided positive outcomes for trainees in EM education programs in India. Lessons learned may apply globally to other contexts and programs.

Violence in the emergency department: a quantitative survey study of healthcare providers in India.

BACKGROUND: Workplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WPV in healthcare, most of the existing research has been conducted in developed countries with established laws and repercussions for violence against healthcare providers. More data on WPV against ED providers practicing in low-resource settings is necessary to understand these providers' unique challenges. OBJECTIVE: This study aims to gain insight into the incidence and characteristics of WPV among ED healthcare providers in India. METHODS: This study was conducted at two EDs in geographically distinct regions of India. A survey was designed to assess violence in EDs among healthcare providers. Surveys were distributed to ED workplace providers, completed by hand, and returned anonymously. Data was entered and stored in the RedCAP database to facilitate analysis. RESULTS: Two hundred surveys were completed by physicians, nurses, and paramedics in Indian EDs. Most reported events involved verbal abuse (68%), followed by physical abuse (26%), outside confrontation (17%), and stalking (5%). By far, the most common perpetrators of violence against healthcare workers were bystanders including patient family members or other accompanying individuals. Notably, reporting was limited, with most cases conveyed to ED or hospital administration. CONCLUSION: These results underscore the prevalence of WPV among Indian ED healthcare providers. High rates of verbal abuse followed by physical abuse are of concern. Most perpetrators of WPV against healthcare providers in this study were patient family members or bystanders rather than the patients themselves. It is imperative to prioritize implementing prevention strategies to create safer work environments for healthcare workers.

Bodies and Bites: a medical school program that teaches anatomy, physiology, and nutrition to elementary school kids.

Undergraduate medical students who participate in community outreach programs gain a multitude of benefits that impact not only their professional development but also the well-being of the communities they serve. At the Virginia Tech Carilion School of Medicine (VTCSOM), students have the opportunity to volunteer in the "Bodies and Bites" program at the West End Center for Youth, an after-school educational center that serves K-12 children in Roanoke, Virginia. The purpose of Bodies and Bites is to teach elementary school children in 2nd to 5th grade how their bodies work and how to keep them healthy through good nutrition and exercise. All sessions are led by VTCSOM medical students and graduate students from our partnering academic institution, the Fralin Biomedical Research Institute (FBRI). Each week, the children and Health Professions students explore a different topic related to human anatomy and physiology using anatomical models, small group discussions, and hands-on activities. At the end of each session, the participants create a healthy snack related to the day's topic. The overall goal of the present study was to assess the perception of the Bodies and Bites program from the view of our student volunteers, and the 4th and 5th graders who attend the West End Center. Now in its 6th year, Bodies and Bites continues to be popular as a voluntary program among our Health Professions students, and is well received by the West End Center and the elementary school children they serve. Our students and community mutually benefit from this program, with the former having an opportunity to briefly disengage from the rigors of their studies while gaining valuable skills in science communication and inspiring children to pursue fields in Science, Technology, Engineering, Math, and Medicine (STEMM), and the latter having fun while learning about their bodies and discovering ways to improve their health.

Shifts in Students' Attitudes Towards Pain Patients, Pain, and Opioid Management Following a Dedicated Medical School Pain Curriculum.

Objective: To examine the immediate effects of a comprehensive pain course on medical students' pre-existing perceptions and attitudes toward pain patients and opioid management. Methods: First-year medical students at a major academic medical center enrolled in a required pre-clerkship pain course in June 2020 and completed pre- and post-course online surveys with Likert-scale questions about their attitudes toward pain management and opioid-related issues. Additionally, the surveys included a free-text question where the students listed the first five words that came to mind when hearing the word "opioids". These words were categorized as "professional" or "lay" words and further as having "positive", "negative", or "neutral" connotations. Data analyses included descriptive statistics, as well as non-parametric and parametric tests. Results: Fifty-four of the 119 students responded to pretest and posttest surveys and were included in paired analyses. There was a significant difference between the number of professional words used before (M=1.21, SD=0.97) and after the course (M=2.40 SD=1.33); t(52)=-6.39, P<0.001. Students also used more lay-positive words after the course (M=0.81, SD=0.63) than they used pre-course (M=0.23, SD=0.43); t(51)=-5.98, P<0.001. Students' post-course responses to several key Likert-scale questions showed significant shifts toward more positive attitudes about caring for patients with pain. For example, students acknowledged greater comfort in providing opioids for chronic pain (P<0.001) where appropriate, and enhanced interest in handling complex pain cases (P<0.001). Conclusion: Results showed that a comprehensive, multi-disciplinary pain course could greatly enhance first-year medical students' attitudes toward pain management, chronic pain patients, and the complex issues surrounding opioids.

Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review.

INTRODUCTION: The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods. METHODS: As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible. RESULTS: Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge. CONCLUSIONS: Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.

Pediatric Code Cart Challenge for Emergency Medicine Trainees in Emergency Departments in India.

BACKGROUND: Code carts provide accessible emergency medication, supplies, and equipment to resuscitate a child. Unfortunately, there are limited studies on pediatric code cart use in resource-limited settings, including in India. METHODS: This was a Pediatric Code Cart Challenge for emergency medicine (EM) trainees in India. After receiving education on pediatric code carts, participants created their code carts and submitted a video showcasing their project. Reviewers evaluated each team's code cart using a rubric. A six-month follow-up survey assessed participants' use of code carts and their perception and satisfaction. RESULTS: Forty-nine participants across six sites completed the survey. The median number of pediatric code cart uses in the past six months was two. Materials frequently used from the code cart included medications (76%), followed by airway equipment (59%), and intravenous (IV) equipment (57%). Only 4% of respondents used an intraosseous (IO) catheter. Two of six sites reported modifying their code cart within the past six months by rearranging and/or adding equipment and medications. Local protocols, pediatric advanced life support guidelines, and references from other hospitals led to changes. Most respondents rated the pediatric code cart useful and appreciated its accessibility, ease of use, organization, and equipment. Respondents said they would add more pediatric equipment, including IO supplies, to improve their code cart. CONCLUSION: Participating sites now have pediatric medications and equipment accessible and organized in their code carts. Additionally, EM trainees learned what is needed and how to improve their current pediatric code carts. Future steps include expanding this pilot project to additional sites in low- and middle-income countries.

Neurocognitive Correlates of Clinical Decision Making: A Pilot Study Using Electroencephalography.

The development of sound clinical reasoning, while essential for optimal patient care, can be quite an elusive process. Researchers typically rely on a self-report or observational measures to study decision making, but clinicians' reasoning processes may not be apparent to themselves or outside observers. This study explored electroencephalography (EEG) to examine neurocognitive correlates of clinical decision making during a simulated American Board of Anesthesiology-style standardized oral exam. Eight novice anesthesiology residents and eight fellows who had recently passed their board exams were included in the study. Measures included EEG recordings from each participant, demographic information, self-reported cognitive load, and observed performance. To examine neurocognitive correlates of clinical decision making, power spectral density (PSD) and functional connectivity between pairs of EEG channels were analyzed. Although both groups reported similar cognitive load (p = 0.840), fellows outperformed novices based on performance scores (p < 0.001). PSD showed no significant differences between the groups. Several coherence features showed significant differences between fellows and residents, mostly related to the channels within the frontal, between the frontal and parietal, and between the frontal and temporal areas. The functional connectivity patterns found in this study could provide some clues for future hypothesis-driven studies in examining the underlying cognitive processes that lead to better clinical reasoning.