Virtual Deliberate Practice Module for Tracheostomy Change Training: An Application of Educational Design Research.

Background: The pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills. Objective: To develop and evaluate a virtual module prototype grounded in deliberate practice using tracheostomy change as an example. Methods: After identifying desirable features of a virtual module by surveying stakeholders, we designed a prototype using VoiceThread, a multimedia-based collaborative learning platform. We created an asynchronous module accessible to learners for repeated skill practice and for video upload of individual performance on a tracheostomy task trainer using personal devices. This virtual module provided a four-step coaching (demonstration, deconstruction, formulation, and performance) to practice tracheostomy change. Two instructors reviewed the learners' performance videos, providing timely feedback for further refinement of skills. Results: Sixty-four residents completed the module, System Usability Scale, and self-efficacy survey. All residents rated the module, with a mean System Usability Scale score of 68.6 ± 18.4 (maximum score of 100). Two independent instructors rated performance videos using a 12-item checklist with mean interobserver agreement of 88.1% (standard deviation, 9.7) and mean performance checklist score (n = 40) of 10.1 (standard deviation, 1.2) out of 12. After training, residents reported high confidence in their ability to list and perform procedural steps, with improvement in median (interquartile range) comfort levels from 1 (1-2) to 4 (3-4) out of 5 (P < 0.0001). Conclusion: We developed an asynchronous deliberate practice module on a virtual platform using tracheostomy change as an example. Residents evaluated the module favorably using system usability and learner self-efficacy surveys with improvement of skills.

Goldenhar syndrome associated with genital tract abnormality.

Goldenhar syndrome, also known as oculo-auriculo-vertebral syndrome, has been described since 1952. Traditionally, the syndrome has been described as having eye, ear, facial and vertebral anomalies. However, numerous case reports and reviews have highlighted multi-organ involvement, including cardiovascular, gastrointestinal, respiratory system and urinary abnormalities. We describe a 13 years old who has a reproductive tract abnormality, which has not been reported previously as a finding of Goldenhar syndrome.