Video-assisted reflection: improving OSCE feedback.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are commonly used to provide feedback to students on their performance in formative examinations. However, students are often unable to act independently on the feedback they receive. This study explored how the use of video-assisted reflection in OSCEs can enhance students' ability to reflect and engage in sustainable feedback. METHODS: Twenty-one students undertaking a mock-final OSCE consented to have one of their examination stations filmed. Participants completed a series of reflective forms immediately after the OSCE, after verbal feedback from an examiner and finally, after watching the video of their own performance. Students were asked to predict their overall grade as well as list areas for improvement. Pearson r correlations examined the relationship between the examiners' grades and the candidates' self-predicted grades. Wilcoxon signed-rank tests were used to compare the length of reflections at each stage. Semi-structured interviews were conducted to explore students' beliefs on self-efficacy and how the video-assisted reflection altered their ability to act on feedback. RESULTS: The students' ability to self-assess and gauge their own performance improved significantly after undertaking the video-assisted reflection (p < 0.01). Furthermore, video-assisted reflection significantly increased the length of the student's reflections. In interviews, participants described multiple ways in which the video-assisted reflection improved their confidence and ability to act on feedback, highlighting a clear enhancement in self-efficacy. DISCUSSION: Video-assisted reflection of recorded OSCE stations represents an effective approach to increase student self-efficacy and subsequently improve engagement in sustainable feedback practice.

Simulated on-call: time well spent.

BACKGROUND: Newly qualified doctors feel unprepared to take responsibility for patients and work independently, lacking confidence in skills essential during on-calls. We designed this study to assess the educational value of simulated on-calls and to explore the characteristics of this approach that contribute to improving students' preparedness. METHODS: A total of 38 final-year medical students attended two sessions, each including a simulated on-call followed by a one-to-one debriefing. Students' confidence and perceived preparedness before and after the programme were measured using questionnaires. Students' performance in two on-call skills was also assessed during both sessions. Focus groups explored the challenges of preparing for on-calls and how this approach enabled students to prepare. RESULTS: Following the programme, students felt significantly more confident in six key skills and significantly more prepared for on-calls (p < 0.001). There was also a significant improvement in students' assessed performance in on-call skills (p < 0.001). All students found it more useful preparation for on-calls than seminars and shadowing on-call doctors. They appreciated the opportunity to work independently and take responsibility in a stressful but safe environment. Having a second session and receiving one-to-one debriefing with personalised feedback enabled students to maximise their learning. DISCUSSION: Following the programme, students had better insight into on-call work and felt that the programme should be a mandatory part of training. The opportunity for students to consolidate learning through personalised feedback and a second session maximised the value of the programme, making the significant time commitment from the facilitators worthwhile. CONCLUSIONS: This programme was feasible to run and its educational value supports its wider use.

Once-daily tigecycline for outpatient parenteral antibiotic therapy: a single-centre observational study.

BACKGROUND: Tigecycline has potential utility in the treatment of complex polymicrobial infections or those caused by MDR organisms in the ambulatory care setting owing to its breadth of antimicrobial coverage. Whilst licensed for twice-daily IV administration, its long half-life permits once-daily administration, which may facilitate successful outpatient parenteral antibiotic therapy (OPAT). METHODS: A retrospective case series of patients receiving once-daily tigecycline under OPAT was analysed at a single-centre NHS acute hospital (January 2016-June 2018). Patient demographics, including comorbidities, antimicrobial indication, concurrent antimicrobial therapies, treatment duration and adverse events related to treatment were recorded using medical records. Treatment outcomes were defined using the BSAC National Outcomes Registry System (NORS). RESULTS: A total of 25 treatment episodes (24 individual patients) were analysed. The most common indications were bone and joint infections (n = 8) and intra-abdominal infections (n = 7). MDR organisms were common, including ESBL-producing Enterobacterales (n = 13) and glycopeptide-resistant enterococci (n = 4). Median treatment duration was 18 days. Nineteen of 25 (76%) cases had complete cure of treatment, 3 patients experienced treatment-related adverse reactions necessitating cessation of therapy and 3 experienced failure due to disease progression. Eight patients experienced non-limiting adverse effects, such as nausea, vomiting and rash, and one patient had a transient rise in amylase 3 times the upper normal limit (with no evidence of pancreatitis). CONCLUSIONS: Once-daily tigecycline can be successfully used for management of complex infections in the OPAT setting, with predominantly mild adverse effects, which can be managed with antiemetics or slow administration.