Educational strategy for the development of skills in exchange transfusion: a randomized clinical trial protocol.

BACKGROUND: Exchange transfusion is a highly complex procedure that requires high levels of expertise. Trainee paediatricians do not have adequate training in exchange transfusion because opportunities to perform this procedure in practice are scarce. This protocol seeks to compare two educational interventions for exchange transfusion that allow students to develop competencies to perform the technique in an appropriate and safe way. METHODS/DESIGN: This is a randomized parallel single-blind clinical trial with allocation by simple randomization to the educational intervention (simulation or a digital didactic environment). Students from the paediatric specialization who volunteer to participate will be included. A practical evaluation of the procedure will be performed through a simulated scenario using a standardized clinical case. The main outcome is defined as the result of evaluation using the Objective Structured Clinical Examination; superior performance will be defined when the percentage is greater than or equal to 85%, and non-superior performance will be defined when the result is less than 84%. The chi-square independence test or the Fisher exact test will be used to evaluate the effect of the interventions. Multivariate analysis will be performed using a non-conditional logistic regression model. Stata 15® software will be used. DISCUSSION: Exchange transfusion is a procedure that requires expertise to achieve adequate outcomes. The inclusion of new educational strategies, such as simulation and digital didactic environments, is seen as a training option that can improve performance in clinical skills, reduce adverse events and increase the level of trust. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04070066. Registered on 28 August 2019. https://clinicaltrials.gov.

Competencias de los residentes de Atención Primaria en el manejo de los problemas prevalentes de oído, nariz y garganta / Competencies of Primary Care residents in the management of prevalent problems of the ear, nose and throat

Los problemas de oído, nariz y garganta son un motivo frecuente de consulta en Atención Primaria. Numerosos estudios han reportado que los médicos de Atención Primaria perciben una capacitación insuficiente en el manejo de estos problemas. El objetivo de este estudio fue evaluar las competencias en el diagnóstico y tratamiento de problemas prevalentes de Otorrinolaringología de médicos residentes de Atención Primaria en un hospital universitario, en Buenos Aires, Argentina, mediante la implementación de un examen clínico objetivo estructurado. Participaron 25 residentes, de Pediatría (7), de Medicina Interna (10) y de Medicina Familiar (8). Los de Medicina Familiar y Pediatría tuvieron mejor desempeño que los de Medicina Interna. Los residentes de Atención Primaria demostraron competencias disímiles en el manejo de problemas prevalentes de Otorrinolaringología. Se detectaron áreas de oportunidad de mejora comunes para los tres grupos, que proporcionaron dirección y motivación en futuros aprendizajes, tanto en conocimientos como en habilidades.

Ear, nose and throat problems are very common in Primary Care settings. Numerous studies have reported that Primary Care physicians feel dissatisfied with their performance and insufficient training to diagnose and manage these problems. The objective of this study was to assess the competency in diagnosis and management of prevalent ear, nose and throat problems in medical residents of Family Medicine, Internal Medicine and Pediatrics at a University Hospital in Buenos Aires, Argentina, using an Objective Structured Clinical Examination. The participants were 25 residents of Pediatrics (7), Internal Medicine (10) and Family Medicine (8). Residents of Family Medicine and Pediatrics showed better performance than residents of Internal Medicine. Residents of Primary Care demonstrated dissimilar competencies in the management of prevalent ear, nose and throat problems. Areas of common improvement opportunities were detected for the three groups, which provided direction and motivation in future learnings in both knowledge and skills.

[Competencies of Primary Care residents in the management of prevalent problems of the ear, nose and throat]. / Competencias de los residentes de Atención Primaria en el manejo de los problemas prevalentes de oído, nariz y garganta.

Ear, nose and throat problems are very common in Primary Care settings. Numerous studies have reported that Primary Care physicians feel dissatisfied with their performance and insufficient training to diagnose and manage these problems. The objective of this study was to assess the competency in diagnosis and management of prevalent ear, nose and throat problems in medical residents of Family Medicine, Internal Medicine and Pediatrics at a University Hospital in Buenos Aires, Argentina, using an Objective Structured Clinical Examination. The participants were 25 residents of Pediatrics (7), Internal Medicine (10) and Family Medicine (8). Residents of Family Medicine and Pediatrics showed better performance than residents of Internal Medicine. Residents of Primary Care demonstrated dissimilar competencies in the management of prevalent ear, nose and throat problems. Areas of common improvement opportunities were detected for the three groups, which provided direction and motivation in future learnings in both knowledge and skills.

Los problemas de oído, nariz y garganta son un motivo frecuente de consulta en Atención Primaria. Numerosos estudios han reportado que los médicos de Atención Primaria perciben una capacitación insuficiente en el manejo de estos problemas. El objetivo de este estudio fue evaluar las competencias en el diagnóstico y tratamiento de problemas prevalentes de Otorrinolaringología de médicos residentes de Atención Primaria en un hospital universitario, en Buenos Aires, Argentina, mediante la implementación de un examen clínico objetivo estructurado. Participaron 25 residentes, de Pediatría (7), de Medicina Interna (10) y de Medicina Familiar (8). Los de Medicina Familiar y Pediatría tuvieron mejor desempeño que los de Medicina Interna. Los residentes de Atención Primaria demostraron competencias disímiles en el manejo de problemas prevalentes de Otorrinolaringología. Se detectaron áreas de oportunidad de mejora comunes para los tres grupos, que proporcionaron dirección y motivación en futuros aprendizajes, tanto en conocimientos como en habilidades.

Evaluación de habilidades transversales de comunicación y colaboración a través de un examen clínico objetivo estructurado de radiología de urgencias para residentes de un programa universitario de especialidad en radiología / Assessment of generic skills in communication and collaboration through an objective structured clinical examination in emergency radiology in a university residency program in Chile

Introducción: La Radiología de Urgencias es una unidad de aprendizaje longitudinal a toda la residencia. En ella los residentes se enfrentan a patología de urgencia en distintas modalidades de imagen. Además del dominio cognitivo, los residentes deben desarrollar habilidades de comunicación y colaboración que les permitan enfrentar adecuadamente los turnos de residencia. Previo a incorporarse a los turnos nocturnos, los residentes deben aprobar un Examen Clínico Objetivo Estructurado (ECOE). Propósito: Evaluar competencias de comunicación y colaboración a través de estaciones de ECOE de Radiología de Urgencias aplicado a residentes de 2º año de residencia. Metodología: Se seleccionaron objetivos específicos a evaluar para las competencias de comunicación y colaboración y contenidos de Radiología Abdominal, Osteoarticular y Pediátrica para diseñar tres estaciones de ECOE, las cuales fueron incorporadas en el instrumento de evaluación aplicado el año 2017. Se calcularon porcentajes de logro por estación y tipo de pauta de evaluación. Para evaluar la implementación de las estaciones, se diseñó y aplicó una encuesta de percepción a los residentes. Resultados: Se diseñaron tres estaciones, dos para el rol Comunicador y una para el rol Colaborador. La validez de contenido se aseguró a través de un panel de expertos. Los porcentajes de logro global en las estaciones fluctuaron entre 74,7% y 95,6%. Las estaciones fueron bien evaluadas por parte de los residentes, quienes valoraron la incorporación de competencias diferentes al dominio cognitivo en el instrumento de evaluación. Conclusión: El ECOE permite certificar habilidades transversales como comunicación y colaboración de manera apropiada

Introduction: Emergency radiology (ER) is taught and learned throughout the entire residency. Trainees are exposed to different subspecialties ER cases and through varied imaging techniques. In addition to the "medical expert" domain, residents must develop communication and collaboration skills that will help them during their call schedule. Before they can take night-call, radiology residents must pass an Objective Structured Clinical Examination (OSCE). Purpose: To evaluate communication and collaboration competencies on an ER-OSCE applied to second-year radiology residents. Methods: Specific learning objectives were defined to evaluate communication and collaboration skills in abdominal, musculoskeletal and pediatric ER. Three OSCE stations were designed for this purpose and added to the evaluation instrument in 2017. On each station, resident performance was assessed with a specific template and percentage of goal achievement was calculated. Trainee´s opinion of this new modality was obtained through a perception survey. Results: Three stations were designed, two for the communicator role and one for the collaborator competency. Validity of content confirmed through an expert panel. Percentages of goal achievement on each station varied between 74,7% and 96,6. The new stations were positively evaluated by residents, which valued that competencies other than "medical expert" were being assessed. Conclusion: ER-OSCE allows the appropriate assessment of generic competencies such as communication and collaboration in radiology.