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1.
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31755741

RESUMEN

INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.


Asunto(s)
Cirugía General/educación , Torsión del Cordón Espermático/cirugía , Urología/educación , Adulto , Actitud del Personal de Salud , Niño , Competencia Clínica/normas , Educación de Postgrado en Medicina/estadística & datos numéricos , Cirugía General/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Masculino , Pediatría/educación , Pediatría/estadística & datos numéricos , Encuestas y Cuestionarios , Urólogos/educación , Urólogos/normas , Urología/estadística & datos numéricos , Gales
2.
Ann Otol Rhinol Laryngol ; 129(1): 46-54, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31466464

RESUMEN

OBJECTIVES: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). METHODS: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. RESULTS: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. CONCLUSION: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. LEVEL OF EVIDENCE: 3b.


Asunto(s)
Laringe/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Procedimientos Quirúrgicos Reconstructivos/educación , Entrenamiento Simulado , Tráquea/cirugía , Animales , Niño , Preescolar , Humanos , Lactante , Laringoestenosis/cirugía , Modelos Animales , Pediatría/educación , Conejos , Ovinos , Porcinos , Estenosis Traqueal/cirugía
3.
J Laparoendosc Adv Surg Tech A ; 29(10): 1362-1367, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31560642

RESUMEN

Background: Most residents do not have a defined program for simulation training in video surgery in Brazil. The training takes place for the most part in vivo or in short courses. The goal of this article is to describe and evaluate a set of exercises using low-cost materials, created by the residents themselves, to enable basic skills training in video surgery. Materials and Methods: Seven exercises were elaborated aiming to simulate main maneuvers performed in video surgery. The residents were guided by a written and video description showing the execution of the exercises, performed the exercises, and answered a questionnaire. After 3 weeks of free training, the residents performed the exercises and answered the questionnaire again. Results: Seven residents started the study; however, 6 completed the two steps. Among the participants, 83% received in vivo video surgery training, and only 2 (33%) received some supervised simulation training in minimally invasive surgery before this time. All participants considered the set of seven exercises representative of the actual skills in video surgery. There was no difficulty in acquiring the materials or in assembling them to carry out the training. All the participants had a shorter training time than initially proposed, on average 1 day/week for 20 minutes. Conclusions: A simple set of exercises can be elaborated by the residents themselves and make feasible the simulated training in video surgery even without the availability of sophisticated and expensive materials. The presence of a tutor and the scheduling of exclusive training seem necessary for more satisfactory results.


Asunto(s)
Cirugía General/educación , Internado y Residencia , Pediatría/educación , Entrenamiento Simulado/métodos , Niño , Competencia Clínica , Humanos , Encuestas y Cuestionarios , Grabación en Video
4.
J Laparoendosc Adv Surg Tech A ; 29(10): 1378-1382, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31539299

RESUMEN

Purpose: Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in endoscopic surgery. However, few studies have focused on pediatric endosurgery. The purpose of this study was to assess the impact of 2D and 3D environments on the time taken and forceps manipulation by comparing experts and trainees using a laparoscopic hepaticojejunostomy simulator. Methods: We have developed a simulator of laparoscopic hepaticojejunostomy for congenital biliary dilatation. Seventeen participants of pediatric surgeons (4 experts and 13 trainees) performed hepaticojejunostomy using our simulator in both 2D and 3D environment. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations. Results: Obtained results show the findings for the required time (seconds; 2D, experts: 810.43 ± 321.64 vs. trainees: 1136.02 ± 409.96, P = .17) (seconds; 3D, experts: 660.21 ± 256.48 vs. trainees: 1017 ± 280.93, P = .039), total path length of right forceps (mm; 2D, experts: 38838.23 ± 30686.63 vs. trainees: 52005.47 ± 31675.02, P = .48)(mm; 3D, experts: 24443.09 ± 12316.32 vs. trainees: 45508.09 ± 26926.27, P = .16), total path length of left forceps (mm; 2D, experts: 131635.54 ± 71669.94 vs. trainees: 245242.48 ± 130940.25, P = .48)(mm; 3D, experts: 88520.42 ± 56766.63 vs. trainees: 230789.75 ± 107315.85, P = .024), average velocities of right forceps (mm/second; 2D, experts: 44.80 ± 21.85 vs. trainees: 44.37 ± 18.92, P = .97) (mm/second; 3D, experts: 37.28 ± 16.49 vs. trainees: 42.58 ± 14.40, P = .54), average velocities of left forceps (mm/second; 2D, experts: 156.65 ± 38.69 vs. trainees: 202.58 ± 63.80, P = .20) (mm/second; 3D, experts: 125.64 ± 44.30 vs. trainees: 219.42 ± 43.82, P < .01). Conclusion: The experts performed more effectively when using the 3D system. Using 3D, the total path length of the left forceps of expert pediatric surgeons was significantly shorter than trainee pediatric surgeons, and the average velocities of the left forceps tip of expert pediatric surgeons was significantly slower than trainee pediatric surgeons. These results suggest that training of assisting hand is necessary for advanced pediatric endosurgery to avoid organ injury.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Biliar/métodos , Quiste del Colédoco/cirugía , Conducto Hepático Común/cirugía , Yeyunostomía/métodos , Laparoscopía/métodos , Pediatría , Entrenamiento Simulado/métodos , Procedimientos Quirúrgicos del Sistema Biliar/educación , Competencia Clínica , Humanos , Imagen Tridimensional , Yeyunostomía/educación , Yeyuno/cirugía , Laparoscopía/educación , Pediatría/educación , Pediatría/métodos , Instrumentos Quirúrgicos
5.
Acta Cir Bras ; 34(7): e201900709, 2019 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31531529

RESUMEN

PURPOSE: To develop a new low-cost, easy-to-make and available training model using chickens' intestine for infant intestinal anastomosis. METHODS: Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount. RESULTS: In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions. CONCLUSION: The new training model using chickens' intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.


Asunto(s)
Anastomosis Quirúrgica/educación , Intestinos/cirugía , Pediatría/educación , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Animales , Pollos , Niño , Humanos , Modelos Animales , Técnicas de Sutura
6.
Pediatrics ; 144(3)2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31383816

RESUMEN

BACKGROUND AND OBJECTIVES: There is an urgent need to advance mental health (MH) education and/or training in pediatric residency programs, yet no consensus on how to achieve this. We created an operational framework from ideas provided by a diverse group of stakeholders on how to advance MH education. METHODS: Concept-mapping methodology was used, which involves brainstorming ideas by completing a focus prompt, sorting ideas into groups, and rating them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis grouped ideas into clusters. Average importance and feasibility were calculated for each statement and cluster and compared statistically in each cluster and between subgroups. RESULTS: Ninety-nine ideas were generated. Sorted ideas yielded a 7-cluster concept map: (1) modalities for MH training, (2) prioritization of MH, (3) systems-based practice, (4) self-awareness and/or relationship building, (5) training in clinical assessment of patients, (6) training in treatment, and (7) diagnosis-specific skills. Two hundred and sixteen participants rated ideas for importance and 209 for feasibility. Four clusters had a statistically significant difference between their importance and feasibility ratings (P < .001). Suburban and rural area respondents (versus urban) rated clusters higher in importance and feasibility (P < .004), trainees rated all clusters higher in feasibility than practicing clinicians, and MH professionals rated prioritization of MH higher in feasibility (3.42 vs 2.98; P < .001). CONCLUSIONS: This comprehensive set of ideas, especially those rated highly in both importance and feasibility, should inform curricular and policy initiatives. Differences between importance and feasibility may explain why there has been little progress in this field.


Asunto(s)
Internado y Residencia/organización & administración , Salud Mental , Pediatría/educación , Desarrollo de Programa , Análisis por Conglomerados , Consenso , Curriculum , Humanos , Participación de los Interesados , Estados Unidos
7.
R I Med J (2013) ; 102(6): 31-34, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31398966

RESUMEN

Corporal punishment (CP) is defined as inflicting pain to redirect an undesired behavior. The objective of the current study is to assess Rhode Island physicians' perceptions, experiences and education regarding CP. Our data may be used to inform future research and education/training for health care providers on how to provide guidance and have conversations surrounding CP. We developed an anonymous survey that assessed the perceptions, experiences and training of Hasbro Children Hospital physicians regarding CP in the medical setting. A total of 58 physicians responded; participants responded that CP was never effective for improving behavior (67.2%) and never recommended CP (98.2%) to patient families. However, most participants reported never received education on CP (67.9%). Our findings highlight that pediatric providers do not find CP an appropriate method of discipline and underscore the need for standardized training and education surrounding this issue.


Asunto(s)
Actitud del Personal de Salud , Relaciones Padres-Hijo , Pediatría/educación , Médicos/psicología , Castigo , Adulto , Niño , Conducta Infantil , Preescolar , Femenino , Humanos , Relaciones Interpersonales , Masculino , Médicos/estadística & datos numéricos , Rhode Island , Encuestas y Cuestionarios
9.
J Grad Med Educ ; 11(4 Suppl): 91-99, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31428264

RESUMEN

Background: While resident participation in global health (GH) rotations has grown, little is known about trainee perceptions of the personal value of these international clinical experiences and their importance to the objectives of GH training. Objective: We sought to better understand the clinical scenarios experienced during international rotations that residents perceived as most meaningful and the frequency of these experiences across scenarios and participating residents. Methods: Using the conceptual framework of Schön's reflection on action, we asked University of Minnesota GH track pediatric and internal medicine-pediatric residents to describe 10 clinical scenarios they found interesting or impactful during their 2016-2017 GH elective. We conducted a qualitative analysis of the deidentified resident narratives and mapped themes to the Accreditation Council for Graduate Medical Education (ACGME) competencies. Results: All eligible residents (n = 13) participated, yielding 129 unique clinical scenarios from 7 countries. We identified 5 thematic groups: (1) addressing challenges in making diagnoses in resource-limited settings; (2) dealing with patient outcomes different from those expected in the United States; (3) encountering and managing diseases in a different clinical context; (4) encountering and managing diseases in a different cultural context; and (5) reflecting on learning and self-growth. Of the 129 unique clinical scenarios, 30% (n = 39) had not been previously experienced by participants. Across the 5 themes, all ACGME core competencies were addressed. Conclusions: Residents identified meaningful scenarios of their GH experiences that are relevant to the educational and clinical objectives of GH training.


Asunto(s)
Competencia Clínica/normas , Salud Global , Medicina Interna/educación , Internacionalidad , Internado y Residencia , Aprendizaje , Pediatría/educación , Acreditación/normas , Adulto , Competencia Cultural , Femenino , Recursos en Salud/provisión & distribución , Humanos , Masculino , Narración , Estados Unidos
10.
J Grad Med Educ ; 11(4 Suppl): 158-164, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31428274

RESUMEN

Background: Postgraduate medical education (PGME) has become increasingly individualized, and entrustable professional activities (EPAs) have been adopted to operationalize this. At the same time, the process and content to determine residents' progress using high-stakes summative entrustment decisions by clinical competency committees (CCCs) is not yet well established. Objective: We evaluated the experiences with a structured process for assessment of EPAs to attain uniform summative entrustment decisions for a national sample of pediatric residents. Methods: An EPA-based national PGME program for pediatric residents was introduced in the Netherlands, including a process of uniform summative entrustment decisions, termed the Evaluation and Assessment of Residents by Supervisors (EARS) procedure. To evaluate the program, we assessed survey data and information from invitational conferences. Results: Beginning in January 2017, 125 pediatric residents in all 8 Dutch residency regions started training in the EARS program. The program enabled robust summative entrustment decisions. Preliminary data suggested that faculty, despite increased preparation time, appreciated the comprehensive appraisal of resident qualifications. The EPA-based program was well accepted by residents. Fifty-one percent (57 of 112) had at least 2 EARS procedures per year, and for 75% (84 of 112) the level of supervision was often or always adjusted to their level of training. Conclusions: A national EPA-based program provided a structured process for summative entrustment decisions by CCCs and enabled individualized stepwise progression of residents toward unsupervised practice. Broader application of these concepts may require adaptations to accommodate different health care systems and specialties.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Internado y Residencia , Pediatría/educación , Evaluación de Programas y Proyectos de Salud , Educación Basada en Competencias/normas , Toma de Decisiones , Educación de Postgrado en Medicina , Docentes Médicos , Humanos , Países Bajos , Encuestas y Cuestionarios
11.
J Grad Med Educ ; 11(4): 430-438, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31440338

RESUMEN

Background: Workplace-based assessment (WBA) is critical to graduating competent physicians. Developing assessment tools that combine the needs of faculty, trainees, and governing bodies is challenging but imperative. Entrustable professional activities (EPAs) are emerging as a clinically oriented framework for trainee assessment. Objective: We sought to develop an EPA-based WBA tool for pediatric critical care medicine (PCCM) fellows. The goals of the tool were to promote learning through benchmarking and tracking entrustment. Methods: A single PCCM EPA was iteratively subdivided into observable practice activities (OPAs) based on national and local data. Using a mixed-methods approach following van der Vleuten's conceptual model for assessment tool utility and Messick's unified validity framework, we sought validity evidence for acceptability, content, internal structure, relation to other variables, response process, and consequences. Results: Evidence was gathered after 1 year of use. Items for assessment were based on correlation between the number of times each item was assessed and the frequency professional activity occurred. Phi-coefficient reliability was 0.65. Narrative comments demonstrated all factors influencing trust, identified by current literature, were cited when determining level of entrustment granted. Mean entrustment levels increased significantly between fellow training years (P = .001). Compliance for once- and twice-weekly tool completion was 50% and 100%, respectively. Average time spent completing the assessment was less than 5 minutes. Conclusions: Using an EPA-OPA framework, we demonstrated utility and validity evidence supporting the tool's outcomes. In addition, narrative comments about entrustment decisions provide important insights for the training program to improve individual fellow advancement toward autonomy.


Asunto(s)
Benchmarking/normas , Competencia Clínica/normas , Cuidados Críticos/normas , Evaluación del Rendimiento de Empleados/normas , Pediatría/educación , Educación Basada en Competencias/normas , Educación de Postgrado en Medicina , Femenino , Humanos , Internado y Residencia , Masculino , Reproducibilidad de los Resultados , Lugar de Trabajo
12.
J Grad Med Educ ; 11(4): 454-459, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31440341

RESUMEN

Background: Formative feedback from residents is essential to improve residency programs, and focus groups may provide rich information. However, residents may withhold information due to fear of retaliation or speak less candidly to please focus group moderators. Objective: We assessed participant perceptions and utility of feedback obtained from a confidential focus group exchange between 2 residency programs. Methods: Anesthesiology and pediatric programs at the same institution participated in 2017. Residents voluntarily provided program feedback during 1 of 2 confidential focus groups for each program. Each focus group was moderated by the program director (PD) of the other specialty. The PDs used thematic analysis to identify themes for use by the respective programs in improvement efforts. An anonymous survey was distributed after the focus groups to collect participant perceptions (quantitative and narrative) on this approach. Results: Thirteen residents of 140 (9.3%) participated (7 anesthesiology, 6 pediatrics). Thematic feedback from focus groups was largely consistent with known issues, although novel information was also obtained (eg, pediatric interns wanted earlier one-on-one meetings with their PD). Survey data suggest that residents were able to share more meaningful feedback than they would otherwise, and they did not feel that having an external moderator (a PD who may have been unfamiliar with the specialty) was a barrier to discussion. The approach required 6 hours of time for each PD and approximately $200 for dinners. Conclusions: The focus group exchange required modest resources, was perceived as safe by residents, and generated robust, actionable feedback for the programs.


Asunto(s)
Anestesiología/educación , Retroalimentación Formativa , Internado y Residencia , Pediatría/educación , Médicos/psicología , Educación de Postgrado en Medicina , Grupos Focales , Humanos , Evaluación de Programas y Proyectos de Salud/tendencias , Encuestas y Cuestionarios
13.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31337695

RESUMEN

OBJECTIVES: Our objective for this study was to explore the experiences of faculty in academic pediatrics who are underrepresented minorities (URMs) at 2 urban medical centers, in particular, the experiences that influenced their pursuit of academic pediatrics. METHODS: Three focus groups were conducted in 2016 with URM faculty from Howard University College of Medicine and Children's National Health System to explore how they were influenced to pursue academic pediatrics. Ten 1-on-1 interviews were also conducted in 2017 with URM faculty at Children's National Health System. Focus groups were coded and analyzed by the research team using standard qualitative methods. The 1-on-1 interviews were coded and analyzed by the primary investigator and verified by members of the research team. RESULTS: A total of 25 faculty participated in the study (15 in the focus groups and 10 in individual interviews). Eighteen of the faculty were women and 7 were men. Findings revealed that mentorship, family, and community influenced participants' career choices. Barriers for URMs in academic pediatrics included (1) lack of other URMs in leadership positions, (2) few URMs practicing academic pediatrics, and (3) the impact of racism and gender and implicit bias in the medical field. CONCLUSIONS: Mentorship and family are major influences on why URMs become academic pediatricians. Lack of URMs in leadership positions, racism, gender bias, and implicit bias are barriers for URMs in academic pediatrics. More research should be conducted on ways to enhance the experience of URMs and to reduce barriers in academia.


Asunto(s)
Selección de Profesión , Docentes Médicos/psicología , Relaciones Familiares/psicología , Mentores/psicología , Grupos Minoritarios/psicología , Pediatría , Adulto , Anciano , Diversidad Cultural , Docentes Médicos/educación , Femenino , Humanos , Masculino , Mentores/educación , Persona de Mediana Edad , Pediatría/educación
14.
BMC Med Educ ; 19(1): 266, 2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31319836

RESUMEN

BACKGROUND: Active learning has been shown to improve knowledge retention, facilitate feedback, and motivate learners. Despite this evidence, lecture, a passive mode of instruction, is the most widely utilized instructional method for residency educational conferences. Team-based learning fosters active learning but is infrequently used during residency training. METHODS: Three team-based learning sessions (one introductory and two content-based) were held during noon conferences in a pediatrics residency program. A pre-post static-group design was used to evaluate learner satisfaction and knowledge gains. Additional data was collected about facilitator preparation, session attendance, and readiness assurance test scores. Descriptive statistics and qualitative content analyses were conducted. RESULTS: Forty-seven residents and students participated (81%, 47 of 58). Prior to the introductory session, the majority of participants (55%) were not familiar with team-based learning. After the three sessions, 65% of residents and students reported high levels of satisfaction with team-based learning. When compared to traditional, lecture-based noon conferences, 76% of participants reported more engagement and 48% perceived more learning in team-based learning sessions. Challenges included low completion rates of the assigned reading prior to the session and abridged discussions due to time limitations during sessions. Each session required 10 hours of preparation for curriculum development. CONCLUSIONS: Team-based learning resulted in greater satisfaction and engagement among learners when compared to lecture-based formats. However, it did not prove to be a feasible instructional method during one-hour residency conferences. Adaptations that promote learner preparation for sessions and overcome time limitations during sessions may improve the feasibility and impact of team-based learning during one-hour conferences. TRIAL REGISTRATION: Not applicable.


Asunto(s)
Competencia Clínica , Educación de Postgrado en Medicina/organización & administración , Internado y Residencia/organización & administración , Pediatría/educación , Aprendizaje Basado en Problemas/métodos , Centros Médicos Académicos , Adulto , Congresos como Asunto , Femenino , Humanos , Masculino , Grupo de Atención al Paciente/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud
15.
J Laparoendosc Adv Surg Tech A ; 29(10): 1334-1341, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31313947

RESUMEN

Purpose: This study aimed to evaluate the learning effects of continuous training with a disease-specific endoscopic surgical simulator for young pediatric surgeons. Materials and Methods: Participants trained with a laparoscopic fundoplication simulator for 1 hour every 10 days. At the start of each training session, we assessed the participant's surgical technique using the surgical skill evaluation system, which evaluates the following items: (1) task time, (2) right-left balance of suturing, (3) suture spacing between the three ligatures, (4) total path length traveled by forceps, (5) velocity of the forceps tips, (6) length of the wrap, (7) number of ligature failures, and (8) comparison of improvements according to assessment point. We examined the learning effects of this continuous training program. Results: Task time, right-left balance of suturing, and sum of the distance traveled by each forceps showed significant progressive improvements (P < .05). Suture spacing and average velocity of forceps tips did not change significantly with training (P = .5781, P = .0781, respectively). However, the ratio of traveled distance between left and right forceps significantly improved (P < .05). There was a significant trend for the wrap length to approach the target value (P < .05). According to the linear mixed-effects model, the number of training sessions required for learning was not uniform and varied depending on the skill. Conclusion: This simulator training program can help pediatric surgeons to acquire surgical skills easily, economically, and safely. In the future, we need to evaluate how surgical skills acquired during this continuous training are reflected in clinical operations.


Asunto(s)
Fundoplicación/educación , Laparoscopía/educación , Pediatría/educación , Entrenamiento Simulado/métodos , Niño , Competencia Clínica/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/métodos , Curva de Aprendizaje , Estudios Longitudinales , Masculino
16.
BMC Res Notes ; 12(1): 411, 2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31307518

RESUMEN

OBJECTIVE: From 2012 to 2015, two Departments of Obstetrics and Gynecology and two Departments of Pediatrics at the University of Copenhagen implemented an English medium international project. The project allowed international students to work in pairs with local Danish speaking students in a clinical setting. The student cohort was supported by Danish doctors who were responsible for student-pair supervision in English and, ultimately, patient care. Drawing on survey responses of 113 Danish doctors, this study considers the doctors' overall evaluation of the program and their perception of the international students' knowledge, skills and attitudes compared with local students. RESULTS: The Danish doctors rated the international and local students comparable in respect to professional commitment (p = 0.347), academic level (p = 0.134), and English proficiency (p = 0.080). The Danish doctors rated the international students significantly lower than the local students regarding communication with Danish doctors, other hospital staff, and patients (p < 0.001 in all cases). Ninety percent of the doctors involved in the project supported continuing working with internationalization if it included mixed pairs of students and a Danish doctor assigned each day to be exclusively responsible for student supervision. Language barriers for international medical students could be overcome but required substantial faculty support.


Asunto(s)
Educación Médica/normas , Hospitales Públicos , Hospitales Universitarios , Médicos/estadística & datos numéricos , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Competencia Clínica/normas , Comunicación , Dinamarca , Femenino , Ginecología/educación , Humanos , Internacionalidad , Masculino , Obstetricia/educación , Pediatría/educación , Encuestas y Cuestionarios
17.
Matern Child Health J ; 23(9): 1159-1166, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31267340

RESUMEN

Background Learning to identify and address social determinants of health (SDH) is a crucial component of pediatric residency training. A virtual tour of an impoverished neighborhood previously demonstrated efficacy in increasing residents' self-assessed knowledge and competence, but its impact on performance has not yet been reported. Online simulated cases are emerging as feasible assessment tools to measure trainees' skills across various healthcare settings. We developed online simulated cases to evaluate residents' retention of the virtual tour's key SDH-related learning objectives 1 month after completing this curriculum. Methods Three online simulated cases with interpolated open-ended questions were created to assess residents' ability to identify SDH, recommend appropriate resources, and display empathy. Scoring rubrics to objectively evaluate responses were developed and borderline scores were decided by a team of educators. Results 19 residents participated. Mean scores for all cases exceeded pre-established borderline scores (statistically significant in two of the three cases). More than 90% of residents identified relevant SDH in the primary care and emergency department cases. Ninety-five percent of residents recommended appropriate resources in all cases, and 89% displayed empathy. Discussion Residents' performance in online simulated cases demonstrated retention and application of the virtual tour's learning objectives, including recognizing SDH, offering appropriate resources, and displaying empathy, which supports the long-term effectiveness of the virtual tour curriculum to train pediatricians about SDH. Online simulated cases provided a standardized and cost-effective way to measure residents' skills related to curricular uptake, suggesting that this assessment approach may be adapted to evaluate other educational interventions.


Asunto(s)
Curriculum/normas , Simulación de Paciente , Pediatría/educación , Determinantes Sociales de la Salud , Adulto , Curriculum/estadística & datos numéricos , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Internado y Residencia/métodos , Internado y Residencia/normas , Internado y Residencia/estadística & datos numéricos , Aprendizaje , Masculino , Pediatría/métodos , Pediatría/normas , Características de la Residencia/estadística & datos numéricos
18.
BMC Med Educ ; 19(1): 245, 2019 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-31277615

RESUMEN

BACKGROUND: This study, undertaken in Bangkok, Thailand, explored the extent to which paediatric residents in a non-Western setting experienced burnout and the potential association with factors in the medical educational climate and work-related quality of life. METHODS: An exploratory sequential mixed methods design was employed in a cross-sectional study. The initial, quantitative phase used the validated Maslach Burnout Inventory, the Postgraduate Hospital Educational Environmental Measure (PHEEM) and Work-Related Quality of Life scale (WRQoL). Regression analysis was used to identify the correlation between burnout and educational climate. Thereafter, residents in all years with high levels of burnout on subscales were interviewed individually. RESULTS: Forty-one paediatric residents completed the three questionnaires. None had high levels related to burnout in all three domains (emotional exhaustion, high level of depersonalization and perceived low personal accomplishment), seven (17%) showed high levels in two out of three domains. Emotional exhaustion and educational climate (perceptions of role autonomy, perceptions of teaching, perceptions of social support) were correlated with work-related quality of life. In the interviews, the main themes related to burnout were inappropriate tasks, teachers and teaching styles, the perception of knowledge insecurity relating to task performance, time dimensions, life crisis during training, role expectations and work allocation clarity, and facilities such as accommodation. CONCLUSIONS: The study, in a non-Western setting, demonstrated a positive relation between educational climate and work-related quality of life. To help reduce the risk of burnout, the following factors were identified: minimize unnecessary or duplicated workload, schedule time arrangements to avoid extension of regular duty hours, and clearly define role expectations. The impact of inappropriate tasks, teachers and teaching styles (including unsafe environment) on the incidence of burnout was also highlighted. Additional studies focusing on teaching styles, safe learning climate and mistreatment in a non-Western context are needed.


Asunto(s)
Agotamiento Profesional/psicología , Docentes/normas , Internado y Residencia , Pediatría/educación , Tolerancia al Trabajo Programado/psicología , Carga de Trabajo/psicología , Adulto , Agotamiento Profesional/epidemiología , Estudios Transversales , Femenino , Humanos , Internado y Residencia/normas , Satisfacción en el Trabajo , Aprendizaje , Masculino , Admisión y Programación de Personal , Calidad de Vida , Apoyo Social , Tailandia/epidemiología , Carga de Trabajo/estadística & datos numéricos , Adulto Joven
19.
Anaesthesia ; 74(10): 1290-1297, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31350856

RESUMEN

There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.


Asunto(s)
Anestesia/efectos adversos , Anestesiología/educación , Seguridad del Paciente , Pediatría/educación , Adulto , África Central , África Oriental , Niño , Competencia Clínica , Comunicación , Evaluación Educacional , Docentes , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Persona de Mediana Edad , Resucitación , Enseñanza , Adulto Joven
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