Transformative Learning, Priming, and Simulation Timing: A Randomized Controlled Pilot Study Among Emergency Medicine Residents.

Background Traditionally, learning is thought to occur best when prerequisite cognitive background information is delivered before simulation training. More recent studies have attempted to analyze the transformative nature of simulation by placing simulation before didactics. However, these studies were flawed as they provided background on the subject before the simulation itself. Our study aims to isolate the transformative effect of simulation and answer the question of whether lecture or simulation should come first. Methodology We designed a novel simulation session and accompanying lecture for 18 Emergency Medicine residents in all three years of training regarding a subject they were entirely unfamiliar with, the emergent management of a left ventricular assist device (LVAD). The residents were randomized into two groups. One group had the lecture (8/18) before their simulation, while the other group (10/18) had the simulation first and the lecture afterward, testing the motivational nature. Thereafter, both groups responded to a post-session survey with Likert-style and open-ended comment questions to assess the reaction to the session and a knowledge-based multiple-choice question test. Results Both groups did not score significantly differently on either the immediate post-test or a retention post-test that we administered four weeks later. Three of eight participants reported in open comments that they were much more comfortable with a lecture-first than a simulation-first format. Conclusions Despite controlling for some of the limitations of previous studies, our results including learners' preferences do not support a transformation in the sequence of clinical skills learning. Until other larger studies prove the opposite, we recommend continuing with the lecture followed by the simulation sequence as per existing conceptual simulation learning frameworks.

Students' Feedback about Feedback; Have our PBL tutors started the shift towards a dialogic ask-tell-ask approach?

OBJECTIVE: A paradigm shift towards a PBL bidirectional dialogic feedback can enhance learners' performance. This study aimed to investigate undergraduate medical students' perceptions of their PBL feedback. METHODS: We sent e-mail invitations to a web-based survey to year one and two students at College of Medicine, King Saud University. Items included the process, content, and benefits of PBL feedback. RESULTS: Of 209 respondents, 110 (53%) were first and 99 (47%) were second-year students. About 50% agreed that the feedback was regularly provided at scheduled timing and 72% perceived feedback environment as non-threatening. Agreement rates that the tutors asked students first to assess their performance, tell them what went well, what the areas for improvement are and develop with them an improvement plan were 59%, 61%, 61% and 52%, respectively. 61% agreed that tutors judged performance not personality. More year one students significantly agreed that the PBL feedback helped them to improve their knowledge acquisition and non-technical skills. CONCLUSION: Many of our PBL tutors have started the shift to a dialogic bi-directional feedback. We recommend continuing the faculty development efforts, peer-reviewing, and seeking student's feedback within the academic quality satisfaction surveys.

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist.

BACKGROUND/AIMS: : This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. MATERIALS AND METHODS: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. RESULTS: : The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). CONCLUSION: : The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.

Stepwise Simulation Course Design Model: Survey Results from 16 Centers.

BACKGROUND AND OBJECTIVES: In 2016 we published a stepwise evidence-based model (subsequently named SimSteps) for curriculum development (CD) of simulation-based courses. The current study aimed to assess the uses, user friendliness, and perceived effectiveness of this model and its worksheet and to obtain suggestions for improvement. METHODS: We sent e-mail invitations for a 14-question web-based survey to 13 health professionals who requested the supplemental worksheet of the stepwise model and 11 authors who cited the model's publication in 14 articles. The survey included quantitative and qualitative items. RESULTS: Sixteen (67%) from seven countries and six professions responded. Ten (63%) used the model: six for both course and faculty development, three for course development only, and one for faculty development only. Both users and nonusers found the model and worksheet applicable and user friendly and agreed that they guided use of a systematic, comprehensive approach to CD. 94% (15 of 16) agreed that they helped CDers integrate educational effectiveness criteria, develop more objective learners' assessment tools, and enhance validity for their courses. Sixty-nine percent (11 of 16) agreed that model and its worksheet helped CDers include nontechnical skills in courses. The highest reported role in enhancing program evaluation results was in the gain of knowledge (five of eight, 63%) and least was clinical outcomes (two of eight, 25%). All respondents would recommend the model and worksheet to a colleague. CONCLUSION: Respondents find the stepwise model and its worksheet user friendly and helpful in developing simulation curricula of high educational standards. Future studies should include larger sample size, objective measures of impact, and longer-term follow-up.

A critical review of obstetric and gynecological physical examination videos available on YouTube: Content analysis and user engagement evaluation.

BACKGROUND: Video-sharing website "YouTube" is a growing source of healthcare information. But, the videos uploaded on this open platform are not peer reviewed, therefore, the information available needs to be sufficiently evaluated. No studies have been conducted to evaluate the authenticity and utility of obstetrics and gynecology (Obs/Gyne) physical examination YouTube videos. This study was performed to analyze the sources, contents, and quality of videos about the Obs/Gyne clinical examination available on YouTube. METHODS: A systematic search was performed on YouTube website using the following key words: "OBSTETRIC," "GYNECOLOGICAL," "SPECULUM OBSTETRIC," "OBSTETRIC CLINICAL," "BIMANUAL PELVIC," and "EXAMINATION" to analyze the sources, contents, and the quality of YouTube videos about the Obs/Gyne clinical examination during the period between November 2015 and March 2017. The videos were classified into educationally useful and useless based on the content, accuracy of the knowledge, and the demonstration. RESULTS: Out of total 457 screened videos, 176 (38.51%) videos met the pre-set inclusion criteria. After review, out of 176 pertinent videos, 84 (47.7%) videos were found educationally useful, and out of these 84 useful videos, only 29 (34.5%) were highly educational in nature. CONCLUSION: YouTube videos showed variable educational value. Only, a small number of videos were identified as useful and can be used by the medical students for self-directed learning and by the clinical teachers for educational purposes or other academic activities.

Correction: Self-reported cheating among medical students: An alarming finding in a cross-sectional study from Saudi Arabia.

[This corrects the article DOI: 10.1371/journal.pone.0194963.].

Undergraduate medical students' perspectives of skills, uses and preferences of information technology in medical education: A cross-sectional study in a Saudi Medical College.

BACKGROUND: Information technology (IT) is widely used in medical education. However, there are not enough studies about IT uses and preferences among traditional and problem-based learning (PBL) medical students. AIM: To compare IT skills, uses and preferences for education between traditional and PBL medical students'. METHOD: A cross-sectional study; a modified Educause Center for Analysis and Research online survey was sent to traditional curriculum 5th and PBL 4th year medical students of King Saud University. RESULTS: Most of the responding 176 students prefer mobile devices and moderate amount of IT in education. Fourth and fifth year students perceived high academic value of Google (94.2 vs. 86.7%, p = 0.34), YouTube (90.7 vs. 92.2%, p = 0.83) and PubMed (83.7 vs. 86.7%, p = 0.06). More 4th year than 5th year students rated themselves as skilled in learning management system (54.7 vs. 21.1%, p = 0.0001) and Smartboard use (40.7 vs. 23.3%, p = 0.04). Most students rated faculty IT skills as effective. Students agreed that technology helps working faster (95.5%) and make learning creative (85.9%). CONCLUSIONS: More integration of information literacy and IT training in medical curricula is needed to enhance better utilization of full features of IT resources available for learning and problem solving. National multi-institutional studies are recommended.

Can Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review.

BACKGROUND: A growing number of wearable devices claim to provide accurate, cheap and easily applicable heart rate variability (HRV) indices. This is mainly accomplished by using wearable photoplethysmography (PPG) and/or electrocardiography (ECG), through simple and non-invasive techniques, as a substitute of the gold standard RR interval estimation through electrocardiogram. Although the agreement between pulse rate variability (PRV) and HRV has been evaluated in the literature, the reported results are still inconclusive especially when using wearable devices. AIM: The purpose of this systematic review is to investigate if wearable devices provide a reliable and precise measurement of classic HRV parameters in rest as well as during exercise. MATERIALS AND METHODS: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases, as well as, through internet search. The 308 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. RESULTS: Eighteen studies were included. Sixteen of them integrated ECG - HRV technology and two of them PPG - PRV technology. All of them examined wearable devices accuracy in RV detection during rest, while only eight of them during exercise. The correlation between classic ECG derived HRV and the wearable RV ranged from very good to excellent during rest, yet it declined progressively as exercise level increased. CONCLUSIONS: Wearable devices may provide a promising alternative solution for measuring RV. However, more robust studies in non-stationary conditions are needed using appropriate methodology in terms of number of subjects involved, acquisition and analysis techniques implied.

Self-reported cheating among medical students: An alarming finding in a cross-sectional study from Saudi Arabia.

Academic misconduct/dishonesty has become widespread behavior among many university students across the globe, and medical education is not an exception. Until recently, few efforts have been made to study the dishonest behavior in Middle-Eastern universities. This study examined the prevalence and predisposing factors of cheating among medical students in Saudi Arabia and suggests suitable preventive measures. A cross-sectional survey-based study was conducted at a government medical college during the 2014-2015 academic year. The response rate was 58.5% (421/720). The overall cheating behavior practiced by the participants was 29%, predominantly by male students. High GPA scoring students were the least likely to cheat. The participants living with their families were more likely to cheat compared to those who were living apart from their families. The reasons participants gave to justify their cheating behavior included getting better grades, passing the course, and lacking preparation while still recognizing that cheating is a 'mistake.' Overall, significant academic misconduct concerning cheating was found among the Saudi medical students; this misconduct is alarming in a reputable government institution. The implementation of strict punishments, requiring ethical courses and creating ethical awareness by exploiting the potential of Islamic religious belief might help to control this problem.

Learning how to "teach one": A needs assessment of the state of faculty development within the Consortium of the American College of Surgeons Accredited Education Institutes.

BACKGROUND: Developing faculty competencies in curriculum development, teaching, and assessment using simulation is critical for the success of the Consortium of the American College of Surgeons Accredited Education Institutes program. The state of and needs for faculty development in the Accredited Education Institute community are unknown currently. The Faculty Development Committee of the Consortium of the Accredited Education Institutes conducted a survey of Accredited Education Institutes to ascertain what types of practices are used currently, with what frequency, and what needs are perceived for further programs and courses to guide the plan of action for the Faculty Development Committee. METHODS: The Faculty Development Committee created a 20-question survey with quantitative and qualitative items aimed at gathering data about practices of faculty development and needs within the Consortium of Accredited Education Institutes. The survey was sent to all 83 Accredited Education Institutes program leaders via Survey Monkey in January 2015 with 2 follow-up reminders. Quantitative data were compiled and analyzed using descriptive statistics, and qualitative data were interpreted for common themes. RESULTS: Fifty-four out of the 83 programs (65%) responded to the survey. Two-thirds of the programs had from 1 to 30 faculty teaching at their Accredited Education Institutes. More than three-quarters of the programs taught general surgery, emergency medicine, or obstetrics/gynecology. More than 60% of programs had some form of faculty development, but 91% reported a need to expand their offerings for faculty development with "extreme value" for debriefing skills (70%), assessment (47%), feedback (40%), and curriculum development (40%). Accredited Education Institutes felt that the Consortium could assist with faculty development through such activities as the provision of online resources, sharing of best practices, provision of a blueprint for development of a faculty curriculum and information related to available, credible master programs of faculty development and health professions education. CONCLUSION: Many Accredited Education Institutes programs are engaged in faculty development activities, but almost all see great needs in faculty development related to debriefing, assessment, and curricular development. These results should help to guide the action and decision-making of the Consortium Faculty Development Committee to improve teaching within the American College of Surgeons Accredited Education Institutes.

A stepwise model for simulation-based curriculum development for clinical skills, a modification of the six-step approach.

BACKGROUND: Despite the rapid growth in the use of simulation in health professions education, courses vary considerably in quality. Many do not integrate efficiently into an overall school/program curriculum or conform to academic accreditation requirements. Moreover, some of the guidelines for simulation design are specialty specific. STUDY DESIGN: We designed a model that integrates best practices for effective simulation-based training and a modification of Kern et al.'s 6-step approach for curriculum development. We invited international simulation and health professions education experts to complete a questionnaire evaluating the model. We reviewed comments and suggested modifications from respondents and reached consensus on a revised version of the model. RESULTS: We recruited 17 simulation and education experts. They expressed a consensus on the seven proposed curricular steps: problem identification and general needs assessment, targeted needs assessment, goals and objectives, educational strategies, individual assessment/feedback, program evaluation, and implementation. We received several suggestions for descriptors that applied the steps to simulation, leading to some revisions in the model. CONCLUSION: We have developed a model that integrates principles of curriculum development and simulation design that is applicable across specialties. Its use could lead to high-quality simulation courses that integrate efficiently into an overall curriculum.

The role of Fibroscan in predicting the presence of varices in patients with cirrhosis.

BACKGROUND/AIM: Transient elastography is a relatively new, noninvasive method of measuring liver stiffness. This study aimed to evaluate the diagnostic accuracy of transient elastography and other noninvasive methods for the diagnosis of esophageal varices (EV) in patients with cirrhosis. METHODS: This cross-sectional study graded EV according to size in 145 consecutive patients with cirrhosis who underwent endoscopy, Fibroscan, and other noninvasive diagnostic methods. The accuracy of these diagnostic methods in diagnosing EV was evaluated on the basis of area under receiver operating characteristic (AUROC) curves. RESULTS: Elastography was successful in 123 patients. Of these, 54.5% had hepatitis C and 10.6% had hepatitis B. EV were absent in 39.8%, small EV was present in 24.4%, and large EV was present in 35.8% of patients. Fibroscan, aspartate aminotransferase-to-platelet ratio index, and international normalized ratio showed low accuracy in diagnosing EV in non-viral-related cirrhosis patients (AUROCs 0.66, 0.68, and 0.67, respectively). Fibroscan and aspartate aminotransferase-to-platelet ratio index were more accurate in measuring EV with a viral etiology (AUROCs 0.704 and 0.703, respectively). A cutoff value of 16.9 kPa was 83.8% sensitive in diagnosing EV in non-viral-cirrhotic patients, whereas a cutoff value of 19.9 kPa was 83.4% sensitive in diagnosing EV in patients with viral hepatitis. Fibroscan was moderately accurate in diagnosing grade I EV and less accurate in diagnosing grades II and III EV in all cirrhotic patients, irrespective of the underlying etiology. CONCLUSION: Fibroscan might be useful in predicting the presence of EV in patients with cirrhosis with a viral etiology. However, endoscopy remains the gold standard for EV screening.

Does coenzyme-Q have a protective effect against atorvastatin induced myopathy? A histopathological and immunohistochemical study in albino rats.

INTRODUCTION: In addition to their lipid-lowering effect, statins have pleiotropic effects that may extend their use to the treatment and prevention of various other diseases such as cancer, osteoporosis, multiple sclerosis, rheumatoid arthritis, type 2 diabetes, and Alzheimer's disease. Consequently, the number of patients taking statins is expected to increase. A side effect of statins, statin-induced myopathy, which may result from reduced muscular coenzyme Q10 levels, limits their use. The current study investigates if supplementing with CoQ10 could ameliorate statin induced myopathy. MATERIALS AND METHODS: Forty adult male albino rats were randomized into 4 groups, with 10 rats per group. The following was administered to the rats using oral gavage for 4 weeks: Group 1: 2 ml of 0.5% carboxymethyl cellulose once daily. Group 2: 100 mg/kg/ day coenzyme Q10 dissolved in 2 ml of cotton seed oil. Group 3: 10 mg/kg once daily atorvastatin dissolved in 0.5% carboxymethyl cellulose. Group 4: concomitantly received CoQ10 and atorvastatin similar to groups 2 and 3 respectively. Plasma creatine kinase levels were measured by using spectrophotometer. The right extensor digitorum longus muscle sections were stained for histological (Haematoxylin & Eosin, Masson trichrome and Phosphotungstic acid haematoxylin) and immunohistochemical (cytochrome C and Bax) examinations. Quantitative measures of cytochrome C and Bax were carried out using image analyzer. RESULTS: Atorvastatin induced increased total creatine kinase, skeletal muscle variations in the sizes and shapes, necrosis, disorganization, nuclear pyknosis, karyorrhexis, karyolysis, dismantled plasma membrane, excess collagen fibers and lipid deposition in addition to loss of cross striation. Atorvastatin increased the intensity of the immune-positive reactions of cytochrome C and Bax. These changes were ameliorated by concomitantly giving coenzyme Q10. CONCLUSION: CoQ10 may ameliorate atorvastatin induced skeletal muscle injury.

Research methodology workshops evaluation using the Kirkpatrick's model: translating theory into practice.

BACKGROUND: Qualitative and quantitative evaluation of academic programs can enhance the development, effectiveness, and dissemination of comparative quality reports as well as quality improvement efforts. OBJECTIVES: To evaluate the five research methodology workshops through assessing participants' satisfaction, knowledge and skills gain and impact on practices by the Kirkpatrick's evaluation model. METHODS: The four level Kirkpatrick's model was applied for the evaluation. Training feedback questionnaires, pre and post tests, learner development plan reports and behavioral surveys were used to evaluate the effectiveness of the workshop programs. RESULTS: Of the 116 participants, 28 (24.1%) liked with appreciation, 62 (53.4%) liked with suggestions and 26 (22.4%) disliked the programs. Pre and post MCQs tests mean scores showed significant improvement of relevant basic knowledge and cognitive skills by 17.67% (p ≤ 0.005). Pre-and-post tests scores on workshops sub-topics also significantly improved for the manuscripts (p ≤ 0.031) and proposal writing (p ≤ 0.834). As for the impact, 56.9% of participants started research, and 6.9% published their studies. The results from participants' performance revealed an overall positive feedback and 79% of participant reported transfer of training skills at their workplace. CONCLUSION: The course outcomes achievement and suggestions given for improvements offer insight into the program which were encouraging and very useful. Encouraging "research culture" and work-based learning are probably the most powerful determinants for research promotion. These findings therefore encourage faculty development unit to continue its training and development in the research methodology aspects.