No cow on the ice: a tail of word games.

In this editorial, the editors raise the issues of language games in the field of health profession education and examines the implications of translating and communicating meaning from one context to another. This examination raises five issues that scholars in healthcare professions education should consider.

Development and validation of a simulation-based assessment tool in colonoscopy.

BACKGROUND: Colonoscopy is difficult to learn. Virtual reality simulation training is helpful, but how and when novices should progress to patient-based training has yet to be established. To date, there is no assessment tool for credentialing novice endoscopists prior to clinical practice. The aim of this study was to develop such an assessment tool based on metrics provided by the simulator. The metrics used for the assessment tool should be able to discriminate between novices, intermediates, and experts and include essential checklist items for patient safety. METHODS: The validation process was conducted based on the Standards for Educational and Psychological Testing. An expert panel decided upon three essential checklist items for patient safety based on Lawshe's method: perforation, hazardous tension to the bowel wall, and cecal intubation. A power calculation was performed. In this study, the Simbionix GI Mentor II simulator was used. Metrics with discriminatory ability were identified with variance analysis and combined to form an aggregate score. Based on this score and the essential items, pass/fail standards were set and reliability was tested. RESULTS: Twenty-four participants (eight novices, eight intermediates, and eight expert endoscopists) performed two simulated colonoscopies. Four metrics with discriminatory ability were identified. The aggregate score ranged from 4.2 to 51.2 points. Novices had a mean score of 10.00 (SD 5.13), intermediates 24.63 (SD 7.91), and experts 30.72 (SD 11.98). The difference in score between novices and the other two groups was statistically significant (p<0.01). Although expert endoscopists had a higher score, the difference was not statistically significant (p=0.40). Reliability was good (Cronbach's alpha=0.86). A pass/fail score was defined at 17.1 points with correct completion of three essential checklist items, resulting in three experts and three intermediates failing and one novice passing the assessment. CONCLUSION: We established a valid and reliable assessment tool with a pass/fail standard on the simulator. We suggest using the assessment after simulation-based training before commencing work-based learning.

Establishing Construct Validity of a Novel Simulator for Guide Wire Navigation in Antegrade Femoral Intramedullary Nailing.

Background: Antegrade femoral intramedullary nailing (IMN) is a common orthopedic procedure that residents are exposed to early in their training. A key component to this procedure is placing the initial guide wire with fluoroscopic guidance. A simulator was developed to train residents on this key skill, building off an existing simulation platform originally developed for wire navigation during a compression hip screw placement. The objective of this study was to assess the construct validity of the IMN simulator. Methods: Thirty orthopedic surgeons participated in the study: 12 had participated in fewer than 10 hip fracture or IMN related procedures and were categorized as novices; 18 were faculty, categorized as experts. Both cohorts were instructed on the goal of the task, placing a guide wire for an IM nail, and the ideal wire position reference that their wire placement would be graded against. Participants completed 2 assessments with the simulator. Performance was graded on the distance from the ideal starting point, distance from the ideal end point, wire trajectory, duration, fluoroscopy image count, and other elements of surgical decision making. A two-way ANOVA analysis was used to analyze the data looking at experience level and trial number. Results: The expert cohort performed significantly better than the novice cohort on all metrics but one (overuse of fluoroscopy). The expert cohort had a more accurate starting point and completed the task while using fewer images and less overall time. Conclusion: This initial study shows that the IMN application of a wire navigation simulator demonstrates good construct validity. With such a large cohort of expert participants, we can be confident that this study captures the performance of active surgeons today. Implementing a training curriculum on this simulator has the potential to increase the performance of the novice level residents prior to their operating on a vulnerable patient. Level of Evidence: III.

The Benefits of Tying Yourself in Knots: Unraveling the Learning Mechanisms of Guided Discovery Learning in an Open Surgical Skills Course.

PURPOSE: Teaching technical skills through the use of guided discovery learning (GDL) is an ongoing topic of research. In this approach, learners practice and struggle before receiving formal instruction. This has shown promise in other domains of learning, yet in the realm of procedural skills, clarity is still needed. This study seeks to address these gaps by investigating efficacy and mechanisms relating to application for a GDL approach in teaching basic surgical skills. METHOD: In 2018, young surgical trainees (N = 16) undertook a 6-week open surgical course applying the principles of GDL, each lesson beginning with a discovery phase before subsequent instruction and practice. A concurrent triangulation mixed-methods approach was used with direct observation and collection of semistructured interviews using a framework designed from productive failure literature. At the end of the course, all participants took a conceptual knowledge test and a performance-based skills test. Performance on the skills test was rated using global ratings and checklists. RESULTS: The GDL cohort outperformed the historical cohort on the written exam (F [1,65] = 4.96, P = .029, d = .62), as well as on the summative suturing test (F [1,65] = 6.23, P = .015, d = .68). Furthermore, 3 main themes that highlight the mechanisms and mediators of efficient GDL were: (1) building conceptual knowledge, (2) motivating self-regulated learning, and (3) the type of skill and psychological safety. CONCLUSIONS: GDL can be an efficient approach to teaching procedural skills. Implications for future research and curricular design are discussed.

How to play the game of medical education: Sociocultural analyses of educational difficulties among medical residents.

This article was migrated. The article was marked as recommended. Medical residents in difficulty struggle to comply with educational requirements. They pose a liability to patient safety and they have problems to adapt to the professional role of a doctor. Consequently, being a resident in difficulty may cause identity crisis and have the potential to disrupt the resident's professional identity as a doctor. Only few studies explore the tipping point between becoming a resident in difficulty or not, and these studies rarely reflect the surrounding sociocultural aspects of the residents' difficulties such as organisational culture in the workplace. This article explores how medical residency training culture influence on residents' risk of ending in difficulty. Our study was based on six focus-group interviews with residents (n=28) and in-depth interviews with residents in difficulty (n=10). The interpretation of data employed sociologist Pierre Bourdieu's theoretical framework around dispositions. Across the data, we identified four themes: Conflicting games in the field of medical education, altruism, organisational hierarchy, and coping with stress. We found a (mis)match between legitimate rules in the field of medicine and the residents' dispositions to appreciate those rules. These results can inform clinical supervisors and consultants in their decisions for supporting residents in difficulty and increasing educational achievement among struggling residents.