A guide to pain assessment and management in adults.

Pain is universally experienced and extremely complex, involving the mind as well as the body. It is activated by a variety of stimuli, including biological, physical and psychological. This article seeks to provide a deeper understanding of the physiology of pain and the various classifications used in clinical practice. It also aims to raise awareness of the skills that nurses require for the assessment and management of an individual patient's pain. It explores the tools available to assist with the assessment of pain and provides an introduction to some of the management strategies that can be used to manage pain. Some of the barriers to effective pain assessment and management are also examined.

Participant Evaluation of a Multi-disciplinary Oncology Preceptorship Training Program for Oncology Health Professionals from Kumasi, Ghana.

A critical shortage of skilled healthcare workers is a primary cause of disparate global cancer outcomes. We report participant evaluation of a multidisciplinary preceptorship program. In collaboration with the city of Kumasi, Ghana, Mayo Clinic and the City Cancer Challenge hosted a preceptorship program for comprehensive multidisciplinary breast and cervix cancer training. A total of 14 healthcare workers from Kumasi received two weeks of training at Mayo Clinic in November and December 2021. Each participant and preceptor were requested to complete an anonymous post-participation survey. Of the 14 trainee participants, 10 (71%) completed the survey. All respondents found the program "valuable and applicable to their clinical practice." Ninety percent reported they were able to "review effective and critical elements in the development and expansion of the multidisciplinary team" and able to "solve practical clinical cases as a team". General themes of satisfaction included: (1) organization and administration, (2) clinical observations and demonstrations, (3) guidelines development, and (4) recognizing the central importance of cultivating a team-based approach. Of the 40 preceptors, 16 (40%) completed the survey. All respondents reported they felt the training would meaningfully "influence patient care in Ghana", that participation "added value or joy to their clinical practice," and all wished to "participate in future preceptorship programs". After a focused two-week program, trainees reported high satisfaction, usefulness from observing specialized cancer care, and value in closely observing a multidisciplinary oncology team. Preceptors reported the experience added joy and perspective to their clinical practice and wished to participate in future programs.

Perceptions of academic staff toward the objective structured clinical examination (OSCE) in clinical nursing: Assessment method.

BACKGROUND: Clinical competence is critical to evaluating nursing students' capacity to undertake professional nursing practice in a safe and professional environment without any bias of examiners. Objective structured clinical examination (OSCE) is used as an assessment method of students' clinical practice skills. AIMS: The aim of this study is to assess the nursing faculty members' perception toward OSCE to be used as an assessment method of nursing students in their performing of nursing procedures, as well as explore the advantages and disadvantages of OSCE as perceived by study participants. METHOD: A descriptive cross-sectional study was used among nursing faculty members (N = 73) who participated on a workshop that were conducted by Jordanian Nursing Council (JNC) between January 2022 and March 2023. RESULT: The mean perception toward OSCE was 105.87 ± 22.02 (p value = 0.001). The majority of faculty members reported a positive perception toward the OSCE (82.2%). The negative perception was significant in gender, age group, level of education, and academic experience (p < 0.05). The majority of faculty members were agree on the advantages of OSCE. CONCLUSION: OSCE is a vital assessment and an objective method in assessing the student's clinical competence. More studies exploring the differences of OSCE perceptions and participant's characteristics are required.

Application of ALSO course in standardized training Resident in Obstetric.

OBJECTIVE: To explore the teaching effect of Advanced Life Support in Obstetrics (ALSO) Course in the standardized training resident in obstetric. METHODS: 60 residents of obstetrics from January 2021 to December 2022 were randomly divided into two groups, observation group and control group. The experimental group used ALSO teaching method, and the control group used traditional teaching method. The teaching effect was evaluated by theoretical examination, direct observation of procedural skills (DOPS) scale and mini clinical evaluation (Mini-CEX) scale. RESULTS: The theoretical achievements of the observation group were significantly higher than that of the control group (P < 0.05). The pre-procedural preparation, safe analgesia, technique of procedure, aseptic technique, seeks help when necessary, post-procedural management, communication skills, humanistic care and overall performance score of the DOPS in the experimental group were higher than those in the control group (P < 0.05). The organization efficiency, humanistic qualities, manipulative skills, clinical judgment, medical interviewing skills and overall clinical competence score of the Mini-CEX in the experimental group were higher than those in the control group (P < 0.05). CONCLUSIONS: ALSO teaching method has an ideal effect in the standardization training of residents of obstetrics, indicating the prospect of active in-depth research and expanded application.

At a glance: a guide to venepuncture in adults.

This article will provide clinical guidance on carrying out venepuncture on an adult. It will discuss site, equipment selection and aseptic non-touch technique. The aims are to increase knowledge of the anatomical structures associated with venepuncture, demonstrate the clinical procedural technique of venepuncture, and provide an awareness of the dangers and complications of this invasive technique.

Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study.

BACKGROUND: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. OBJECTIVE: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. METHODS: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. RESULTS: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. CONCLUSIONS: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction.

A guide to cannulation in adults.

This article provides clinical guidance on performing cannulation on an adult. The site, equipment selection and aseptic non-touch technique will be discussed. The clinical procedural technique of cannulation will be explained and the article will also provide an awareness of the dangers and complications of this invasive technique for both the patient and the health professional.

Assessing the effectiveness of massive open online courses on improving clinical skills in medical education in China: A meta-analysis.

Massive Open Online Courses (MOOCs) are a new phenomenon in education worldwide. In China, MOOCs have been widely used in medical courses. However, the effects of MOOCs on improving clinical skills are controversial. Therefore, we conducted the study to verify whether the application of MOOCs in medical courses can improve participants' clinical skills in China. A systematic literature search was carried out using the PubMed, Embase, Web of Science, CNKI and Wanfang databases according to the predetermined criteria. The Hedges' g and its corresponding 95% confidence interval were selected to assess the effects of MOOCs on participants' clinical skills. Subgroup analyses, sensitivity analysis and publication bias test were performed in the study. A total of thirty-two records (thirty-two studies) with 3422 participants were identified in our study. There was a significant improvement in clinical skill scores of participants in the MOOC group compared with the control group. Subgroup analyses showed similar results in different student groups. Our study supported the notion that the MOOC-based teaching method appeared to be a more effective method than the conventional teaching technique for the improvement of participants' clinical skills in China.

Effectiveness of endotracheal intubation and mask ventilation procedural skills training on second-year student using modified Peyton's Four-Step approach during COVID-19 pandemic.

BACKGROUND: Airway emergency is the reason behind competency in mask ventilation and intubation skills for doctors. Procedural skills are taught through face-to-face training. However, the COVID-19 pandemic has had an impact on the education system, including medical education. The face-to-face training method cannot be carried out and requires a modification to an online method. Therefore, Peyton's Four-Step Approach is modified to adapt this change. OBJECTIVE: Assessing the effectiveness of learning methods between modified Peyton's Four-Step approach and classic Peyton's Four Step approach in learning basic skills of mask ventilation and intubation during the COVID-19 pandemic. METHOD: This was an experimental study with two groups of subjects in the Basic ClinicalSkills module of endotracheal intubation and mask ventilation at the Faculty ofMedicine, Universitas Indonesia during February-June 2022. The first group received training with classic Peyton's Four-Step approach and another group with modified Peyton's Four-Step approach. Both groups were tested and assessed using rubric score and global rating score, and asked to fill a feedback questionnaire. RESULTS: This study was conducted with 133 students in the classic group and 96 students in the modified group. The median rubric score was 21.2 for both groups and the global rating score showed 82%and 78% students passed, for classic and modified group respectively. Therubric score and global rating score, also the pass rate between two learningmethods showed no significant results (P > 0.05). The satisfaction and self-confidence questionnaires got answers 'agree and strongly agree' for all questions. CONCLUSION: The learning method using modified and classic Peyton Four-StepApproach were equally effective for learning basic skill of endotracheal intubation and mask ventilation for students of the Faculty of Medicine,University of Indonesia. Both methods provided equal students' satisfaction and self-confidence.

Realistic simulation case scenario as a vertical integration teaching tool for medical students: A mixed methods study.

Realistic simulation-based learning has recently become an integral part of medical education and can provide several advantages if applied effectively. This study aimed to develop and validate a realistic simulation case scenario (RSCS) as a novel teaching tool for preclinical medical students. Furthermore, we aimed to evaluate student perception of this tool as a teaching strategy, as well as to acquire an in-depth understanding of student perspectives. We employed the mixed methods approach to explore how clinical reasoning develops through a validated RSCS. This study, which included 50 third-year medical students, was conducted at the College of Medicine, Dar Al Uloom University, KSA between November 2021 and February 2022. Most of the participants (94%) were satisfied with the RSCS method and 92% of the participants reported RSCS as more effective in terms of achieving learning objectives. Many advantages of RSCS have been reported, including the provision of realistic knowledge relating to critical care management, encouraging student participation in the learning process, and enhancing interpersonal and problem-solving skills. In conclusion, RSCS is an effective and dynamic teaching approach that aids in knowledge consolidation with a significant impact on the emotions and cognitive abilities of students.

'You learn to smile with your eyes', exploring the impact of enhanced personal protective equipment on primary care dental practitioners in the UK: An interpretative phenomenological study.

OBJECTIVE: The aim of the study was to explore how dental practitioners in primary care settings perceive the impact of enhanced personal protective equipment (PPE) upon patient communication and wider clinical practice. METHODS: This study utilized a qualitative approach, rooted in critical realism. An interpretative phenomenological analysis (IPA) methodology was adopted as the study method. In accordance with IPA, in-depth semi-structured interviews were conducted. Eight dental practitioners were recruited, with data analysis conducted according to the principles of IPA. RESULTS: Three themes were synthesized (related to communication and clinical practice): (1) Impaired communication and relationship building; (2) Physical impacts and required adjustments when wearing enhanced-PPE; and (3) Psychological stress of implementing enhanced-PPE. Theme one reflects changes to the dynamic of communication between patients and colleagues brought about by enhanced-PPE. Theme two describes the physical and psychological strains of providing care in enhanced-PPE and the ways through which practitioners tried to overcome these challenges. Theme three explores how the roll-out and guidance related to the use of enhanced-PPE affected clinical practice. CONCLUSIONS: Dental Practitioners described several barriers to communication as well as physical and mental stressors caused by enhanced-PPE, all of which were perceived to impact upon the quality of care provided to patients. Further research is required to develop effective interventions to mitigate the impact of enhanced-PPE upon clinical practice and to explore the long-term impact of enhanced-PPE on clinical practice, post-COVID.

A Novel Teaching-Learning Method of Utilizing Ultrasonography as a Tool to Enhance Clinical Examination Skills of House Surgeons in Evaluating Cervical Lymph Nodes.

Aim: A study was conducted to ascertain if ultrasonography assisted learning facilitates the House Surgeons to enhance their clinical skill of identifying enlarged cervical lymph nodes. Materials and Methods: A prospective, cross-sectional analytical study was conducted in the in a Medical College for 6 months from May to October 2021. It included 50 house surgeons posted to the department of ENT on rotation and patients with one or more enlarged cervical lymph nodes. Initially an ENT teacher demonstrated clinical examination of neck for lymph nodes to the House Surgeons. Each House Surgeon examined 10 patients and their findings were matched with those of ENT specialist & Ultrasonography findings (pre TL score). Further they underwent Ultrasonography assisted learning and subsequently post TL scores were found for each House Surgeon based on their findings in 10 more patients. Paired T Test was done to ascertain statistical significance between pre TL and post TL scores. Result: Fifty House Surgeons (mean age 23.3 years) and 258 patients (mean age 43.5 years) were included in the study. There was significant improvement in the post TL scores of the House Surgeons obtained after ultrasonography assisted learning in comparison with pre TL scores (p < 0.001). Conclusion: Ultrasonography assisted learning enhances the clinical examination skills of assessing for enlarged cervical lymph nodes.

The Role of Videotaped Clinical Skills Aggregated Peer Evaluations in the Enhancement of Evaluation Skills of Individual Medical School Faculty Members.

The conventional methodology for appraising medical students has some limitations like inherent subjectivity, unstructured nature, and bias. Implementing the Objective Structured Clinical Examination (OSCE) can mitigate these shortcomings. However, the OSCE presents challenges, including substantial financial costs and time-intensive processes, particularly when assessing a large cohort of students. Consequently, an alternative assessment was needed to keep the advantages of OSCE and mask its limitations, especially in resource-constrained settings. In addition, many scholars have expressed concern over medical students' and interns' inadequate interviewing and physical examination competencies in recent years. Due to easy availability, videotaping is a convenient method for objectively observing students for aggregate review by faculty in order to ascertain what exactly faculty are assessing during medical student evaluations. This technique allows for aggregate faculty group improvement in the ability of educators to assess students' technical proficiency, data collection capabilities, standardized patient interaction demeanor, and strategies for fostering standardized patient comfort. Nonetheless, aggregate evaluation of videotape recordings for faculty assessment development or reliance on verbal feedback from medical students about faculty's ability to assess student skill is a matter of debate. Due to increased subspecialization, the subspecialist or specialist examiners face difficulties in assessing students' skills in specific and/or generalized domains. Despite these challenges, assessing the ability of faculty members' observation and subsequent evaluation of medical trainees remains a vital aspect of assessment throughout various specialties. This paper presents the concept of faculty members individually observing and rating premade recordings of standardized students performing clinical skills for evaluation so that when the individual faculty members' ratings are aggregated and summarized collectively for evaluation by the faculty members as a group, both the group and the individual faculty members will gain a greater understanding of what are appropriate ratings versus outlier ratings.

Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study.

PURPOSE OF THE STUDY: The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. METHODS: SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. RESULTS: An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. CONCLUSION: Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

Using insights from cognitive science for the teaching of clinical skills: AMEE Guide No. 155.

Students have to develop a wide variety of clinical skills, from cannulation to advanced life support, prior to entering clinical practice. An important challenge for health professions' educators is the implementation of strategies for effectively supporting students in their acquisition of different types of clinical skills and also to minimize skill decay over time. Cognitive science provides a unified approach that can inform how to maximize clinical skill acquisition and also minimize skill decay. The Guide discusses the nature of expertise and mastery development, the key insights from cognitive science for clinical skill development and skill retention, how these insights can be practically applied and integrated with current approaches used in clinical skills teaching.

Observing expert opinion of medical affairs pharmaceutical physicians on the value of their clinical experience to the pharmaceutical industry using the Jandhyala method.

BACKGROUND: The pharmaceutical industry requires a highly qualified workforce with diverse skillsets. Medical affairs pharmaceutical physicians (MAPPs) have unique qualifications among pharmaceutical company employees, but the exact contribution of their education and training is unknown. This study aimed to identify the medical education and training competencies MAPPs use in the pharmaceutical industry in relation to the four external stakeholders, regulators, payors, prescribers, and patients. METHOD: Ten MAPPs were recruited using convenience sampling via professional networks. A systematic literature review and the Jandhyala method, a two-stage qualitative online consensus method, identified which of MAPPs' medical education and training competencies they used in their work with each external stakeholder. Statistical analyses determined heterogeneity in the relevance of competencies and competency categories to each stakeholder. RESULTS: Nine MAPPs completed the study. Of the 59 competencies identified, 54 were relevant to all external stakeholders. Relevance of competencies varied significantly between external stakeholders (p = .0434). Binary competency scores varied significantly for three pairs of stakeholders, "patient vs. payor" (p = .025), "prescriber vs. regulator" (p = .013) and "prescriber vs. payor" (p = .008). Between-stakeholder overall frequency count varied significantly for two of the nine competency categories. CONCLUSION: MAPPs develop a highly specialized set of competencies during medical education and training from which they use distinct subsets to meet the needs of external stakeholders in the pharmaceutical industry. Undergraduate and postgraduate competency-based medical education appears to prepare MAPPs for cognitive and technical work. Further exploration may aid understanding of how they develop soft skills.

Medical affairs pharmaceutical physicians (MAPPs) are of key importance in promoting patient centricity in the pharmaceutical industry. Their competency-based medical education and clinical experience give them a unique skillset among pharmaceutical company employees. MAPPs utilize their training to benefit pharmaceutical companies as well as the four external stakeholders in medicine adoption: regulators, payors, prescribers and patients. Previous work has suggested that their education and training may account for their ability to benefit all external stakeholders; however, this has not been explored in detail. The aim of this study was to identify competencies MAPPs develop during medical education, training and clinical experience and which of these they use in their work with each of the four external stakeholders.To do this, first, we reviewed the literature and asked MAPPs to self-report the competencies they developed during medical education and training, and which were relevant to their work with each of the four stakeholders. We found that 54 of the 59 identified competencies were relevant to work with all external stakeholders. However, the relevance of individual competencies varied between external stakeholders, with further analysis showing that the difference appeared to be accounted for by differences between three main pairs of stakeholders. These were "patient vs. payor", "prescriber vs. regulator" and "prescriber vs. payor. In other words, MAPPs were likely to use different competencies in their work with each stakeholder. With our analysis of competency categories, we concluded that MAPPs use a highly specialized combination of competencies adapted to each external stakeholder.

Innovative models for teaching reproduction in small animals: The experience at DIMEVET of Bologna University.

For a long time, the main way to acquire the skills necessary for good veterinary practice has been the traditional apprenticeship model (observe, assist, and perform under supervision). However, in the last years, more creative and innovative teaching models have been adopted by academic institutions and, parallelly, the opportunities to gain hands-on experience for clinical and surgical procedures are becoming more limited. For that reason, the introduction of the models can provide a potential solution to the ethical and legal implications related to the use of live animals for educational purposes and the biosafety risks deriving from the manipulation of human/animal cadavers. The activity on this topic at DIMEVET and, in particular, the experience about teaching reproduction includes in-house production and use of models for learning skills both for degree (fifth and third years of course) and post-graduate courses. Our models are designed on the basis of two fundamental aspect: the student level and the teacher target. The aim of this study was to evaluate, for the first time in literature, how much the use of simulators impacts on practical teaching in degrees and post graduate courses at DIMEVET, considering different learners with different levels of knowledge and skills. Namely, effectiveness, adequacy and quality of simulators have been checked assessing students' learning experience and teacher's opinion by specific satisfaction questionnaires and considering the attendance at the training sessions and the results of a final examination (PHY group) and an in vivo test (POST group). The rate of satisfaction was high among the three groups considered and the participants that had used the models had a higher success, both in the final examination and in vivo test. Data collected have been useful in order to show an improvement in teaching at DIMEVET in the field of reproduction, despite the relatively short years of experience using simulation. With this study we demonstrate that the adequacy of the models is not correlated to how simulators is built, whether with basic materials or not faithfully in terms of anatomical appearance, but it is important that it is realistic in terms of psychomotor procedure. In conclusion, the use of models permits the student to gain the hand-eye coordination and dexterity necessary to perform certain skills and the models proposed are meeting the desired educational goals.

Construction of multi-level medical training platform system in clinical skills simulation training center / 中华医学教育探索杂志

This study mainly introduces the exploration of the construction and management of multi-level medical training platform in clinical skills center of the Affiliated Hospital of Yangzhou University. Through the construction of a multi-level clinical skills training platform, a reasonable hierarchical training program is formulated by taking the clinical basic skills training platform and the clinical specialist skills training platform as the basic core teaching content. This program adopts various ways to improve the teaching quality, effectively promote students' ability of clinical practice step by step, meet the needs of different levels of medical personnel in different stages, scientifically and effectively cultivate the high-quality medical personals, and give full play to the role of hospital clinical skills center in medical education, which lays a good foundation for the continuous improvement of teaching quality in hospitals.

Practical research of diversified laboratory open training to improve clinical skills of medical students / 中华医学教育探索杂志

Objective:To improve the clinical skills of medical students, and explore the implementation plan and effect of diversified laboratory open training.Methods:A total of 808 undergraduate students of clinical medicine in Batch 2015 were selected for diversified laboratory open training in the 5th, 6th and 7th semesters. Multiple reservation methods were adopted including: personal independent network reservation, written reservation, "registered" network reservation; diversified open model: students practice independently, "workshop" special operation training, team make-up lessons; diversified practice modules: basic skills, specialist skills, and comprehensive skills. The results of the questionnaire survey on the two stages of students' diversified laboratory open training and the end of the internship were analyzed; and the Batch 2015 and Batch 2014 graduation skills test scores were compared. SPSS 20.0 software was used for t-test. Results:After the opening of the diversified laboratory: 92.61% (664/717) of the students were satisfied with the open model; 93.58% (671/717) of the students were satisfied with the reservation method; 94.42% (677/717) of the students thought that it could promote learning motivation; 97.35% (698/717) of the students thought that it could stimulate learning interest; 96.51% (692/717) of the students thought that it could help knowledge and skills grasp. After the internship and the return to the school, the questionnaire showed that 98.02% (741/756) of the students thought it could improve clinical skills; 92.33% (698/756) of the students thought it could cultivate clinical thinking; 95.63% (723/756) of the students thought it could enhance self-confidence in the internship; 94.18% (712/756) of the students thought it could increase a sense of professional belonging. The students' graduation skills (90.33±5.59) and single skill exam scores of Batch 2015 were better than Batch 2014 (82.22±7.19), with a statistically significant difference ( P<0.001). Conclusion:The opening of diversified laboratory could stimulate the interest and motivation of learning, help to improve clinical skills and clinical thinking, and enhance confidence in internship and sense of professional belonging.

Application of modified DOPS as formative assessment in clinical skills training for professional graduate students / 中华医学教育探索杂志

Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.