Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.660
Filtrar
1.
J Educ Eval Health Prof ; 17: 5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32079052

RESUMO

Feedback has been shown to be an important driver for learning. However, many factors, such as the emotional reactions feedback evokes, may impact its effect. This study aimed to explore medical students' perspectives on the verbal feedback they receive during an objective structured clinical examination (OSCE); their emotional reaction to this; and its impact on their subsequent performance. To do this, medical students enrolled at 4 Canadian medical schools were invited to complete a web-based survey regarding their experiences. One hundred and fifty-eight participants completed the survey. Twenty-nine percent of respondents asserted that they had experienced emotional reactions to verbal feedback received in an OSCE setting. The most common emotional responses reported were embarrassment and anxiousness. Some students (n=20) reported that the feedback they received negatively impacted subsequent OSCE performance. This study demonstrates that feedback provided during an OSCE has the ability to evoke an emotional response in students and to potentially impact subsequent performance.


Assuntos
Educação de Graduação em Medicina/métodos , Retroalimentação , Estudantes de Medicina , Adulto , Canadá , Competência Clínica , Avaliação Educacional , Humanos , Aprendizagem , Faculdades de Medicina , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 99(2): e18514, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914023

RESUMO

BACKGROUND: This study will assess the effects of the project-based learning (PBL) for participants undergoing clinical oncology teaching (COT). METHODS: A systematic and comprehensive literature records will be identified from the electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched from their inceptions up to the present. Any relevant randomized controlled trials on the effects of PBL in participants receiving COT will be considered for inclusion. Study quality will be assessed using the Cochrane risk of bias tool. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: This study will assess the effects of PBL in participants receiving COT through assessing the primary outcomes of psychological disorders, student satisfaction, and student feedback, and secondary outcomes of examination scores, excellence rates, course examination pass rates, and clinical knowledge or skills. CONCLUSION: The findings of this study will summarize the latest evidence on the effects of PBL in participants receiving in COT. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019150433.


Assuntos
Educação de Graduação em Medicina/métodos , Oncologia/educação , Estudantes/psicologia , China/epidemiologia , Bases de Dados Factuais , Humanos , Satisfação Pessoal , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Estudantes/estatística & dados numéricos , Ensino/normas
4.
Urology ; 135: 28-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31628969

RESUMO

OBJECTIVE: To address information overload for trainees, a concise electronic case-based urology learning program (CBULP) was developed. Previous qualitative assessments suggested CBULP's potential efficacy/utility. Herein we assess CBULP more stringently by evaluating test performance before/after reviewing a CBULP curriculum covering core concepts in testicular cancer. METHODS: Eleven of 33 CBULP testicular cancer cases were strategically selected for this curriculum. A 26 question multiple-choice test was developed to assess fundamental knowledge about testis cancer tumor biology and evaluation/management. Pretest was administered to PGY4/PGY1 residents at 2 pilot urology-training programs, and medical students interested in Urology. Participants were given 4 weeks to review the curriculum and the test was then repeated. A control group (4 PGY1s) was administered the pretest and repeat test in an analogous manner without provision of the CBULP curriculum. RESULTS: Twenty individuals took the pretest (7 medical students, 8 PGY1s, and 5 PGY4s), and 17 (85%) took the post-test (5 medical students, 8 PGY1s, and 4 PGY4s,). As expected, PGY4s performed significantly better than the other 2 groups on the pre- and post-test. However, significant improvement in test performance was seen across all groups that utilized the CBULP curriculum (P <.02), with highest increase demonstrated by PGY1 residents (4.75 more questions correct, P = .002). The control arm did not demonstrate significant improvement (P = .20). CONCLUSION: Significant improvement in test performance was observed after completion of the CBULP testicular series. This study suggests that CBULP can be an efficacious and clinically useful educational resource for urologic residents and students interested in the field.


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Internato e Residência/métodos , Neoplasias Testiculares/diagnóstico , Urologia/educação , Adulto , Competência Clínica , Instrução por Computador/métodos , Educação de Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina/estatística & dados numéricos , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
5.
Acad Med ; 95(2): 194-199, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31464734

RESUMO

An important tenet of competency-based medical education is that the educational continuum should be seamless. The transition from undergraduate medical education (UME) to graduate medical education (GME) is far from seamless, however. Current practices around this transition drive students to focus on appearing to be competitively prepared for residency. A communication at the completion of UME-an educational handover-would encourage students to focus on actually preparing for the care of patients. In April 2018, the American Medical Association's Accelerating Change in Medical Education consortium meeting included a debate and discussion on providing learner performance measures as part of a responsible educational handover from UME to GME. In this Perspective, the authors describe the resulting 5 recommendations for developing such a handover: (1) The purpose of the educational handover should be to provide medical school performance data to guide continued improvement in learner ability and performance, (2) the process used to create an educational handover should be philosophically and practically aligned with the learner's continuous quality improvement, (3) the educational handover should be learner driven with a focus on individualized learning plans that are coproduced by the learner and a coach or advisor, (4) the transfer of information within an educational handover should be done in a standardized format, and (5) together, medical schools and residency programs must invest in adequate infrastructure to support learner improvement. These recommendations are shared to encourage implementation of the educational handover and to generate a potential research agenda that can inform policy and best practices.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Educação de Graduação em Medicina/métodos , Comunicação , Guias como Assunto , Humanos , Autoaprendizagem como Assunto
6.
Ultraschall Med ; 41(1): 36-43, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31745964

RESUMO

BACKGROUND: Diagnostic ultrasound has a crucial importance in clinical settings, especially in intensive care medicine where bedside ultrasound has become indispensable. Medical students as well as residents therefore have a strong interest in learning this useful skill. Since staff resources are limited, more and more universities are using student tutors in a peer-assisted learning concept (PAL) to teach medical students early in their training. To date, there is very sparse data about knowledge retention after peer-assisted teaching. The aim of this study was to evaluate whether PAL is a suitable method for teaching complex skills like abdominal ultrasound and to evaluate whether students do achieve adequate long-term knowledge retention after peer-assisted teaching. METHOD: A total of 40 volunteer 3rd to 5th year students were randomly assigned to a basic abdominal ultrasound course in small training groups of 5 persons each. Participants were evaluated using a pre-post-test design by a validated objective structured clinical examination (OSCE) before and immediately after the course. To measure the retention of knowledge, 15 former participants were randomly selected to repeat the OSCE assessment after one year. RESULTS: All groups showed a significant improvement in practical skills and knowledge gain after the training with mean values of 13.1 for pre-test compared to 83.5 (maximum 100 points) for post-test (p < 0.001). The overall score achieved after one year was 78.7 and did not significantly differ from the post-test result. CONCLUSION: PAL is effective for teaching abdominal ultrasound. Students were able to accomplish a satisfactory level of ultrasound skills. We further demonstrated that PAL can assure long-term knowledge retention.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Ultrassonografia , Abdome/diagnóstico por imagem , Currículo , Educação de Graduação em Medicina/métodos , Avaliação Educacional , Humanos , Grupo Associado
7.
Rev Med Chil ; 147(6): 790-798, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859833

RESUMO

BACKGROUND: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. AIM: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. MATERIAL AND METHODS: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. RESULTS: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. CONCLUSIONS: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.


Assuntos
Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Chile , Humanos , Aprendizagem , Estudantes de Medicina , Inquéritos e Questionários , Fatores de Tempo
8.
South Med J ; 112(11): 571-580, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31682738

RESUMO

OBJECTIVE: To describe the use of the e-Delphi combined with the Community Priority Index (CPI) to support medical curriculum enrichment. METHODS: This mixed-methods study was conducted from December 2017 to May 2018 at Baylor College of Medicine in Houston, Texas. First, a nominal group identified a topical list. Second, to refine the curriculum content and achieve consensus, an e-Delphi was implemented with healthcare experts regarding the following target cohorts (N = 40): transformed postbaccalaureate premedical scholar students, medical students, clinical fellows, and junior faculty. Third, the CPI incorporated multicriteria decision making and calculation of standardized prioritization scores (range 0-1) with bootstrap 95% confidence intervals (CIs). RESULTS: Among transformed postbaccalaureate premedical scholar students, medical students, and clinical fellows, the e-Delphi-CPI system's highest ranked topic was in the domain of leadership skills and competence for transformed postbaccalaureate premedical scholar students (CPI 0.87, 95% CI 0.58-0.94), medical students (CPI 0.85, 95% CI 0.36-0.91), and clinical fellows (CPI 0.86, 95% CI 0.32-0.92), respectively. For junior faculty, the highest ranked topic was introductory research methods (CPI 0.90, 95% CI 0.65-1.00). In each cohort, the top three ranked topics also contained leadership skills and competence and introductory research methods. The system ranked practical issues in health disparity as the third most valued domain among transformed postbaccalaureate premedical scholar students. CONCLUSIONS: The integrated e-Delphi-CPI system identified the highest ranked options across all of the domains and established comparability across cohorts. We recommend the e-Delphi-CPI system to advance medical curriculum enrichment processes.


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Pesquisa Biomédica , Competência Clínica , Técnica Delfos , Disparidades em Assistência à Saúde , Humanos , Liderança , Informática Médica , Resiliência Psicológica , Mídias Sociais , Texas
9.
West J Emerg Med ; 20(6): 893-902, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31738716

RESUMO

INTRODUCTION: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. METHODS: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. RESULTS: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. CONCLUSION: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.


Assuntos
Educação de Graduação em Medicina/métodos , Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Internato e Residência/métodos , Desempenho de Papéis , Treinamento por Simulação/métodos , Revelação da Verdade , Adulto , Comunicação , Currículo , Feminino , Humanos , Masculino , Relações Profissional-Família , Autoeficácia , Método Simples-Cego
10.
Neurology ; 93(24): 1046-1055, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31757871

RESUMO

OBJECTIVE: To develop an educational framework basis for improving the teaching of the neurologic examination (NE) by asking German neurologists to (1) identify the basic elements of the screening NE and (2) nominate the steps they would deem mandatory for medical students to master. METHODS: We conducted a questionnaire-based survey among neurologists working in a hospital or ambulatory setting in southwest Germany. To define the screening NE, neurologists were asked to list the NE components they normally use in clinical encounters with patients in whom neurologic findings are unlikely. Furthermore, they were asked to identify additional elements of the NE which they would consider mandatory for students to master. RESULTS: Our neurologists nominated a set of 23 elements as being essential for a screening NE. There was high consensus among the 2 groups, and the results were concordant with international data. Furthermore, nearly 60 additional maneuvers of the NE were deemed obligatory for students to master. CONCLUSION: Our results reinforce the international consensus for screening NE components and confirm a large set of additional examination steps that medical students should master, thereby indicating the need for an educational NE teaching concept. To solve this educational challenge, we propose a longitudinal curriculum that incorporates the "core + clusters" framework, thus combining the screening NE (core) with hypothesis-driven sets of maneuvers (clusters). Based on our data, we provide an initial proposal for the core and neurologic diagnostic clusters which is applicable to both novice and advanced learners across the continuum of training.


Assuntos
Competência Clínica/normas , Educação de Graduação em Medicina/normas , Exame Neurológico/normas , Neurologistas/normas , Inquéritos e Questionários , Ensino/normas , Educação de Graduação em Medicina/métodos , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Exame Neurológico/métodos , Estudantes de Medicina
12.
Educ Prim Care ; 30(5): 317-318, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31551007

RESUMO

There is increasing interest in LICs. However for use in the UK and Europe, both the name and nature of LICs need considerable adaption.


Assuntos
Estágio Clínico/organização & administração , Educação de Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/métodos , Europa (Continente) , Humanos , Atenção Primária à Saúde , Estudantes de Medicina , Reino Unido
13.
J Laparoendosc Adv Surg Tech A ; 29(10): 1252-1258, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31509069

RESUMO

Background and Aim: Training programs for developing laparoscopic suturing skills range from dry-box training to virtual simulator training. There are advantages and disadvantages to each training method; however, which training is best for medical students and young surgeons is unclear. The aim of this study was to compare the proficiency of medical students in acquiring laparoscopic suturing skills after various routes of short-term training: via a video, an expert teacher, or a virtual simulator. Materials and Methods: Seventeen medical students were registered and divided randomly into three groups: group receiving personal training while watching a training video (video group), group receiving training under the guidance of an expert (teaching group), and group receiving personal training with a virtual simulator (virtual group). The students practiced laparoscopic suturing and tying skills for 1 hour. Following their training, they performed the evaluation task of three sutures and ties using a laparoscopic fundoplication simulator. We developed a 1-year-old infant body model (body weight 10 kg) based on computed tomography data and established a pneumoperitoneum body model based on a clinical situation. Results: The path length of the assistant forceps in the virtual group tended to be longer than in the other groups. The average acceleration of the assistant forceps in the virtual group was faster than in the other groups (P = .04). There were no significant differences in the other evaluation parameters. Conclusion: A long-term and combination training study should be performed to develop the best method for training medical students and inexperienced young surgeons.


Assuntos
Competência Clínica , Educação de Graduação em Medicina/métodos , Fundoplicatura/educação , Laparoscopia/educação , Treinamento por Simulação/métodos , Pesquisa Comparativa da Efetividade , Fundoplicatura/métodos , Humanos , Lactente , Japão , Laparoscopia/métodos
14.
J Pak Med Assoc ; 69(9): 1287-1292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511713

RESUMO

OBJECTIVE: To explore perceptions of students and teachers about learning and teaching strategies used in the delivery of Surgery Module in a relatively newly established medical college. . METHODS: The mixed-methods research with convergent parallel design was conducted at the Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia, from January 2017 to February 2018. Students in the study completed the Motivated Strategies for Learning Questionnaire on the basis of which correlation analyses were conducted to determine the association among study variables and final scores. For qualitative part, 2 focus group discussions and 3 interviews were performed with students and teachers respectively. Their verbatim responses were recorded and analysed. Themes were generated. RESULTS: There were 47 students in the study. There were positive correlations between learning strategies, cognitive and metacognitive and resource management, with final grades of students (p<0.001). Items of the questionnaire showed positive correlation with each other. Some of the major themes were elaboration, organization, critical thinking, self-regulatory learning, group and peer learning, and focus of learning. Some important subthemes were personal notes, concept map, goals, think out of the box, life-long learning, open discussion, feedback, deep learning and alignment. CONCLUSIONS: High achievers were found to be using learning strategies effectively. Both students and teachers favoured critical thinking, deep and conceptual learning, and learners' active participation.


Assuntos
Educação de Graduação em Medicina/métodos , Cirurgia Geral/educação , Aprendizagem , Ensino , Desempenho Acadêmico , Adulto , Formação de Conceito , Docentes de Medicina , Comportamento de Busca de Ajuda , Humanos , Masculino , Pesquisa Qualitativa , Arábia Saudita , Estudantes de Medicina , Habilidades para Realização de Testes , Pensamento , Gerenciamento do Tempo , Adulto Jovem
15.
Educ Health (Abingdon) ; 32(1): 3-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512586

RESUMO

Background: Professionalism is the foundation of the doctor-patient relationship with emotional competency at its core. This competency is based on emotional intelligence (EI), contributing to effective work performance. As EI is reasonably new in health professions education in India, this study was conducted to assess the effect of reflection and peer feedback on EI scores among undergraduate medical students and explore facilitating and hindering factors for augmenting EI. Methods: This pre- and post interventional study was conducted among 94 final-year (Part I) medical students from a rural medical college in Central India. Baseline assessment of EI scores was done using a self-reported validated EI scale, and then, a mini-workshop was conducted to sensitize students on EI and to train them in writing reflection and giving peer feedback. Between the pretest and posttest, students were asked to write weekly reflection and take monthly feedback from the "peer" of their choice. Posttest assessment was done at 1 week, 1 month, and 3 months. Force-field analysis was undertaken with 10 students each with highest and lowest EI scores to assess facilitating and hindering factors. Results: There was a significant improvement (P < 0.0001) in the EI scores at each subsequent time point from baseline. Students who were male, from nuclear families and considered themselves spiritual had significantly higher median EI scores. Students reported self-motivation, social support, and openness to learn new things as enabling forces for augmenting EI. Hindering factors were time constraint and lack of mutual trust in the relationship between students. Discussion: Based on the findings, it can be concluded that personal introspection methods such as self-reflection and peer feedback help to improve the EI of undergraduate students. Therefore, it is imperative that the students are trained in these skills for building their emotional competencies.


Assuntos
Educação de Graduação em Medicina/métodos , Inteligência Emocional , Estudantes de Medicina/psicologia , Empatia , Retroalimentação , Feminino , Humanos , Índia , Masculino , Autoimagem , Autorrelato , Inquéritos e Questionários
16.
Med Educ Online ; 24(1): 1666538, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31526248

RESUMO

With the increasing use of technology in education, online learning has become a common teaching method. How effective online learning is for undergraduate medical education remains unknown. This article's aim is to evaluate whether online learning when compared to offline learning can improve learning outcomes of undergraduate medical students. Five databases and four key journals of medical education were searched using 10 terms and their Boolean combinations during 2000-2017. The extracted articles on undergraduates' knowledge and skill outcomes were synthesized using a random effects model for the meta-analysis.16 out of 3,700 published articles were identified. The meta-analyses affirmed a statistically significant difference between online and offline learning for knowledge and skill outcomes based on post-test scores (SMD = 0.81; 95% CI: 0.43, 1.20; p < 0.0001; n = 15). The only comparison result based on retention test scores was also statistically significant (SMD = 4.64; 95% CI: 3.19, 6.09; p < 0.00001). The meta-analyses discovered no significant difference when using pre- and post-test score gains (SMD = 3.03; 95% CI: -0.13, 4.13; p = 0.07; n = 3). There is no evidence that offline learning works better. And compared to offline learning, online learning has advantages to enhance undergraduates' knowledge and skills, therefore, can be considered as a potential method in undergraduate medical teaching.


Assuntos
Educação a Distância , Educação de Graduação em Medicina/métodos , Ensino/normas , Humanos , Internet , Estudantes de Medicina
17.
Adv Physiol Educ ; 43(4): 512-518, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31553640

RESUMO

Historically, attendance has been a marker of academic performance, but the current medical education literature has had mixed results. In addition, attendance is dropping in the preclinical curricula, whereas, at the same time, the focus on United States Medical Licensing Examination Step 1 performance is increasing. This present study is a mixed-method approach correlating student attendance and access to the formal curriculum in a second-year pathophysiology course to performance on Step 1. Additionally, survey and focus group data evaluated the usage and importance of both the formal curriculum and third-party resources. Out of 112 eligible students, 77 participated in the study. There was no correlation between attendance or access to the learning materials and Step 1 performance. There was a strong correlation between the performance on the final examination and that of Step 1 (r = 0.813; P < 0.001) and a moderate correlation between formative quiz (r = 0.321; P = 0.005) and individual readiness assessment test performance (r = 0.351; P = 0.002) and Step 1 performance. Survey and focus group data show that students place high importance on faculty-developed materials that they can use on their own, but not attendance. The third-party resources are highly used as an adjunct to the formal curriculum and to focus on Step 1 study. Attendance and access to the formal curriculum do not predict Step 1 performance, whereas performance on high- and low-stakes internal assessments do. Further study on how the lack of social interaction gained from attendance affects development of other competencies and the learning climate are warranted.


Assuntos
Desempenho Acadêmico , Educação de Graduação em Medicina/métodos , Fisiologia/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Medicina , Desempenho Acadêmico/normas , Educação de Graduação em Medicina/normas , Avaliação Educacional/métodos , Humanos , Estados Unidos/epidemiologia
18.
BMC Med Educ ; 19(1): 328, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481036

RESUMO

BACKGROUND: Deakin's Rural Community Clinical School (RCCS) is a Longitudinal Integrated Clerkship (LIC) program in Western Victoria. Students undertake a year-long placement in a rural General Practice, many of which also host General Practice Registrars. There is a lack of evidence addressing the role and impact of Vertically Integrated Learning (VI) in practices hosting both LIC medical students and General Practice Registrars. The objective of the study was to establish how VI is perceived in the LIC context and the impact that it has on both learners and practices, in order to consider how to potentiate the role it can play in facilitating learning. METHODS: Semi-structured, in-depth, qualitative interviews were undertaken, with 15 participants located in RCCS General Practices. Emergent themes were identified by thematic analysis. RESULTS: Five main interconnected themes were identified; (i) understanding and structure, (ii) planning and evaluation, (iii) benefits, (iv) facilitators, and (v) barriers. CONCLUSION: VI in a rural LIC is not clearly understood, even by participants. VI structure and methodology varied considerably between practices. Benefits included satisfying and efficient sharing of knowledge between learners at different levels. VI was facilitated by the supportive and collegiate environment identified as being present in a rural LIC context. Resources for VI are needed to guide content and expectations across the continuum of medical training and evaluate its role. The financial impact of VI in a rural LIC warrants further exploration.


Assuntos
Estágio Clínico/normas , Educação de Pós-Graduação em Medicina/métodos , Educação de Graduação em Medicina/métodos , Medicina Geral/educação , Estudantes de Medicina , Humanos , Entrevistas como Assunto , Aprendizagem , Estudos Longitudinais , Modelos Educacionais , Preceptoria , Pesquisa Qualitativa , Serviços de Saúde Rural
19.
J Bone Joint Surg Am ; 101(17): e88, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483408

RESUMO

BACKGROUND: FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS: Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS: At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS: Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE: FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved.


Assuntos
Parafusos Ósseos , Educação de Graduação em Medicina/métodos , Implantação de Prótese/educação , Treinamento por Simulação/métodos , Adolescente , Adulto , Competência Clínica/normas , Desenho de Equipamento , Feminino , Fluoroscopia , Humanos , Curva de Aprendizado , Londres , Masculino , Destreza Motora/fisiologia , Implantação de Prótese/normas , Método Simples-Cego , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA