RESUMEN

PURPOSE: This study aimed to measure student satisfaction with a revised ophthalmology delivery format, which due to the pandemic had previously relied on a remote online flipped classroom (OFC) format compared to a blended learning format. This educational strategy combined online learning with in-person seminars and practical patient centred sessions. Our previous investigations demonstrated a significant lack of student satisfaction with a curriculum solely reliant on a remote OFC, as such we hypothesised that a blended learning approach would result in improved levels of student satisfaction and knowledge gain. METHODS: Non-randomised intervention study of two groups; group 1 = OFC group and group 2 = BL group, compared perspectives of 4th year ophthalmology students using a validated course evaluation questionnaire (CEQ). RESULTS: A total of 59 students from the BL group (n = 257; response rate = 23.0%) and 28 from the OFC group agreed to participate in the study (n = 114; response rate = 24.6%). Participants in the BL group felt it was easier to determine the standard of work that was expected (77.42% v 60.71%) and demonstrated significantly increased satisfaction with staff motivation of students (95.16% v 64.29%, p <0.001) and provision of feedback (74.19% v 46.43%, p = 0.004), compared to the OFC group. Furthermore, students in the BL group also felt the course significantly improved their analytical skills (64.52% v 42.85%, p = 0.023) and ability to work as part of team (69.36% v 25%, p <0.001) as well as reporting reduced dissatisfaction with the level of choice afforded in terms of how they would learn (33.88% v 60.71%, p = 0.31) and the how they were assessed (59.68% v 89.28%, p = 0.004). No evidence of a statistical difference in exam score was observed. CONCLUSIONS: The COVID-19 pandemic necessitated an unavoidable pivot to online and distance learning, to meet the challenges presented by government mandates and social distancing requirements. Since many of these directives have been reversed, it is important to evaluate the effectiveness and learner perceptions' of the online and distance learning interventions. In this study we demonstrated a significant student preference for BL compared to the OFC approach, with comparable student performances determined by MCQ examinations. Our findings suggest a preference for reintroducing in-person and patient engagement activities in post-pandemic health professions education.

Asunto(s)

RESUMEN

PURPOSE: In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. METHODS: Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. RESULTS: Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. CONCLUSION: The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.

RESUMEN

BACKGROUND: Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS: The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS: From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS: The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.

Asunto(s)

RESUMEN

PURPOSE: This study aimed to measure stakeholder satisfaction with our usual delivery format, which previously relied on a blend of didactic lectures and clinical skills sessions compared to a revised format, which had more emphasis on online learning. We hypothesised that the online flipped classroom (OFC) would facilitate delivery of content in the wake of the pandemic, and result in improved levels of student satisfaction and knowledge gain. DESIGN: Non randomised intervention study. Group 1 = Traditional delivery (TD) and Group 2 = OFC group. METHODS: A validated course evaluation questionnaire (CEQ) compared perspectives of teaching faculty (n = 5) and students with the traditional delivery (TD) of the 4th year ophthalmology clinical attachment and an OFC approach (TD n = 129 v OFC n = 114). RESULTS: The OFC group (n = 114; response rate = 24.6%) reported significantly reduced satisfaction with staff motivation of students and provision of feedback, compared to TD (n = 129; response rate = 17.8%). OFC students also felt it was harder to determine what standard of work was expected and found the course less beneficial at helping develop problem-solving skills. Students were dissatisfied with the level of choice afforded by the OFC, specifically how they would learn and assessment options. No significant difference in exam score was observed between the TD and OFC groups. For faculty (n = 5), there was no evidence of a difference between OFC and TD. CONCLUSIONS: Students indicated a preference for the TD compared to the OFC approach. However, both delivery approaches led to comparable student performances as determined by MCQ examination.

Asunto(s)

RESUMEN

PURPOSE: Despite the demonstrated value of simulated participant (SP) feedback, we are only beginning to understand how to optimize SPs' feedback practices for communication skills and strengthen their role as educators. SPs portray roles and engage in feedback practices to support simulated-based learning for communication skills training. SPs come to their role with diverse experiences, knowledge, and training, such as (a) professional actors, (b) lay people, and (c) health professions educators. This study explored what factors influenced SPs' role as educators, including their preparation, training, and approach to role portrayal and feedback practices and how these aspects were influenced by SPs' backgrounds. METHODS: Using grounded theory methodology, we collected and analysed data iteratively from 16 semi-structured in-depth interviews. We identified key concepts, using constant comparison and by exploring how concepts were related , to develop a conceptual model of SPs as educators. RESULTS: The SP role as educator was shaped by several interrelated dualities which spanned both the SP and learner roles and contributed to the identity formation of both SP and learner: (a) building competence (SP competence as educator and learner competence as healthcare professional), (b) engaging in reflective practice (SPs prompting learner reflection and SPs reflecting on their own role), and (c) establishing a safe space (SP needing to feel safe in their role to create safety to support learner engagement). SPs' backgrounds influenced how they learned to portray roles and how they engaged in feedback practices, both in-action, through in-role prompts and cues, and on-action, through post-scenario feedback discussions. CONCLUSION: Our conceptual model about SPs as educators informs SP selection and training. Further, this model enables practical suggestions for SP educators and faculty who involve SPs in teaching. Enhanced feedback practices have the potential to improve learning from simulated encounters.

Asunto(s)

RESUMEN

Brachytherapy is an efficacious treatment option because of its benefits for patient recovery, dose localization and conformity, but these favorable outcomes can be ensured only if the transrectal ultrasound (TRUS) system is optimized for the specific application of ultrasound-guided prostate brachytherapy. The ability to delineate the prostate from surrounding tissue during TRUS-guided prostate brachytherapy is vital for treatment planning, and consequently, so is the contrast resolution. This study describes the development of task-specific contrast-detail phantoms with clinically relevant contrast and spherical target sizes for contrast-detail performance evaluation of TRUS systems used in the brachytherapy procedure. The procedure for objective assessment of the contrast detectability of the TRUS systems is also described; a program was developed in MATLAB (R2017a, The MathWorks, Natick, MA, USA) to quantitatively analyze image quality in terms of the lesion signal-to-noise ratio (LSNR) and validated with representative control test images. The LSNR of the Hitachi EUB-7500A (2013, Hitachi, Ltd, Tokyo, Japan) TRUS system was measured on sagittal and transverse TRUS images of the contrast-detail phantoms described in this work. Results revealed the efficacy of the device as an image quality evaluation tool and the impact of the size, depth and relative contrast of the targets to the surrounding tissue on the contrast detectability of a TRUS system for both transducer arrays. The MATLAB program objectively measured the contrast detectability of the TRUS system and has the potential to determine optimized imaging parameters that could be designed as part of standardization of the imaging protocol used in TRUS-guided prostate brachytherapy for prostate cancer.

Asunto(s)

RESUMEN

PURPOSE: Ultrasound imaging training is not required as part of radiation oncology training programs nor does any objective competency measure exist to independently assess performance. Physical simulation training can provide a structured approach to this training but only if suitably challenging training simulators exist. This study describes the design and preliminary evaluation of a simulation-based transrectal ultrasound (TRUS) imaging training workshop developed for medical physicists involved in low-dose-rate (LDR) prostate brachytherapy (PBT). METHODS: The study incorporated novel high-fidelity anthropomorphic PBT TRUS training simulators and a TRUS imaging module with a blended-learning pedagogical approach, to address TRUS image optimisation and managing image quality. RESULTS: Results demonstrated a significant improvement in knowledge, with an average increase in multiple choice question score of 61% (P < 0.0002), and that there was a 46% (P < 0.0001) average increase in the participants perceived understanding of TRUS scanner operation, and an increase of 36% (P < 0.001) in participants readiness to optimise image quality and mitigate image artefacts. Focus group data explored participants' experiences, perceptions and challenges with TRUS LDR PBT. CONCLUSIONS: This study suggests a benefit in offering a simulation training workshop to medical physicists and the potential benefit to other healthcare professionals involved in prostate brachytherapy, by incorporating novel high-fidelity anthropomorphic PBT TRUS training simulators, in a simulated environment to practice ultrasound image optimisation for PBT image guidance. This approach to training would enable competency-based skill acquisition and continued proficiency or health professionals in the TRUS PBT procedure, outside of the surgical environment without direct exposure to patients.

Asunto(s)

RESUMEN

BACKGROUND: COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research. METHODS: The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts. RESULTS: One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement). CONCLUSIONS: This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.

Asunto(s)

RESUMEN

The quality of the trans-rectal ultrasound (TRUS) image, and thus seed placement during the prostate brachytherapy (PBT) procedure, relies on the user's technical and clinical competency. Simulation-based medical education can provide a structured approach for the acquisition of clinical competencies, but the efficacy of the training relies on the fidelity of the training simulators. In this work, the design, development and preliminary evaluation of an anthropomorphic training phantom for TRUS PBT is described. TRUS clinical patient data informed the design of 3-D printed moulds to fabricate prostate targets. Tissue-mimicking materials were included that had the sonographic characteristics of the prostate and overlying tissues, as well as the clinically relevant physical response, to provide haptic feedback to the user. Through an iterative design process, prototypes were constructed. These prototypes were quantitatively evaluated using a specification list and evaluated by an experienced clinical brachytherapy oncologist; their feedback was implemented, and the results of this evaluation are presented.

Asunto(s)

RESUMEN

BACKGROUND: The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned. METHODS: The authors systematically searched four online databases and hand searched MedEdPublish up to 24 May 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias for included articles. Discrepancies were resolved by a third author. A descriptive synthesis and outcomes were reported. RESULTS: Forty-nine articles were included. The majority were from North America, Asia and Europe. Sixteen studies described Kirkpatrick's outcomes, with one study describing levels 1-3. A few papers were of exceptional quality, though the risk of bias framework generally revealed capricious reporting of underpinning theory, resources, setting, educational methods, and content. Key developments were pivoting educational delivery from classroom-based learning to virtual spaces, replacing clinical placement based learning with alternate approaches, and supporting direct patient contact with mitigated risk. Training for treating patients with COVID-19, service reconfiguration, assessment, well-being, faculty development, and admissions were all addressed, with the latter categories receiving the least attention. CONCLUSIONS: This review highlights several areas of educational response in the immediate aftermath of the COVID-19 pandemic and identifies a few articles of exceptional quality that can serve as models for future developments and educational reporting. There was often a lack of practical detail to support the educational community in enactment of novel interventions, as well as limited evaluation data. However, the range of options deployed offers much guidance for the medical education community moving forward and there was an indication that outcome data and greater detail will be reported in the future.

Asunto(s)

RESUMEN

Objective: To explore the experience of work-related stress in brain injury professionals and to identify the contributing factors to work-related stress. Methods: 17 brain injury professionals participated in one-time interviews conducted either in person or utilising video conferencing. The data were analysed utilising a Grounded Theory approach. Results: Participants reported that working in brain injury rehabilitation is difficult due to the complex and unpredictable nature of brain injury. The impact of limited funding and resources was endorsed by all participants as the most stressful aspect of working in this field. Emotional experiences associated with treating survivors and organisational factors increase the risk for work-related stress. Brain injury professionals rely on support provided by coworkers and supervisors. Conclusion: This study provides a deeper understanding of work-related stress and challenges of working in the brain injury rehabilitation field, as well as appreciation for the personal and organisational strategies that may help to offset stress. The unpredictable nature of working in brain injury rehabilitation impacted professionals at the micro, mezzo, and macro levels of practice. Overall, it was apparent that the participants interviewed were highly resilient individuals, demonstrating acceptance and flexibility in the limitations they face working in the field of brain injury rehabilitation.

Asunto(s)

RESUMEN

Ultrasound guided brachytherapy for the treatment of prostate cancer has become a routine treatment option, due to many benefits including patient recovery and dose localisation [1]; however it is not clear whether the standards which govern the image quality for these systems are adequate. Upon review of the recommended standards for ultrasound systems used in prostate brachytherapy procedures, the recommended tests do not appear to be specific to the clinical application of ultrasound guided prostate brachytherapy. Rather they are generic and similar to those recommended for other clinical applications such as general abdominal scanning [2]. Furthermore, there is growing evidence that these tests should be specific to the clinical application [3,4] in order to gain meaningful data about the performance of the system for the application, and also to detect clinically relevant changes in quality control results. An additional problem is that there are no clinically relevant test phantom recommended for the quality assurance of ultrasound systems used in prostate brachytherapy. The image quality for this application of ultrasound needs to be monitored to ensure consistent levels of confidence in the procedure. This paper reviews the currently recommended test guidelines and test phantoms for ultrasound systems used in prostate brachytherapy from the different standard bodies and professional organisations. A critical analysis of those tests which are most reflective of the imaging and guidance tasks undertaken in an ultrasound guided prostate brachytherapy procedure will also be presented to inform the design of a TRUS quality assurance protocol.

Asunto(s)

RESUMEN

IMPORTANCE: Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested. OBJECTIVE: To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N = 600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n = 242), assessed control (n = 237), or no-contact control (n = 121). INTERVENTIONS: A 20- to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months. MAIN OUTCOMES AND MEASURES: Incidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system. RESULTS: Of 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels. CONCLUSIONS AND RELEVANCE: For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting. TRIAL REGISTRATION: clinicaltrials.gov Identifer: NCT01207258.

Asunto(s)

RESUMEN

Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative methods (n = 20) to identify relationships between inner setting variables and DBT implementation. Four interpersonal variables-team cohesion, team communication, team climate, and supervision-were correlated with the quantity of DBT elements implemented. Qualitative themes corroborated these findings. Additional variables were connected to implementation by either quantitative or qualitative findings, but not both.

Asunto(s)

RESUMEN

In this research we examined how the conditions of Haiti's tent communities, inhabited by those displaced by the January 10, 2010, earthquake, shaped access and adherence to highly active antiretroviral treatment (HAART) for Haitians with HIV. Conditions in the encampments were marked by unhygienic and cramped living spaces, exposure to the elements, a lack of privacy, unavailability of food and clean water, and a dependence on poorly functioning aid agencies. These conditions shaped access and adherence to HAART by (a) exacerbating the stigma of being HIV positive and undermining mental health; (b) presenting logistical challenges to accessing medical care, storing pills, and ingesting them safely and privately; and (c) sustaining a political economy of aid characterized by unequal treatment in major HAART-dispensing centers, unequal circulation of international funds, and the emergence of alternative medical institutions within encampments that could improve future treatment. Policy and intervention implications are discussed.

Asunto(s)