A study of teaching module on subcutaneous drug administration and communication skills in pharmacology according to competency-based medical education curriculum

Background: Theory lectures in pharmacology are covering various oral and parenteral routes of drug administration, mainly focusing on knowledge domain, but soft and psychomotor skills were less taught in undergraduate students. Demonstrating correct method of subcutaneous route of drug administration and communication skills as introduced by competency-based medical education (CBME) competency-based curriculum will help in early acquisition of the skills and minimize the errors in administration in insulin, heparin, and vaccines. Aim and Objectives: The aims of this study were to teach the subcutaneous drug administration (S/C) and communication skills to undergraduate students in pharmacology and to evaluate the perception of students and teachers toward new CBME curriculum. Materials and Methods: Correct technique of subcutaneous drug administration was demonstrated on mannequins after browsing through the videos of S/C route. Students were told to perform it independently on mannequins. Perception of students and staff members were collected with pre-validated questionnaire provided after the practical teaching hours. Results: In our study, majority of students (94%) felt that learning S/C route of drug administration correctly will help in managing various patients like administration of insulin in diabetic patients in their near future days. They were well advanced in communicating with patients regarding usage of medications and were (90%) also in favor of introduction of this experiment in UG curriculum. Conclusions: Our study concluded that subcutaneous teaching technique introduced by CBME curriculum in practical classes was well accepted by students and were more confident in soft skills and psychomotor skills at the end of the study.

Simulation-based training in ear, nose and throat skills and emergencies

Abstract Objectives: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. Methods: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5-6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. Results: The participants had significant improvement in the post-test scores in all three scenarios (p < 0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p < 0.05). Conclusion: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. Level of evidence: II.

A study of teaching module on intramuscular drug administration and communication skills in pharmacology according to CBME curriculum

Background: Theory classes in pharmacology are taking care of teaching of various oral and parenteral routes of drug administration, mainly focusing on knowledge domain but soft and psychomotor skills are under taught or deficient in undergraduate students. Demonstrating correct method of intramuscular route of drug administration and communication skills as introduced by competency based medical education (CBME) competency-based curriculum, will help in early acquisition of the skills and minimize the errors in administration. Aim and Objectives: The aim of the study is to teach the IM drug administration and communication skills to undergraduate students in pharmacology and to evaluate the perception of students and teachers toward new CBME curriculum. Materials and Methods: Correct technique of intramuscular drug administration was demonstrated on mannequins after going through the videos of IM. Students were told to perform it independently on mannequins. Perception of students and staff members were collected with pre-validated questionnaire provided after the practical teaching hour. Results: In our study, the majority of students (96%) felt that learning IM route of drug administration correctly will help in managing the patients in their near future days. They were well advanced in communicating with patients regarding usage of medications and were (86%) also in favor of introduction of this experiment in UG curriculum. Conclusions: Our study concluded that IM teaching technique introduced by CBME curriculum in practical classes was well accepted by students and were more confident in soft skills and psychomotor skills at the end of the study.

Characteristics of the Distance and Space Required for Knife Slashing Using a Motion Capture System / 法医学杂志

OBJECTIVES@#To investigate the relationship between the perpetrator's sex, victim's position and slashing location as well as anthropometric parameters on distance and space required for slashing, to provide the theoretical basis for the judgment of whether the crime scene was consistent with the criminal activity space.@*METHODS@#The kinematics data of 12 male and 12 female subjects slashing the neck of standing and supine mannequins as well as the chest of the standing mannequins with a kitchen knife were obtained by using a 3D motion capture system. The relationship between the perpetrator's sex-victim's position, the perpetrator's sex-slashing location, and anthropometric parameters and the distance and space required for the slashing were analyzed by two-factor repeated measures ANOVA and Pearson correlation analysis respectively.@*RESULTS@#Compared with slashing the neck of supine mannequins, the distance (L) and normalized L (l) of slashing the neck of standing mannequins were greater, while vertical distance (LVR) and normalized LVR (lVR) of the knife side were smaller. Compared with slashing the neck of standing mannequins, the L and l slashing the chest of standing mannequins were greater, while LVR and lVR were smaller. Horizontal distance (LHR) and normalized LHR (lHR) of the knife side in males were greater than that in females. Height and arm length were positively correlated with L, LHR, and LVR when striking the standing mannequins.@*CONCLUSIONS@#When slashing the neck of supine or standing victims, the slashing distance is shorter and the slashing height is greater. Furthermore, the distance and space required for slashing are correlate with anthropometric parameters.

Introduction of a teaching module on intravenous drug administration and communication skills in pharmacology

Background: Pharmacology practicals mainly focus on increasing the knowledge component but teaching on psychomotor and soft skills is largely lacking. Teaching correct method of intravenous drug administration and the communication skills about drug therapy in Pharmacology practical classes can help in minimizing the errors in drug administration and improving the patient compliance and adherence to the therapy. Objectives of this study were teaching module on intravenous drug administration and communication skills to undergraduate students in Pharmacology and to evaluate the perceptions of students and teachers towards the new teaching module.Methods: Correct methods of intravenous drug administration were demonstrated in practical classes. Role play was done to teach about communication skills regarding right method of using an inhaler and also about prescribing the correct dosage regimens. Perceptions of students and teaching staff members were collected on the teaching module.Results: Almost all of the students (>96 %) were of the opinion that learning correct drug administration methods and communication skills was relevant to the future practice and 95% students felt that after the role play sessions, they were better equipped in communicating with the patients about the medication use and were in favour of teaching these to all the medical students.Conclusions: Our study concludes that the teaching module on intravenous drug administration and communication skills was well accepted by both the teaching staff and the students and was found feasible and relevant to be introduced in the curriculum by both of them.

The ergonomic analysis of different holding gun methods for standing guard soldiers / 中华劳动卫生职业病杂志

Objective@#To study the effects of different holding gun methods and gun weight on health when standing guard, and propose a way to support the health of long-term standing guard soldiers.@*Methods@#We created different percentile mannequins by Classic JACK, and adjusted the standing guard posture based on its standards for soldiers. The pressure on lumbar L4/L5 and moment on ankles and knees were analysied for different holding gun methods and gun weight. Then the mathematical models of joint load, gun weight and body mass index were studied by multiple regression analysis.@*Results@#Holding gun methods and gun weight influence the force characteristics on ankles, knees and lumbar L4/L5. Holding gun with a brace and hands applying downward force -2 kgf could significantly reduce lumbar L4/L5 pressure. When the hand force is -5, -3, -4, -3, -2, -1, 0, 1, 2 kgf, and the weight of the gun is 0, Lumbar vertebrae L4/L5 joint pressure of people with different body mass index(P1, P5, P55, P95, P99) are the smallest, respectively 269, 281, 321, 408, 444 N, and the same change trend occurs when the weight of the gun is 2, 4, and 8 kg.The moment on ankles and knees were less with the same holding gun method and the hands downward force ranged from 0 to -4 kgf, and the higher the body mass index is, the more the hands downward force needed to make the moment on ankles and knees zero. That is, the moment on ankles could be zero when the hands downward force ranged from -1 to -3 kgf, the moment on knees could be zero when the hands downward force ranged from -1.1 to -3.7 kgf.@*Conclusion@#To reduce the pressure on lumbar L4/L5 and moment on ankles and knees, so as to cut down occupational risk of long-standing operation, we advise the long-term standing guard soldiers holding gun with a brace and hands applying downward force -2 kgf.

Diseño e implementación de un modelo de enseñanza en ambiente simulado de paracentesis abdomina / Design and implementation of an environment teaching model simulated abdominal paracentesis

Resumen: El aprendizaje de los estudiantes de Medicina de Pregrado en ambiente simulado constituye una alternativa en la obtención de competencias técnicas y no técnicas. Objetivo: Desarrollar un fantoma e implementar un taller modular de entrenamiento de paracentesis abdominal en ambiente simulado para estudiantes de Medicina. Métodos: Se diseñaron y desarrollaron modelos para la realización de paracentesis abdominal en la Escuela de Diseño de la Pontificia Universidad Católica de Chile (PUC) y se implementó un taller para alumnos de 4to año de Medicina de la PUC, utilizando un enfoque constructivista, sesiones de entrenamiento simulado con debriefing basadas en el modelo plus-delta y evaluación pre y post-procedimiento siguiendo los principios de evaluación para el aprendizaje. Resultados: Se desarrollaron 3 prototipos hasta llegar a un modelo definitivo de alta fidelidad basado en la percepción de 20 expertos. 237 alumnos asistieron a un taller de paracentesis abdominal en el Centro de Cirugía Experimental y Simulación Universidad Católica (UC). Este consistió en una actividad práctica grupal (7-8 alumnos por sesión) que incluyó: una evaluación pre-sesión, un vídeo instruccional, una demostración en tiempo real en el fantoma por parte de un docente, la realización guiada del procedimiento por parte de los alumnos, debriefing y cierre de la sesión. Conclusiones: Un modelo de enseñanza en ambiente simulado es posible de ser diseñado e implementado exitosamente en un centro educacional para estudiantes de Medicina de Pregrado. Este taller de paracentesis permite entrenar a los alumnos en la realización de paracentesis abdominal en un ambiente seguro para los alumnos y pacientes y puede ser implementado a bajo costo en otros centros o instituciones. (AU)

Abstract: Simulated environments are an option in the learning process of undergraduate medical students in order to obtain technical and non-technical. Aim: To develop a mannequin for abdominal paracentesis and the implementation of a training workshop to perform abdominal paracentesis in a simulated environment for undergraduate medical students. Methods: The prototypes were designed and developed to perform abdominal paracentesis at the School of Design at the Pontificia Universidad Católica de Chile (PUC) and a workshop was implemented in a course with 4-year medical students at the PUC, using a constructivist approach and simulated training sessions and providing debriefing (based on plus-delta model) and pre-post training assessment following the principles of Assessment for Learning. Results: Three prototypes were developed until the final high-fidelity-mannequin was achieved. The abdominal paracentesis workshop was attended by 237 students at the Universidad Católica (UC) Experimental Surgery and Simulation Center. This was a hands-on group activity (7-8 students per session) including pre-session assessment, instructional video-tape, real-time demonstration of abdominal paracentesis procedure by the clinical teacher, followed by abdominal paracentesis performed by the students, debriefing and closing session. Conclusions: A teaching model in a simulated environment is feasible to be successfully designed and implemented in an educational center for undergraduate medical students. This workshop allows students training process to perform abdominal paracentesis in a safe environment for students and patients and it can be implemented in other centers or institutions with low cost.(AU)

Do mannequin chests provide an accurate representation of a human chest for simulated decompression of tension pneumothoraxes? / 世界急诊医学杂志（英文）

BACKGROUND: Tension pneumothorax (TPX) is an uncommon but life-threatening condition. It is important that this uncommon presentation, managed by needle decompression, is practised by paramedics using a range of educationally sound and realistic mannequins. The objective of this study is to identify if the chest wall thickness (CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest. METHODS: This is a two-part study. A review of the literature was conducted to identify chest wal thickness in humans and measurement of chest wal thickness on two commonly used mannequins. The literature search was conducted using the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE databases from their beginning until the end of May 2012. Key words included chest wall thickness, tension pneumothorax, pneumothorax, thoracostomy, needle thoracostomy, decompression, and needle test. Studies were included if they reported chest wal thickness. RESULTS: For the literature review, 4461 articles were located with 9 meeting the inclusion criteria. Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line. The Laerdal? manikin in the area of the second intercostal space mid clavicular line, right side of the chest was 1.1 cm thick with the left 1.5 cm. The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm. CONCLUSION: Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.

A questionnaire survey concerning the distribution and equipment of clinical skills laboratories in Japanese medical schools: Simulation-based skills training courses in clinical skills laboratories / 医学教育

1) Simulation-based training is critical for medical students to acquire clinical skills. We sent questionnaires to all 80 medical schools in Japan asking about the status of clinical skills laboratories and received responses from 73 medical schools.2) Fifty-nine schools have skills laboratories. Forty-nine schools have curricula integrating simulation-based skills training. The 3 most common apparatuses are venopuncture trainers, basic life support mannequins, and skin-suturing trainers. Lung and heart sound auscultation trainers, advanced cardiac life support mannequins, and ophthalmoscopy trainers are used at more than 50 schools.3) Thirty-two of the 59 schools have simulation-based skills-training courses that are not included in the undergraduate medical curriculum. Medical staff and people in the community are participating. The four most common courses are, in descending order, basic life support, intermediate cardiac life support, advanced cardiac life support, and automated external defibrillation, which are held at more than 16 schools.

Simulation design and research on forming principle of anthropometric ECG / 医疗卫生装备

Objective To vividly display the forming principle of anthropometric ECG by using mannequin.Methods A mannequin was made using conductive paper with"heart" designed in left chest and its ECG was measured.Results The forming principles of ECG from mannequin and real people were identical.Mannequin had the same physical characteristics as real human body.Conclusion The change of ECG caused by pure physical factors can be studied by using the mannequin,which helps doctors properly analyze ECG and make accurate diagnosis.