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1.
Anesth Analg ; 133(5): 1331-1341, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1566542

ABSTRACT

In 2020, the coronavirus disease 2019 (COVID-19) pandemic interrupted the administration of the APPLIED Examination, the final part of the American Board of Anesthesiology (ABA) staged examination system for initial certification. In response, the ABA developed, piloted, and implemented an Internet-based "virtual" form of the examination to allow administration of both components of the APPLIED Exam (Standardized Oral Examination and Objective Structured Clinical Examination) when it was impractical and unsafe for candidates and examiners to travel and have in-person interactions. This article describes the development of the ABA virtual APPLIED Examination, including its rationale, examination format, technology infrastructure, candidate communication, and examiner training. Although the logistics are formidable, we report a methodology for successfully introducing a large-scale, high-stakes, 2-element, remote examination that replicates previously validated assessments.


Subject(s)
Anesthesiology/education , COVID-19/epidemiology , Certification/methods , Computer-Assisted Instruction/methods , Educational Measurement/methods , Specialty Boards , Anesthesiology/standards , COVID-19/prevention & control , Certification/standards , Clinical Competence/standards , Computer-Assisted Instruction/standards , Educational Measurement/standards , Humans , Internship and Residency/methods , Internship and Residency/standards , Specialty Boards/standards , United States/epidemiology
2.
J Cardiovasc Med (Hagerstown) ; 22(9): 711-715, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1496885

ABSTRACT

CoronaVIrus Disease-19 (COVID-19) had a huge impact on human health and economy. However, to this date, the effects of the pandemic on the training of young cardiologists are only partially known. To assess the consequences of the pandemic on the education of the cardiologists in training, we performed a 23-item national survey that has been delivered to 1443 Italian cardiologists in training, registered in the database of the Italian Society of Cardiology (SIC). Six hundred and thirty-three cardiologists in training participated in the survey. Ninety-five percent of the respondents affirmed that the training programme has been somewhat stopped or greatly jeopardized by the pandemic. For 61% of the fellows in training (FITs), the pandemic had a negative effect on their education. Moreover, 59% of the respondents believe that they would not be able to fill the gap gained during that period over the rest of their training. A negative impact on the psycho-physical well being has been reported by 86% of the FITs. The COVID-19 pandemic had an unparalleled impact on the education, formation and mental state of the cardiologists in training. Regulatory agencies, universities and politicians should make a great effort in the organization and reorganization of the teaching programs of the cardiologists of tomorrow.


Subject(s)
COVID-19 , Cardiologists , Cardiology/education , Communicable Disease Control , Education , Internship and Residency , COVID-19/epidemiology , COVID-19/prevention & control , Cardiologists/education , Cardiologists/psychology , Cardiologists/standards , Clinical Competence/standards , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Education/organization & administration , Education/standards , Fellowships and Scholarships/methods , Fellowships and Scholarships/statistics & numerical data , Humans , Internship and Residency/methods , Internship and Residency/organization & administration , Internship and Residency/standards , Italy/epidemiology , Needs Assessment , SARS-CoV-2 , Societies, Medical/statistics & numerical data , Surveys and Questionnaires
6.
J Nurses Prof Dev ; 37(4): 216-219, 2021.
Article in English | MEDLINE | ID: covidwho-1334309

ABSTRACT

Traditional in-person delivery of nursing orientation programs at a large academic hospital could not occur because of the COVID-19 pandemic, with the need to limit group sizes and adhere to physical distancing guidelines. A nurse educator team pivoted the orientation program to a virtual model combined with the review of select clinical skills and buddy shifts. This model effectively met the nurses' needs required to practice safely on an inpatient environment.


Subject(s)
COVID-19 , Clinical Competence/standards , Education, Distance , Inservice Training/organization & administration , Nursing Staff, Hospital/organization & administration , Physical Distancing , Faculty, Nursing , Humans , Organizational Innovation , Surveys and Questionnaires
7.
J Nurses Prof Dev ; 37(4): 220-225, 2021.
Article in English | MEDLINE | ID: covidwho-1334307

ABSTRACT

Rapid response is a common term in hospital settings, reflecting immediate clinical response to a critical challenge. In preparation for the oncoming pandemic of novel coronavirus 2019, nurse leaders within a large health system in the Mountain West region implemented a rapid response to prepare nondirect care registered nurses for deployment to the bedside. This article highlights the prompt action, organization, and implementation of this process, as well as the lessons learned for future events.


Subject(s)
COVID-19 , Clinical Competence/standards , Nurses/standards , Nursing Care/standards , Organizational Innovation , Humans , Leadership , United States
8.
PLoS One ; 16(7): e0254922, 2021.
Article in English | MEDLINE | ID: covidwho-1318325

ABSTRACT

PROBLEM: Despite mounting evidence that incorporation of QI curricula into surgical trainee education improves morbidity and outcomes, surgery training programs lack standardized QI curricula and tools to measure QI knowledge. In the current study, we developed, implemented, and evaluated a quality improvement curriculum for surgical residents. INTERVENTION: Surgical trainees participated in a longitudinal, year-long (2019-2020) curriculum based on the Institute for Healthcare Improvement's online program. Online curriculum was supplemented with in person didactics and small group projects. Acquisition of skills was assessed pre- and post- course via self-report on a Likert scale as well as the Quality Improvement Knowledge Application Tool (QIKAT). Self-efficacy scores were assessed using the General Self-Efficacy Scale. 9 out of 18 total course participants completed the post course survey. This first course cohort was analyzed as a pilot for future work. CONTEXT: The project was developed and deployed among surgical residents during their research/lab year. Teams of surgical residents were partnered with a faculty project mentor, as well as non-physician teammates for project work. IMPACT: Participation in the QI course significantly increased skills related to studying the process (p = 0.0463), making changes in a system (p = 0.0167), identifying whether a change leads to an improvement (p = 0.0039), using small cycles of change (p = 0.0000), identifying best practices and comparing them to local practices (p = 0.0020), using PDSA model as a systematic framework for trial and learning (p = 0.0004), identifying how data is linked to specific processes (p = 0.0488), and building the next improvement cycle upon success or failure (p = 0.0316). There was also a significant improvement in aim (p = 0.037) and change (p = 0.029) responses to one QIKAT vignette. LESSONS LEARNED: We describe the effectiveness of a pilot longitudinal, multi component QI course based on the IHI online curriculum in improving surgical trainee knowledge and use of key QI skills.


Subject(s)
Clinical Competence/standards , Education, Medical, Graduate/standards , Quality Improvement , Surgeons/standards , Curriculum/standards , Female , Humans , Internship and Residency/standards , Male , Surveys and Questionnaires
9.
Med Educ Online ; 26(1): 1953953, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1309553

ABSTRACT

Augmented reality (AR) is a relatively new technology that allows for digitally generated three-dimensional representations to be integrated with real environmental stimuli. AR can make use of smart phones, tablets, or other devices to achieve a highly stimulating learning environment and hands-on immersive experience. The use of AR in industry is becoming widespread with applications being developed for use not just for entertainment and gaming but also healthcare, retail and marketing, education, military, travel and tourism, automotive industry, manufacturing, architecture, and engineering. Due to the distinct learning advantages that AR offers, such as remote learning and interactive simulations, AR-based teaching programs are also increasingly being adopted within medical schools across the world. These advantages are further highlighted by the current COVID-19 pandemic, which has caused an even greater shift towards online learning. In this review, we investigate the use of AR in medical training/education and its effect on students' experiences and learning outcomes. This includes the main goals of AR-based learning, such as to simplify the delivery and enhance the comprehension of complex information. We also describe how AR can enhance the experiences of medical students, by improving knowledge and understanding, practical skills and social skills. These concepts are discussed within the context of specific AR medical training programs, such as HoloHuman, OculAR SIM, and HoloPatient. Finally, we discuss the challenges of AR in learning and teaching and propose future directions for the use of this technology in medical education.


Subject(s)
Augmented Reality , Computer-Assisted Instruction/methods , Education, Medical, Undergraduate/organization & administration , Students, Medical/statistics & numerical data , COVID-19/epidemiology , Clinical Competence/standards , Education, Distance/methods , Humans , Learning , Schools, Medical/organization & administration
10.
Acad Med ; 96(9): 1236-1238, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1281877

ABSTRACT

The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.


Subject(s)
Clinical Competence/standards , Educational Measurement/methods , Licensure, Medical/standards , COVID-19/prevention & control , Educational Measurement/standards , Humans , Licensure, Medical/trends , United States
11.
Rev Clin Esp (Barc) ; 221(8): 456-463, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1275670

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-min time limit and ranged from six to 21 questions (mean: 1.1 min/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.


Subject(s)
COVID-19 , Clinical Competence/standards , Computer Simulation , Educational Measurement/methods , Schools, Medical , Humans , Spain
12.
Med Educ Online ; 26(1): 1940765, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1269454

ABSTRACT

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students' and teachers' views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students' and teachers' perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures.


Subject(s)
COVID-19/epidemiology , Clinical Competence/standards , Education, Distance , Education, Medical, Undergraduate/organization & administration , Adult , Competency-Based Education/organization & administration , Curriculum , Education, Medical, Undergraduate/standards , Faculty, Medical , Focus Groups , Germany , Humans , Male , Pandemics , Qualitative Research , SARS-CoV-2 , Students, Medical
13.
Acad Med ; 96(9): 1239-1241, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1254863

ABSTRACT

The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills (CS) in 2020 in response to the COVID-19 pandemic marked the end of a decades-long debate about the utility and value of the exam. For all its controversy, the implementation of Step 2 CS in 2004 brought about profound changes to the landscape of medical education, altering the curriculum and assessment practices of medical schools to ensure students were prepared to take and pass this licensing exam. Its elimination, while celebrated by some, is not without potential negative consequences. As the responsibility for assessing students' clinical skills shifts back to medical schools, educators must take care not to lose the ground they have gained in advancing clinical skills education. Instead, they need to innovate, collaborate, and share resources; hold themselves accountable; and ultimately rise to the challenge of ensuring that physicians have the necessary clinical skills to safely and effectively practice medicine.


Subject(s)
Clinical Competence/standards , Educational Measurement/methods , Licensure, Medical/standards , COVID-19/prevention & control , Education, Medical, Undergraduate/standards , Education, Medical, Undergraduate/trends , Educational Measurement/standards , Humans , Licensure, Medical/trends , United States
14.
J Educ Eval Health Prof ; 18: 11, 2021.
Article in English | MEDLINE | ID: covidwho-1249655

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has required educators to adapt the in-person objective structured clinical examination (OSCE) to online settings in order for it to remain a critical component of the multifaceted assessment of a student's competency. This systematic scoping review aimed to summarize the assessment methods and validity and reliability of the measurement tools used in current online OSCE (hereafter, referred to as teleOSCE) approaches. A comprehensive literature review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Articles were eligible if they reported any form of performance assessment, in any field of healthcare, delivered in an online format. Two reviewers independently screened the results and analyzed relevant studies. Eleven articles were included in the analysis. Pre-recorded videos were used in 3 studies, while observations by remote examiners through an online platform were used in 7 studies. Acceptability as perceived by students was reported in 2 studies. This systematic scoping review identified several insights garnered from implementing teleOSCEs, the components transferable from telemedicine, and the need for systemic research to establish the ideal teleOSCE framework. TeleOSCEs may be able to improve the accessibility and reproducibility of clinical assessments and equip students with the requisite skills to effectively practice telemedicine in the future.


Subject(s)
Clinical Competence/standards , Educational Measurement/methods , Internet , Reproducibility of Results , COVID-19 , Humans , SARS-CoV-2 , Students, Medical
15.
World Neurosurg ; 151: 182-189, 2021 07.
Article in English | MEDLINE | ID: covidwho-1240646

ABSTRACT

OBJECTIVE: Metric-based surgical training can be used to quantify the level and progression of neurosurgical performance to optimize and monitor training progress. Here we applied innovative metrics to a physical neurosurgery trainer to explore whether these metrics differentiate between different levels of experience across different tasks. METHODS: Twenty-four participants (9 experts, 15 novices) performed 4 tasks (dissection, spatial adaptation, depth adaptation, and the A-B-A task) using the PsT1 training system. Four performance metrics (collision, precision, dissected area, and time) and 6 kinematic metrics (dispersion, path length, depth perception, velocity, acceleration, and motion smoothness) were collected. RESULTS: For all tasks, the execution time (t) of the experts was significantly lower than that of novices (P < 0.05). The experts performed significantly better in all but 2 of the other metrics, dispersion and sectional area, corresponding to the A-B-A task and dissection task, respectively, for which they showed a nonsignificant trend towards better performance (P = 0.052 and P = 0.076, respectively). CONCLUSIONS: It is possible to differentiate between the skill levels of novices and experts according to parameters derived from the PsT1 platform, paving the way for the quantitative assessment of training progress using this system. During the current coronavirus disease 2019 pandemic, neurosurgical simulators that gather surgical performance metrics offer a solution to the educational needs of residents.


Subject(s)
Clinical Competence , Neuroendoscopy/education , Neuroendoscopy/methods , Psychomotor Performance/physiology , Simulation Training/methods , Clinical Competence/standards , Humans , Neuroendoscopy/standards , Simulation Training/standards
18.
Anesth Analg ; 132(5): 1338-1343, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1186597

ABSTRACT

The negative impacts of sleep deprivation and fatigue have long been recognized. Numerous studies have documented the ill effects of impaired alertness associated with the disruption of the sleep-wake cycle; these include an increased incidence of human error-related accidents, increased morbidity and mortality, and an overall decrement in social, financial, and human productivity. While there are multiple studies on the impact of sleep deprivation and fatigue in resident physicians, far fewer have examined the effects on attending physicians, and only a handful addresses the accumulated effects of chronic sleep disturbances on acute sleep loss during a night call-shift. Moreover, the rapid and unprecedented spread of coronavirus disease 2019 (COVID-19) pandemic significantly increased the level of anxiety and stress on the physical, psychological, and the economic well-being of the entire world, with heightened effect on frontline clinicians. Additional studies are necessary to evaluate the emotional and physical toll of the pandemic in clinicians, and its impact on sleep health, general well-being, and performance.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Clinical Competence/standards , Sleep Deprivation/epidemiology , Sleep Deprivation/psychology , Work Schedule Tolerance/psychology , COVID-19/therapy , Fatigue/epidemiology , Fatigue/psychology , Humans
19.
J Med Internet Res ; 22(11): e22706, 2020 11 05.
Article in English | MEDLINE | ID: covidwho-1186723

ABSTRACT

BACKGROUND: Digital health technologies can be key to improving health outcomes, provided health care workers are adequately trained to use these technologies. There have been efforts to identify digital competencies for different health care worker groups; however, an overview of these efforts has yet to be consolidated and analyzed. OBJECTIVE: The review aims to identify and study existing digital health competency frameworks for health care workers and provide recommendations for future digital health training initiatives and framework development. METHODS: A literature search was performed to collate digital health competency frameworks published from 2000. A total of 6 databases including gray literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by the reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks. RESULTS: In total, 30 frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, were published since 2016, and were developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains pertained to basic information technology literacy, health information management, digital communication, ethical, legal, or regulatory requirements, and data privacy and security. The Health Information Technology Competencies framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health care workers. CONCLUSIONS: Digital health training initiatives should focus on competencies relevant to a particular health care worker group, role, level of seniority, and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health care workers' training. Digital health frameworks should be regularly updated with novel digital health technologies, be applicable to low- and middle-income countries, and include overlooked health care worker groups such as allied health professionals.


Subject(s)
Clinical Competence/standards , Health Personnel/education , Health Workforce/standards , Curriculum , Humans
20.
Acad Med ; 96(11): 1534-1539, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1153258

ABSTRACT

Patient-provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians' ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. "Just-in-time" simulation-simulation-based training immediately before an intervention-provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients' and families' experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner's understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone's role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.


Subject(s)
Clinical Competence/standards , Learning/physiology , Observation/methods , Patient-Centered Care/standards , Training Support/organization & administration , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/psychology , COVID-19/virology , Cognition/physiology , Communication , Computer Simulation , Emotions/physiology , Empathy/physiology , Feedback , Humans , Male , Patient Safety , SARS-CoV-2/genetics
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