Comparative Evaluation of Choose Your Own Adventure and Traditional Linear Case Formats in Radiology Small Group Teaching.

RATIONALE AND OBJECTIVES: We aim to compare Choose Your Own Adventure (CYOA) presentation format with linear case format as educational methods for teaching a radiology small group session to medical students. MATERIALS AND METHODS: A radiology small group session was held for preclinical second-year medical students in the pulmonary course, whereby eight classrooms of students and eight radiology facilitators were each randomized to do either the linear case format or the nonlinear CYOA presentation format. All students in attendance were administered a survey at the end of the session, which assessed students' perceptions using five-point Likert-type questions. The survey also contained a four-question knowledge quiz on chest radiology. The facilitators were administered a qualitative survey as well. Between-group analyses were performed using Student's t-test. RESULTS: Of the 144 students who attended the small group sessions, 143 students completed the survey (99.3%). The CYOA format group reported significantly greater engagement in the cases (4.5 ± 0.7 vs. 3.8 ± 0.7, p < 0.001), satisfaction with the format (4.6 ± 0.6 vs. 3.7 ± 0.9, p < 0.001), and enhancement of clinical decision making skills (4.5 ± 0.6 vs. 3.5 ± 0.9, p < 0.001). The linear format group reported a greater role for the facilitator to add value (4.6 ± 0.5 vs. 4.3 ± 1.1, p = 0.033). There was no significant difference between groups in performance on the knowledge quiz. CONCLUSION: Medical students reported higher satisfaction, engagement, and enhanced clinical decision making skills with the CYOA presentation method compared to linear case format for radiology small group learning.

Google Glass Video Capture of Cardiopulmonary Resuscitation Events: A Pilot Simulation Study.

BACKGROUND: Video recording of resuscitation from fixed camera locations has been used to assess adherence to guidelines and provide feedback on performance. However, inpatient cardiac arrests often happen in unpredictable locations and crowded rooms, making video recording of these events problematic. OBJECTIVE: We sought to understand the feasibility of Google Glass (GG) as a method for recording inpatient cardiac arrests and capturing salient resuscitation factors for post-event review. METHODS: This observational study involved recording simulated cardiac arrest events on inpatient medical wards. Each simulation was reviewed by 3 methods: in-room physician direct observation, stationary video camera (SVC), and GG. Nurse and physician specialists analyzed the videos for global visibility and audibility, as well as recording quality of predefined resuscitation events and behaviors. Resident code leaders were surveyed regarding attitudes toward GG use in the clinical emergency setting. RESULTS: Of 11 simulated cardiac arrest events, 9 were successfully recorded by all observation methods (1 GG failure, 1 SVC failure). GG was judged slightly better than SVC recording for average global visualization (3.95 versus 3.15, P = .0003) and average global audibility (4.77 versus 4.42, P = .002). Of the GG videos, 19% had limitations in overall interpretability compared with 35% of SVC recordings (P = .039). All 10 survey respondents agreed that GG was easy to use; however, 2 found it distracting and 3 were uncomfortable with future use during actual resuscitations. CONCLUSIONS: GG is a feasible and acceptable method for capturing simulated resuscitation events in the inpatient setting.

Impact of levels of simulation fidelity on training of interns in ACLS.

AIM: Identifying the modality and fidelity of simulation that offers the greatest benefit to the learner is critical to Advanced Cardiac Life Support (ACLS) training. Our hypothesis is that participants who receive ACLS training on high-fidelity mannequins will perform better than those trained on low-fidelity mannequins. METHODS: The study was performed in the context of an ACLS Initial Provider course for new postgraduate year 1 residents and involved 3 training arms: (1) low-fidelity, (2) mid-fidelity, and (3) high-fidelity. Educational outcomes were evaluated by written scores, student evaluations of the course, and expert rater reviews of megacode performance. RESULTS: A convenience sample of 54 subjects was randomized to 1 of the 3 training arms. All 3 groups significantly improved based on written posttest scores (P < 0.0001); however, pretest to posttest improvement among the 3 training arms was not significantly different: low-fidelity = 42.3 (95% CI, 35.7-48.9); mid-fidelity = 41.3 (95% CI, 34.7-47.9); high-fidelity = 40.8 (95% CI, 34.3-47.5; P = 0.95). All participants felt the simulator environment was realistic regardless of level of fidelity. Participants in the high-fidelity group were less likely to feel comfortable in the simulator environment (P = 0.0045). Clinical performance as assessed by expert raters' megacode scores was better for high-fidelity (66.3) than mid-fidelity (60.1) (P = 0.04). CONCLUSION: Overall, there was no difference among the 3 groups in test scores or perceived instructor or course quality; however, subjects trained on high-fidelity mannequins performed better than those trained on mid-fidelity with respect to megacode performance.

Blood and body fluid exposures among US medical students in Botswana.

INTRODUCTION: Medical students from resource-rich countries who rotate in resource-limited settings have little pre-departure experience performing procedures, and lack familiarity with local equipment. The risk of blood and body fluid exposures during such rotations is significant. AIM: 1) Determine whether a simulation-based intervention reduced exposures among US medical students on a rotation in Botswana; 2) determine whether exposures were underreported; 3) describe exposures and provision of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP). SETTING: University of Pennsylvania medical students who traveled to Botswana for a clinical rotation from July 2007 to February 2010 were eligible to participate. PROGRAM DESCRIPTION: Twenty-two students participated in the simulation-based intervention. PROGRAM EVALUATION: To evaluate the intervention, we used a pre/post quasi-experimental design and administered a retrospective survey. The response rate was 81.7% (67/82). Needlesticks were eliminated [8/48 (16.7%) to 0/19 (0.0%), p = 0.07]. Splashes were unchanged (6/48 [12.5%) to 3/19 (15.8%), p=>0.99]. Three students did not report their exposure. Fifteen exposures were reported to an attending, who counseled the student regarding HIV PEP. Three students did not take PEP because the exposure was low-risk. DISCUSSION: Our intervention was associated with a decrease in needlestick exposures. Medical schools should consider training to reduce exposures abroad.