Development and content validation of the checklist for assessing placement of a small-bore chest tube (CAPS) for small-bore chest tube placement.

Background: Small-bore chest tube (SBCT) placement via modified Seldinger technique is a commonly performed invasive procedure for treatment of pleural effusion and pneumothorax. When performed suboptimally, it may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. In this paper, we describe the development and content validation of a SBCT placement checklist. Methods: A literature review across multiple medical databases and seminal textbooks was performed to identify all publications describing procedural steps involved in SBCT placement. No studies were identified that involved systematic development of a checklist for this purpose. After the first iteration of a comprehensive checklist (CAPS) based on literature review was developed, the modified Delphi technique involving a panel of nine multidisciplinary experts was used to modify it and establish its content validity. Results: After four Delphi rounds, the mean expert-rated Likert score across all checklist items was 6.85 ± 0.68 (out of 7). The final, 31-item checklist had a high internal consistency (Cronbach's alpha = 0.846) with 95% of the responses (by nine experts across 31 checklist items) being a numerical score of 6 or 7. Conclusions: This study reports the development and content validity of a comprehensive checklist for teaching and assessing SBCT placement. For purposes of demonstrating construct validity, this checklist should next be studied in the simulation and clinical setting.

Anesthesiology Patient Handoff Education Interventions: A Systematic Review.

BACKGROUND: Anesthesiology provider handoffs are complex, occur frequently, and have been associated with adverse patient outcomes. The authors sought to determine the degree to which anesthesiology handoff studies with educational interventions incorporated tenets of educational best practices. METHODS: The research team conducted a systematic review of the peer-reviewed literature focused on handoff studies with education interventions that included anesthesiology providers. Searches were conducted using PubMed, Embase, Scopus, Cochrane, and ERIC (2010-September 2021). Each phase of the article review process included at least two trained independent reviewers. In addition, pairs of trained reviewers abstracted study characteristics RESULTS: Twenty-six articles met inclusion criteria. Two thirds (18/26; 69.2%) were published after 2017, and almost three fourths (19/26; 73.1%) included learners. Education intervention descriptions varied, with only 15.4% (4/26) briefly mentioning education theory, 7.7% (2/26) with clear education objectives, and 7.7% (2/26) assessing curriculum via participant satisfaction. Most (22/26; 84.6%) assessed Kirkpatrick's level 3 (handoff behavior change), and 26.9% (7/26) assessed level 4b (patient outcomes). Medical education quality scores were low (range 6-24, mean 11.3; max 32), with more than half (15/26; 57.7%) receiving scores ≤ 10. CONCLUSION: Educational interventions demonstrate marked heterogeneity in the use of educational theoretical concepts and established curriculum development best practices. Future studies should report on important aspects of educational interventions, which would allow for comparison across studies, yield the essential data needed to identify handoff education best practices, and improve patient safety.

Comparing traditional, immersive simulation with Rapid Cycle Deliberate Practice in postgraduate year 2 anesthesiology residents.

BACKGROUND: Rapid Cycle Deliberate Practice (RCDP) is an increasingly popular simulation technique that allows learners to achieve mastery of skills through repetition, feedback, and increasing difficulty. This manuscript describes the implementation and assessment of RCDP in an anesthesia residency curriculum. METHODS: Researchers describe the comparison of RCDP with traditional instructional methods for anesthesiology residents' application of Emergency Cardiovascular Care (ECC) and communication principles in a simulated environment. Residents (n = 21) were randomly assigned to either Traditional or RCDP education groups, with each resident attending 2 days of bootcamp. On their first day, the Traditional group received a lecture, then participated in a group, immersive simulation with reflective debriefing. The RCDP group received education through an RCDP simulation session. On their second bootcamp day, all participants individually engaged in an immersive simulation, then completed the "Satisfaction and Self-Confidence in Learning" survey. Application of ECC and communication principles during the simulation was scored by a blinded reviewer through video review. Participants ended the bootcamp by ranking the experiences they found most valuable. RESULTS: No significant differences were found in the different group members' individual performances during the immersive simulation, nor in the experiences they deemed most valuable. However, the Traditional education group reported higher levels of satisfaction and self-confidence in learning in 5 areas (p = 0.004-0.04). CONCLUSIONS: Regardless of RCDP or Traditional education grouping, anesthesia residents demonstrated no difference in ECC skill level or perceived value of interventions. However, members of the Traditional education group reported higher levels of satisfaction and self-confidence in numerous areas. Additional RCDP opportunities in the anesthesia residency program should be considered prior to excluding it as an educational method in our program.

Healthcare Provider Stress and Virtual Reality Simulation: A Scoping Review.

SUMMARY STATEMENT: Despite the significant role that stress plays in clinical care and education and the potential benefit of virtual reality (VR) as a simulation modality, there is a dearth of literature on stress and VR. The results of this scoping review have shown the positive effect that VR simulation can have on mitigating the negative aspects of stress during simulation and clinical training as well as improving provider performance and affect. Virtual reality technology, and immersive VR specifically, has the potential to powerfully transform how simulation education is being conducted. Because of this, the authors encourage researchers to put more focus into this topic and in determining how VR can be used to provide simulations with excellent training and a strong sense of presence for the purpose of addressing how stress can impact learners' clinical training and performance.

Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes.

PURPOSE: To systematically review the literature regarding surgical outcomes for treatment of partial tears of the distal biceps brachii tendon. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A systematic review of the literature regarding treatment of partial tears of the distal biceps tendon was conducted using PubMed, Embase, and Cochrane. Inclusion criteria consisted of studies in the English language on the treatment of partial distal biceps tendon tears. Exclusion criteria consisted of (1) studies without outcome data, (2) studies that did not specify the degree of distal biceps tendon tear (ie, complete rupture vs partial tear), and (3) studies without partial tear subgroup data. Two investigators independently reviewed the abstracts from all identified articles. RESULTS: Only 5 patients who underwent successful nonsurgical treatment were identified; all were treated with different algorithms, and because of the small number, outcomes for nonsurgical treatment are not included in this review. Therefore, 19 studies involving 86 partial tears that underwent surgical treatment are reported; at least 65 of these received a trial of nonsurgical treatment before surgery. Surgery resulted in 94% satisfactory clinical outcomes. Of the 16 studies (n = 83) that specified the presence or absence of surgical complications, lateral antebrachial cutaneous nerve paresthesia (17%), posterior interosseous nerve palsy (6%), elbow discomfort (2%), surgical revision (2%), and asymptomatic heterotopic ossification (1%) were reported. CONCLUSIONS: Surgical treatment including tendon tear completion and anatomic repair to the radial tuberosity can yield satisfactory results and appears to provide predictable outcomes. Further research is necessary to better define the optimal regimen and duration of nonsurgical treatment, as well as the indications for surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Taking library instruction into the online environment: one health sciences library's experience.

In 2012, an academic health sciences library serving a large research university and medical center introduced synchronous online training for a diverse group of users, including clinicians, researchers, faculty, and distance students. Participants in these "Express Training" classes completed two surveys to assess their experiences. Survey results indicated classes were well received but revealed some areas for improvement. Included are issues that should be considered when implementing online library instruction to meet the diverse needs of academic health sciences library users. Given the popularity of online training among on-campus and distance users, it will be continued and expanded.