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2.
Simul Healthc ; 13(4): 289-294, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29771812

ABSTRACT

INTRODUCTION: During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation. METHODS: Potential performance checklist items were gathered from published arthrocentesis guidelines and aggregated into a performance checklist using Lawshe's method. An expert panel used this performance checklist and an FTA analysis questionnaire to evaluate a simulator's ability to respond to the physical actions required by the performance checklist. RESULTS: Thirteen items, from a pool of 39, were included on the performance checklist. Experts had mixed reviews of the simulator's FTA and its suitability for use in simulation. Unexpectedly, some positive FTA was found for several tasks where the simulator lacked functionality. CONCLUSIONS: By developing a detailed list of specific tasks required to complete a clinical procedure, and surveying experts on the simulator's response to those actions, educators can gain insight into the simulator's clinical accuracy and suitability. Unexpected of positive FTA ratings of function deficits suggest that further revision of the survey method is required.


Subject(s)
Arthrocentesis/education , Simulation Training/organization & administration , Task Performance and Analysis , Clinical Competence , Humans , Simulation Training/standards , User-Computer Interface
3.
J Pak Med Assoc ; 68(2): 240-246, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29479100

ABSTRACT

OBJECTIVE: To explore the effects of simulation training on paediatric residents' confidence and skills in managing advanced skills in critical care. METHODS: The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junior residents in paediatrics. All paediatric residents (years 1 and 2) were recruited into two workshops, held one week apart. The first workshop covered lumbar puncture/ cerebrospinal fluid interpretation, oral intubation, bone marrow aspiration, and critical airway management. The second workshop covered chest tube insertion, pleural tap, insertion of central line, and arthrocentesis. The participants were surveyed using a 5-point Likert scale survey pre- and post-course, assessing their confidence. Their practical skills were assessed using a pre-objective structured clinical examination on the same day and post-course objective structured clinical examination a week later on selected skills. The outcome measures were: (1) pre-/post-course confidence rating, and (2) pre-/post-course objective structured clinical examination results. Data was analysed using SPSS 20. RESULTS: Of the 16 participants, 8(50%) were boys and 8(50%) girls. Besides, 13(81%) residents were in year-1 and 3(19%) in year-2. Median post-course confidence level ranks for all the skills were higher (p<0.05). There was no improvement in mean pre-objective structured clinical examination scores (2.31±2.66/ 7.46±3.02) and post- objective structured clinical examination scores (22.54±4.39/ 31.85±6.90) in Year 1 residents (p<0.001). CONCLUSIONS: Simulation course was significantly successful in improving residents' clinical skills and confidence in performing critical tasks.


Subject(s)
Arthrocentesis/education , Clinical Competence , Education, Medical, Graduate , Internship and Residency , Pediatrics/education , Simulation Training/methods , Thoracentesis/education , Thoracostomy/education , Airway Management , Bone Marrow Examination , Catheterization, Central Venous , Critical Care , Female , Humans , Intubation, Intratracheal , Male , Pilot Projects , Spinal Puncture
4.
Fam Med ; 49(10): 789-795, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29190405

ABSTRACT

BACKGROUND AND OBJECTIVES: A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. METHODS: A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. RESULTS: All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. CONCLUSIONS: A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.


Subject(s)
Arthrocentesis/education , Biopsy , Clinical Competence , Education, Medical, Graduate/methods , Family Practice/education , Programmed Instructions as Topic , Prosthesis Implantation/education , Checklist , Humans , Internship and Residency , Intrauterine Devices , Knee Joint/surgery , Pilot Projects , Teaching
5.
Acad Med ; 92(11): 1632-1643, 2017 11.
Article in English | MEDLINE | ID: mdl-28489618

ABSTRACT

PURPOSE: Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training. METHOD: The authors systematically searched Medline, Embase, the Cochrane Library, and ERIC through April 2015. Studies were screened in three phases; all reviews were performed independently and in duplicate. The authors extracted information on learner and patient demographics, study design and methodological quality, and details of training interventions and measured outcomes. A three-step realist synthesis was performed to synthesize findings on each study's context, mechanism, and outcome, and to identify a foundational training model. RESULTS: From an initial 6,671 studies, 149 studies were further reduced to 67 (45%) reporting sufficient information for realist synthesis. Analysis yielded four types of procedural skills training interventions. There was relative consistency across contexts and significant differences in mechanisms and outcomes across the four intervention types. The medical procedural service was identified as an adaptable foundational training model. CONCLUSIONS: The observed heterogeneity in procedural skills training implies that programs are not consistently developing residents who are competent in core procedures. The findings suggest that researchers in education and quality improvement will need to collaborate to design training that develops a "competent core" of proceduralists using simulation and clinical rotations.


Subject(s)
Clinical Competence , Internal Medicine/education , Arthrocentesis/education , Catheterization, Central Venous , Humans , Paracentesis/education , Spinal Puncture , Thoracentesis/education
6.
Am J Emerg Med ; 35(2): 240-244, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27810253

ABSTRACT

PURPOSE: The objectives of this study were to evaluate emergency medicine resident-performed ultrasound for diagnosis of effusions, compare the success of a landmark-guided (LM) approach with an ultrasound-guided (US) technique for hip, ankle and wrist arthrocentesis, and compare change in provider confidence with LM and US arthrocentesis. METHODS: After a brief video on LM and US arthrocentesis, residents were asked to identify artificially created effusions in the hip, ankle and wrist in a cadaver model and to perform US and LM arthrocentesis of the effusions. Outcomes included success of joint aspiration, time to aspiration, and number of attempts. Residents were surveyed regarding their confidence in identifying effusions with ultrasound and performing LM and US arthrocentesis. RESULTS: Eighteen residents completed the study. Sensitivity of ultrasound for detecting joint effusion was 86% and specificity was 90%. Residents were successful with ultrasound in 96% of attempts and with landmark 89% of attempts (p=0.257). Median number of attempts was 1 with ultrasound and 2 with landmarks (p=0.12). Median time to success with ultrasound was 38s and 51s with landmarks (p=0.23). After the session, confidence in both US and LM arthrocentesis improved significantly, however the post intervention confidence in US arthrocentesis was higher than LM (4.3 vs. 3.8, p<0.001). CONCLUSIONS: EM residents were able to successfully identify joint effusions with ultrasound, however we were unable to detect significant differences in actual procedural success between the two modalities. Further studies are needed to define the role of ultrasound for arthrocentesis in the emergency department.


Subject(s)
Arthrocentesis/methods , Cadaver , Clinical Competence/standards , Emergency Medicine/education , Internship and Residency/standards , Ultrasonography, Interventional/standards , Anatomic Landmarks , Ankle Joint/diagnostic imaging , Arthrocentesis/education , Arthrocentesis/instrumentation , Emergency Medicine/methods , Emergency Medicine/standards , Hip Joint/diagnostic imaging , Humans , Knee Joint/diagnostic imaging , Prospective Studies , Self Efficacy , Ultrasonography, Interventional/methods , Wrist Joint/diagnostic imaging
7.
Ann R Coll Surg Engl ; 98(8): 543-546, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27791410

ABSTRACT

INTRODUCTION The roles of non-medically trained practitioners within the NHS are expanding; they are now being employed by many specialties, including surgery, to relieve pressures on healthcare teams. AIMS To investigate the learning curve and competence of an orthopaedic surgical care practitioner (SCP) in performing hip aspirations. METHODS Data were retrospectively collected on 510 orthopaedic hip aspirations, of which 360 were completed by a single SCP and 150 were completed by surgeons before the SCP took over routine aspiration. The 360 aspirations completed by an SCP were separated into groups of 30 by date, so any trend in failure rate could be analysed. Ordinal χ2 analysis was used to analyse this trend and Pearson χ2 analysis was used to analyse differences in failure rates between professionals. RESULTS The hip aspiration failure rate for the SCP was significantly lower than for the surgeons; 8.6% vs 20.7% (P<0.001). With the experience gained in completing the first 210 procedures, the failure rate of the SCP dropped to 3.3% for the remaining 150 procedures. This downward trend in hip aspiration failure rate, with advancing experience of the SCP, was shown to be statistically significant (P=0.006). DISCUSSION SCPs who complete hip aspirations on a regular basis have significantly lower failure rates than surgeons, probably as a result of the learning curve, which this study demonstrated. Other trusts should consider delegating routine hip aspiration work to a designated SCP to lower failure rates.


Subject(s)
Arthrocentesis/standards , Clinical Competence , Hip Joint , Learning Curve , Surgeons/standards , Arthrocentesis/education , Humans , Surgeons/education
8.
J Vet Med Educ ; 43(1): 88-94, 2016.
Article in English | MEDLINE | ID: mdl-26760439

ABSTRACT

The purpose of this study was to determine if a recently developed cadaveric canine model was an effective tool for teaching arthrocentesis to fourth-year veterinary students. Arthrocentesis is an important diagnostic tool and technical skill that can be difficult to teach in the clinical setting. Eighteen fourth-year veterinary students participated in a within-subjects experiment that evaluated their ability to successfully perform arthrocentesis in the canine model and in an unmodified control cadaver. Students completed an online survey about the experience. Ability to perform the procedure was assessed by monitoring the number of attempts and redirects required to enter the joint and by recording any volume recovered from the arthrocentesis. In both phases of the study, the participants were able to aspirate a measurable volume of fluid from the joints of the model. Participants recorded an increase in confidence with arthrocentesis after using the model in the first phase of the study and unanimously supported inclusion of the exercise in future teaching situations.


Subject(s)
Arthrocentesis/veterinary , Clinical Competence , Education, Veterinary/methods , Adult , Animals , Arthrocentesis/education , Cadaver , Cohort Studies , Dogs , Female , Humans , Male , Models, Animal , Students , Young Adult
9.
Int J Rheum Dis ; 18(7): 742-50, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25988953

ABSTRACT

AIM: A knee arthrocentesis (KA) workshop using synthetic knee model was arranged for all sixth-year medical students (MS) in our institute to ensure equity in receiving training. We evaluated confidence level and knowledge of KA and synovial fluid analysis testing pre- and post-workshop for MS. METHODS: The workshop was divided into two parts. The first part was to provide knowledge in arthrocentesis and synovial fluid interpretation and the second was a practice session on the synthetic model under supervision. This is a report of pre-and post-workshop self-evaluation about the confidence in performing KA (0-10 scales), improvement of knowledge in KA, and synovial fluid analysis earned from attending the workshop. Pearson χ(2) test or Fisher's exact test was used to compare categorical variables, where appropriate. RESULTS: There were 247 MS attended and 228 (92.3%) evaluated the workshops. Ninety-six (42.1%) MS had experience in KA prior to this workshop. The mean (SD) levels of confidence in performing the procedure before and after the workshop were 3.6 (2.5) and 7.5 (1.7), respectively, P < 0.001. Improvement was shown regardless of previous exposure to KA. Knowledge of appropriate testing for synovial fluid was significantly improved in all items explored after the workshop and extended to the better scores earned from a competency examination. CONCLUSIONS: A hands-on structured workshop using a synthetic knee model for KA is a successful model for improving medical students' confidence in performing the procedure with evidence of sustaining knowledge in short-term follow-up.


Subject(s)
Arthrocentesis/education , Clinical Competence , Education, Medical, Undergraduate/methods , Knee Joint , Models, Anatomic , Students, Medical , Teaching/methods , Biomarkers/analysis , Chi-Square Distribution , Curriculum , Educational Measurement , Educational Status , Humans , Learning Curve , Surveys and Questionnaires , Synovial Fluid/chemistry , Task Performance and Analysis , Thailand , Universities
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