Quantifying Novice and Expert Differences in Visual Diagnostic Reasoning in Veterinary Pathology Using Eye-Tracking Technology.

Visual diagnostic reasoning is the cognitive process by which pathologists reach a diagnosis based on visual stimuli (cytologic, histopathologic, or gross imagery). Currently, there is little to no literature examining visual reasoning in veterinary pathology. The objective of the study was to use eye tracking to establish baseline quantitative and qualitative differences between the visual reasoning processes of novice and expert veterinary pathologists viewing cytology specimens. Novice and expert participants were each shown 10 cytology images and asked to formulate a diagnosis while wearing eye-tracking equipment (10 slides) and while concurrently verbalizing their thought processes using the think-aloud protocol (5 slides). Compared to novices, experts demonstrated significantly higher diagnostic accuracy (p <.017), shorter time to diagnosis (p <.017), and a higher percentage of time spent viewing areas of diagnostic interest (p <.017). Experts elicited more key diagnostic features in the think-aloud protocol and had more efficient patterns of eye movement. These findings suggest that experts' fast time to diagnosis, efficient eye-movement patterns, and preference for viewing areas of interest supports system 1 (pattern-recognition) reasoning and script-inductive knowledge structures with system 2 (analytic) reasoning to verify their diagnosis.

An objective structured clinical exam to measure intrinsic CanMEDS roles.

BACKGROUND: The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. METHOD: We developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program. RESULTS: In total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall. DISCUSSION: The OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations. CONCLUSION: An OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as residency programs move into competency-based medical education.

Using Comprehensive Video-Module Instruction as an Alternative Approach for Teaching IUD Insertion.

BACKGROUND AND OBJECTIVES: Family medicine clinicians and residents have increasing educational and work demands that have made it difficult to provide and access training on specific procedures such as IUD insertion. The purpose of this study was to determine whether the use of video-module instruction could provide residents with the necessary knowledge and skills to perform an IUD insertion correctly when compared with the traditional form of instruction, which is a lecture-demonstration session provided by an academic gynecologist. METHODS: Thirty-nine family medicine residents participated in the study during the induction period at the beginning of their residency program in July 2012 at the University of Calgary. A randomized, two group pretest/posttest experimental research design was used to compare the procedural knowledge and skills performance (posttest only) of residents trained using an alternative instructional intervention (video-module teaching) with the traditional lecture-demonstration approach to teaching IUD insertion. RESULTS: Both teaching methods were effective in providing procedural knowledge instruction, and the paired-samples t tests results were almost identical: t (37)=1.35. On the other hand, performance scores were significantly higher in the video-module group: t (37)=2.37, 95% CI (0.61, 8.00), with a mean difference in performance of 4.31. There were no significant differences in residents' satisfaction scores, and there was no correlation between the different scores and sex or age or between performance and level of satisfaction. CONCLUSIONS: This video-module instruction is an effective method to provide comprehensive IUD insertion training, and the psychomotor skills gain (performance component) was significantly higher than the traditional method of instruction.

Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses: systematic review and meta-analysis.

BACKGROUND: A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study. METHODS: We conducted a systematic review and meta-analysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates. RESULTS: 23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95% CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95% CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95% CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95% CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 person-years (95% CI 5.5 to 9.0) in the endovascular group. CONCLUSIONS: Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

Rural longitudinal integrated clerkships: changing interests and demographics of medical students.

INTRODUCTION: The University of Calgary Longitudinal Integrated Clerkship (UCLIC) is an integrated curriculum of at least 32 weeks' duration based in rural communities. Rural LICs have been proposed as a method to respond to the needs of underserved rural communities; therefore, assessing evolving learner interest and demographics over time is of importance to rural communities. METHODS: Three surveys were administered to first-year medical students at the University of Calgary from the classes of 2009, 2010 and 2015. The surveys assessed demographic information as well as interest in and attitudes toward pursuing a rural-based LIC. RESULTS: Overall, 42% of students (76% of decided students) reported that they would consider the rural UCLIC. Between 2009 and 2010, the proportion of students who would not consider the UCLIC decreased from 25% to 8%, and thereafter was maintained at that level. Over the same period, interest among students considering Royal College of Physicians and Surgeons of Canada (RCPSC) specialties significantly increased. Although student attitudes about the value of the LIC were consistently positive, students remained concerned about social considerations. CONCLUSION: There has been an increase in student willingness to consider a rural LIC, most significantly among students interested in RCPSC specialties. Career plans and demographics of students continue to influence their interest in and attitudes toward LICs.

INTRODUCTION: Le stage intégré longitudinal (SIL) de l'Université de Calgary (ou UCLIC pour University of Calgary Longitudinal Integrated Clerkship) est un programme intégré d'une durée minimale de 32 semaines en communauté rurale. Les SIL ruraux ont été proposés comme moyen de répondre aux besoins des communautés rurales moins bien desservies; il est donc important pour les communautés rurales de suivre l'évolution des intérêts et des caractéristiques démographiques des stagiaires au fil du temps. MÉTHODES: Trois sondages ont été administrés à des étudiants de première année de médecine à l'Université de Calgary des promotions de 2009, 2010 et 2015. Les sondages portaient sur leurs données démographiques de même que sur leur intérêt et leurs attitudes à l'endroit d'un SIL en milieu rural. RÉSULTATS: Dans l'ensemble, 42 % des étudiants (76 % des étudiants décidés) ont déclaré qu'ils envisageraient un SIL en milieu rural. Entre 2009 et 2010, la proportion d'étudiants qui n'envisageaient pas un tel stage a diminué de 25 %, à 8 %, et par la suite s'est maintenue à ce niveau. Au cours de la même période, l'intérêt à l'égard de ce stage chez les étudiants qui envisageaient une spécialisation du Collège royal des médecins et chirurgiens du Canada (CRMCC) a significativement augmenté. Même si leurs attitudes à propos de la valeur d'un SIL sont demeurées favorables, les étudiants ont dit se soucier des enjeux sociaux. CONCLUSION: On a constaté que les étudiants envisagent plus volontiers un SIL en milieu rural s'ils souhaitent faire une spécialisation du CRMCC. Les plans de carrière et les caractéristiques démographiques continuent d'influer sur leurs intérêts et leurs attitudes à l'endroit des SIL.

Educational interventions to improve cytology visual diagnostic reasoning measured by eye tracking.

The teaching of visual diagnostic reasoning skills, to date, has been conducted in a largely unstructured apprenticeship manner. The purpose of this study was to assess if the introduction of two educational interventions improved the visual diagnostic reasoning skills of novices. These were (1) the active use of key diagnostic features and (2) image repetition. A pre-test and post-test research design was used to compare the two teaching interventions to a traditional teaching group and an expert group using eye tracking as an assessment method. The time to diagnosis and the percentage of time spent viewing an area of diagnostic interest (AOI) were compared using independent t-tests, paired t-tests, and analysis of covariance (ANCOVA). Diagnostic accuracy as a dichotomous variable was compared using Chi-square tables. Students taught in an active-learning manner with image repetition behaved most like experts, with no significant difference from experts for percentage of time spent in the AOIs and a significantly faster time to diagnosis than experts (p<.017). Our results from the educational interventions suggest a greater level of improvement in the eye tracking of students that were taught key diagnostic features in an active-learning forum and were shown multiple case examples.

Insight into team competence in medical, nursing and respiratory therapy students.

This study provides information for educators about levels of competence in teams comprised of medical, nursing and respiratory therapy students after receiving a simulation-based team-training (SBT) curriculum with and without an additional formalized 30-min team-training (TT) module. A two-group pre- and post-test research design was used to evaluate team competence with respect to leadership, roles and responsibilities, communication, situation awareness and resource utilization. All scenarios were digitally recorded and evaluated using the KidSIM Team Performance Scale by six experts from medicine, nursing and respiratory therapy. The lowest scores occurred for items that reflected situation awareness. All teams improved their aggregate scores from Time 1 to Time 2 (p < 0.05). Student teams in the intervention group achieved significantly higher performance scores at Time 1 (Cohen's d = 0.92, p < 0.001) and Time 2 (d = 0.61, p < 0.01). All student teams demonstrated significant improvement in their ability to work more effectively by Time 2. The results suggest that situational awareness is an advanced expectation for the undergraduate student team. The provision of a formalized TT module prior to engaging student teams in a simulation-based TT curriculum led to significantly higher performances at Time 1 and 2.

A simulation-based intervention teaching seizure management to caregivers: A randomized controlled pilot study.

OBJECTIVES: To examine the effect of simulation-based seizure management teaching on improving caregiver competence and reported confidence with managing seizures. The authors hypothesized that simulation-based education would lead to a higher level of demonstrated competence and reported confidence in family members and caregivers. Simulation has not been previously studied in this context. METHODS: A two-group pre- and post-test experimental research design involving a total of 61 caregivers was used. The intervention was a simulation-based seizure curriculum delivered as a supplement to traditional seizure discharge teaching. Caregiver performance was analyzed using a seizure management checklist. Caregivers' perception of self-efficacy was captured using a self-efficacy questionnaire. RESULTS: Caregivers in the experimental group achieved significantly higher postintervention performance scores than caregivers in the control group in both premedication and postmedication seizure management (P<0.01). Additionally, they achieved significantly higher scores on the self-efficacy questionnaire including items reflecting confidence managing the seizure at home (P<0.05). CONCLUSION: Caregivers receiving the supplemental simulation-based curriculum achieved significantly higher levels of competence and reported confidence, supporting a positive relationship between simulation-based seizure discharge education, and caregiver competence and confidence in managing seizures. Simulation sessions provided insight into caregiver knowledge but, more importantly, insight into the caregiver's ability to apply knowledge under stressful conditions, allowing tailoring of curriculum to meet individual needs. These findings may have applications and relevance for management of other acute or chronic medical conditions.

OBJECTIFS: Examiner l'effet de l'enseignement de la prise en charge des convulsions par simulation pour améliorer les compétences des soignants et leur confiance déclarée à traiter les convulsions. Les auteurs postulent que l'enseignement par simulation accroîtrait les compétences démontrées et la confiance déclarée des membres de la famille et des soignants. La simulation n'a jamais été étudiée dans ce contexte. MÉTHODOLOGIE: Une méthodologie de recherche expérimentale en deux groupes avant et après le test a été privilégiée auprès de 61 soignants. L'intervention consistait en un cours par simulation sur les convulsions donné en plus de l'enseignement habituel sur les convulsions présenté au congé. Le rendement des soignants a été analysé au moyen d'une liste de vérification de la prise en charge des convulsions. La perception d'auto-efficacité du soignant a été saisie au moyen d'un questionnaire d'auto-efficacité. RÉSULTATS: Les soignants du groupe expérimental ont obtenu des indices de rendement considérablement plus élevés après l'intervention que ceux du groupe témoin, tant avant qu'après la prise en charge des convulsions par médication (P<0,01). De plus, ils ont obtenu des indices considérablement plus élevés au questionnaire d'auto-efficacité, y compris les questions reflétant la confiance à soigner les convulsions à domicile (P<0,05). CONCLUSION: Les soignants qui avaient eu un cours par simulation ont obtenu des taux de compétence et de confiance déclarée beaucoup plus élevés. Ces résultats corroborent la relation positive entre l'enseignement sur les convulsions par simulation au congé et la compétence et la confiance des soignants envers la prise en charge des convulsions. Les séances de simulation donnaient un aperçu des compétences des soignants, mais, surtout, de leur capacité à appliquer leurs connaissances dans des conditions stressantes, ce qui permet d'adapter le cours à leurs besoins. Ces observations peuvent être utiles et pertinentes pour la prise en charge d'autres maladies aiguës ou chroniques.

Two for one: surgical skills and CanMEDS roles--a combined course for surgical residents.

BACKGROUND: The purpose of this study was to develop a surgical skills program for first-year surgical residents by integrating the Canadian Medical Education Direction for Specialists (CanMEDS) roles. METHODS: A 9-week course combining basic surgical skills and CanMEDS roles was developed and provided to 24 residents from the Departments of Surgery and Obstetrics and Gynecology at the University of Calgary. Sessions consisted of a pretest/posttest, teaching the surgical skills, supervised practice, posttest, and teaching CanMEDS roles. RESULTS: The pretest scores indicated the residents' preparation and understanding of the session, which improved as the course progressed. The residents' satisfaction surveys graded on a scale from 1 to 5, syllabus content, syllabus effectiveness, teaching expectations, technical demonstrations, practice sessions, confidence gained, and bench model fidelity indicated a mean of 4.09 (standard deviation = 0.81) satisfaction with the new course. Similarly, preceptors' satisfaction surveys graded on a scale from 1 to 5 demonstrated a mean of 4.16 (standard deviation = 0.69) satisfaction. CONCLUSIONS: Surgical skills and CanMEDS roles of communication, professionalism, collaborator and manager, can be taught simultaneously proving that this new teaching format can be feasible, effective, and logistically convenient, providing a satisfying experience for both residents and preceptors.

Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents.

BACKGROUND: There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework. OBJECTIVE: The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER). METHOD: ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training. RESULTS: A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α  =  0.90 to 0.95 for each subscale and α  =  0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles. CONCLUSION: Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.

The construct and criterion validity of the multi-source feedback process to assess physician performance: a meta-analysis.

BACKGROUND: The purpose of this study was to conduct a meta-analysis on the construct and criterion validity of multi-source feedback (MSF) to assess physicians and surgeons in practice. METHODS: In this study, we followed the guidelines for the reporting of observational studies included in a meta-analysis. In addition to PubMed and MEDLINE databases, the CINAHL, EMBASE, and PsycINFO databases were searched from January 1975 to November 2012. All articles listed in the references of the MSF studies were reviewed to ensure that all relevant publications were identified. All 35 articles were independently coded by two authors (AA, TD), and any discrepancies (eg, effect size calculations) were reviewed by the other authors (KA, AD, CV). RESULTS: Physician/surgeon performance measures from 35 studies were identified. A random-effects model of weighted mean effect size differences (d) resulted in: construct validity coefficients for the MSF system on physician/surgeon performance across different levels in practice ranged from d=0.14 (95% confidence interval [CI] 0.40-0.69) to d=1.78 (95% CI 1.20-2.30); construct validity coefficients for the MSF on physician/surgeon performance on two different occasions ranged from d=0.23 (95% CI 0.13-0.33) to d=0.90 (95% CI 0.74-1.10); concurrent validity coefficients for the MSF based on differences in assessor group ratings ranged from d=0.50 (95% CI 0.47-0.52) to d=0.57 (95% CI 0.55-0.60); and predictive validity coefficients for the MSF on physician/surgeon performance across different standardized measures ranged from d=1.28 (95% CI 1.16-1.41) to d=1.43 (95% CI 0.87-2.00). CONCLUSION: The construct and criterion validity of the MSF system is supported by small to large effect size differences based on the MSF process and physician/surgeon performance across different clinical and nonclinical domain measures.

The reliability, validity, and feasibility of multisource feedback physician assessment: a systematic review.

PURPOSE: The use of multisource feedback (MSF) or 360-degree evaluation has become a recognized method of assessing physician performance in practice. The purpose of the present systematic review was to investigate the reliability, generalizability, validity, and feasibility of MSF for the assessment of physicians. METHOD: The authors searched the EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL databases for peer-reviewed, English-language articles published from 1975 to January, 2013. Studies were included if they met the follow ing inclusion criteria: used one or more MSF instruments to assess physician performance in practice; reported psychometric evidence of the instrument(s) in the form of reliability, generalizability coefficients, and construct or criterion-related validity; and provided information regarding the administration or feasibility of the process in collecting the feedback data. RESULTS: Of the 96 full-text articles assessed for eligibility, 43 articles were included. The use of MSF has been shown to be an effective method for providing feedback to physicians from a multitude of specialties about their clinical and nonclinical (i.e., professionalism, communication, interpersonal relationship, management) performance. In general, assessment of physician performance was based on the completion of the MSF instruments by 8 medical colleagues, 8 coworkers, and 25 patients to achieve adequate reliability and generalizability coefficients of α ≥ 0.90 and Ep ≥ 0.80, respectively. CONCLUSIONS: The use of MSF employing medical colleagues, coworkers, and patients as a method to assess physicians in practice has been shown to have high reliability, validity, and feasibility.

Development of an orthopedic surgery trauma patient handover checklist.

BACKGROUND: In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. METHODS: We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. RESULTS: Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. CONCLUSION: Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.

CONTEXTE: En chirurgie, le transfert préopératoire des polytraumatisés nécessitant une chirurgie est un processus que l'on doit rendre aussi sécuritaire que possible. Nous avons voulu déterminer quels renseignements cliniques vitaux doivent être transmis aux équipes de soins et préparer une liste de vérification standardisée à cette fin. MÉTHODES: Nous avons réalisé des entrevues standardisées par petits groupes au sujet du transfert des polytraumatisés. À partir des renseignements recueillis, nous avons élaboré un questionnaire pour obtenir le point de vue de tous les membres de l'Association canadienne d'orthopédie (ACO) au sujet des éléments jugés les plus importants sur une liste de vérification en vue du transfert. Nous avons analysé les réponses pour dresser une liste de vérification standardisée. RÉSULTATS: Sur les 1106 membres de l'ACO, 247 ont répondu au questionnaire. Les 7 éléments jugés les plus importants pour assurer la sécurité des patients lors du transfert ont été : comorbidités, diagnostic, état de préparation pour le bloc opératoire, stabilité, blessures connexes, histoire et mécanisme du traumatisme et questions en suspens. Les recommandations des experts ont été les suivantes : que les transferts s'effectuent de la même façon chaque jour, qu'on obtienne toutes les radiographies appropriées disponibles, qu'on dispose de temps suffisant, qu'on obtienne toute les analyses de laboratoire appropriées et qu'on aie plus de temps à consacrer aux patients plus grièvement blessés. CONCLUSION: Nos principales recommandations pour un transfert sécuritaire sont d'utiliser des listes de vérification standardisées spécifiques aux besoins des patients et des sites. Nous fournissons un modèle type de liste de vérification pour les transferts qui devrait être utilisée pour le transfert en chirurgie des polytraumatisés. À notre connaissance, il s'agit de la première liste de vérification rapide et simple mise au point à cette fin par un groupe d'experts en chirurgie orthopédique.

Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis.

BACKGROUND: Throughout their medical education, learners face multiple transition periods associated with increased demands, producing stress and concern about the adequacy of their skills for their new role. OBJECTIVE: We evaluated the effectiveness of boot camps in improving clinical skills, knowledge, and confidence during transitions into postgraduate or discipline-specific residency programs. METHODS: Boot camps are in-training courses combining simulation-based practice with other educational methods to enhance learning and preparation for individuals entering new clinical roles. We performed a search of MEDLINE, CINAHL, PsycINFO, EMBASE, and ERIC using boot camp and comparable search terms. Inclusion criteria included studies that reported on medical education boot camps, involved learners entering new clinical roles in North American programs, and reported empirical data on the effectiveness of boot camps to improve clinical skills, knowledge, and/or confidence. A random effects model meta-analysis was performed to combined mean effect size differences (Cohen's d) across studies based on pretest/posttest or comparison group analyses. RESULTS: The search returned 1096 articles, 15 of which met all inclusion criteria. Combined effect size estimates showed learners who completed boot camp courses had significantly "large" improvements in clinical skills (d  =  1.78; 95% CI 1.33-2.22; P < .001), knowledge (d  =  2.08; 95% CI 1.20-2.96; P < .001), and confidence (d  =  1.89; 95% CI 1.63-2.15; P < .001). CONCLUSIONS: Boot camps were shown as an effective educational strategy to improve learners' clinical skills, knowledge, and confidence. Focus on pretest/posttest research designs limits the strength of these findings.

Optimizing biomedical science learning in a veterinary curriculum: a review.

As veterinary medical curricula evolve, the time dedicated to biomedical science teaching, as well as the role of biomedical science knowledge in veterinary education, has been scrutinized. Aside from being mandated by accrediting bodies, biomedical science knowledge plays an important role in developing clinical, diagnostic, and therapeutic reasoning skills in the application of clinical skills, in supporting evidence-based veterinary practice and life-long learning, and in advancing biomedical knowledge and comparative medicine. With an increasing volume and fast pace of change in biomedical knowledge, as well as increased demands on curricular time, there has been pressure to make biomedical science education efficient and relevant for veterinary medicine. This has lead to a shift in biomedical education from fact-based, teacher-centered and discipline-based teaching to applicable, student-centered, integrated teaching. This movement is supported by adult learning theories and is thought to enhance students' transference of biomedical science into their clinical practice. The importance of biomedical science in veterinary education and the theories of biomedical science learning will be discussed in this article. In addition, we will explore current advances in biomedical teaching methodologies that are aimed to maximize knowledge retention and application for clinical veterinary training and practice.

Feasibility and fidelity of practising surgical fixation on a virtual ulna bone.

BACKGROUND: Surgical simulators provide a safe environment to learn and practise psychomotor skills. A goal for these simulators is to achieve high levels of fidelity. The purpose of this study was to develop a reliable surgical simulator fidelity questionnaire and to assess whether a newly developed virtual haptic simulator for fixation of an ulna has comparable levels of fidelity as Sawbones. METHODS: Simulator fidelity questionnaires were developed. We performed a stratified randomized study with surgical trainees. They performed fixation of the ulna using a virtual simulator and Sawbones. They completed the fidelity questionnaires after each procedure. RESULTS: Twenty-two trainees participated in the study. The reliability of the fidelity questionnaire for each separate domain (environment, equipment, psychological) was Cronbach α greater than 0.70, except for virtual environment. The Sawbones had significantly higher levels of fidelity than the virtual simulator (p < 0.001) with a large effect size difference (Cohen d < 1.3). CONCLUSION: The newly developed fidelity questionnaire is a reliable tool that can potentially be used to determine the fidelity of other surgical simulators. Increasing the fidelity of this virtual simulator is required before its use as a training tool for surgical fixation. The virtual simulator brings with it the added benefits of repeated, independent safe use with immediate, objective feedback and the potential to alter the complexity of the skill.

CONTEXTE: Les simulateurs chirurgicaux offrent un environnement sécuritaire pour apprendre et pour exercer les habiletés psychomotrices. L'un des objectifs de ces simu - lateurs est de produire des degrés élevés de fidélité. Le but de cette étude était de mettre au point un questionnaire fiable sur la fidélité des simulateurs chirurgicaux et de vérifier si un nouveau simulateur virtuel, avec interface haptique, pour la fixation du cubitus présentait des taux de fidélité comparables à ceux du simulateur Sawbones. MÉTHODES: Des questionnaires sur la fidélité des simulateurs ont été préparés. Nous avons procédé à une étude randomisée stratifiée auprès de stagiaires en chirurgie qui ont effectué une fixation du cubitus à l'aide du simulateur virtuel et à l'aide du simulateur Sawbones. Ils ont répondu au questionnaire sur la fidélité après chaque intervention. RÉSULTANTS: Vingt-deux stagiaires ont participé à l'étude. La fiabilité du questionnaire sur la fidélité pour chaque domaine distinct (environnement, équipement, dimension psychologique) correspondait à un coefficient α Cronbach supérieur à 0,70, sauf pour ce qui est de l'environnement virtuel. Le simulateur Sawbones a présenté des taux de fidélité significativement plus élevés que le simulateur virtuel (p < 0,001), avec une différence importante au plan de la taille de l'effet (indice d de Cohen < 1,3). CONCLUSIONS: Le nouveau questionnaire sur la fidélité s'est révélé un outil fiable qui peut servir à déterminer le degré de fidélité d'autres simulateurs chirurgicaux. Il faudra améliorer la fidélité de ce simulateur virtuel avant de pouvoir l'utiliser comme outil de formation pour la fixation chirurgicale. Ce simulateur virtuel a l'avantage de permettre des utilisations sécuritaires répétées et indépendantes avec des résultats immédiats et objectifs et de modifier la complexité de l'habileté.

Multisource feedback to assess surgical practice: a systematic review.

BACKGROUND: The assessment, maintenance of competence, and recertification for surgeons have recently received increased attention from many health organizations. Assessment of physicians' competencies with multisource feedback (MSF) has become widespread in recent years. The aim of the present study was to investigate further the use of MSF for assessing surgical practice by conducting a systematic review of the published research. METHODS: A systematic literature review was conducted to identify the use of MSF in surgical settings. The search was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL for articles in English up to August 2012. Studies were included if they reported information about at least 1 out of feasibility, reliability, generalizability, and validity of the MSF. RESULTS: A total of 780 articles were identified with the initial search and 772 articles were excluded based on the exclusion criteria. Eight studies met the inclusion criteria for this systematic review. Reliability (Cronbach α ≥ 0.90) was reported in 4 studies and generalizability (Ep2 ≥ 0.70) was reported in 4 studies. Evidence for content, criterion-related, and construct validity was reported in all 8 studies. CONCLUSION: MSF is a feasible, reliable, and valid method to assess surgical practice, particularly for nontechnical competencies such as communication skills, interpersonal skills, collegiality, humanism, and professionalism. Meanwhile, procedural competence needs to be assessed by different assessment methods. Further implementation for the use of MSF is desirable.

A comparison of orthopaedic resident performance on surgical fixation of an ulnar fracture using virtual reality and synthetic models.

BACKGROUND: Surgical trainees develop surgical skills using various techniques, with simulators providing a safe learning environment. Fracture fixation is the most common procedure in orthopaedic surgery, and residents may benefit from simulated fracture fixation. The performance of residents on a virtual simulator that allows them to practice the surgical fixation of fractures by providing a sense of touch (haptics) has not yet been compared with their performance using other methods of practicing fracture fixation, such as a Sawbones simulator model. The purpose of this study was to assess whether residents performed similarly on a newly developed virtual simulator compared with a Sawbones simulator fracture fixation model. METHODS: A stratified, randomized controlled study involving twenty-two orthopaedic surgery residents was performed. The residents were randomized to first perform surgical fixation of the ulna on either the virtual or the Sawbones simulator, after which they performed the same procedure on the other simulator. Their performance was evaluated by examiners experienced in fracture fixation who completed a task-specific checklist, global rating scale (GRS) form, and time-to-completion record for each participant on each simulator. RESULTS: Both simulators distinguished between differing experience levels, demonstrating construct validity; for the Sawbones simulator, the Cohen d value (effect size) was >0.90, and for the virtual simulator, d was >1.10 (p < 0.05 for both). The participants achieved significantly better scores on the virtual simulator compared with the Sawbones simulator (p < 0.05) for all measures except time to completion. The GRS scores showed a high level of internal consistency (Cronbach α, >0.80). However, Pearson product-moment correlation analysis showed no significant correlations between the results on the two simulators; therefore, concurrent validity was not achieved. CONCLUSIONS: The newly developed virtual ulnar surgical fixation simulator, which incorporates haptics, shows promise for helping surgical trainees learn and practice basic skills, but it did not attain the same standards as the current standard Sawbones simulator. The procedural measures used to assess resident performance demonstrated good reliability and validity, and both the Sawbones and the virtual simulator showed evidence of construct validity.

Development of a team performance scale to assess undergraduate health professionals.

PURPOSE: Interprofessional simulation-based team training is strongly endorsed as a potential solution for improving teamwork in health care delivery. Unfortunately, there are few teamwork evaluation instruments. The present study developed and tested the psychometric characteristics of the newly developed KidSIM Team Performance Scale checklist. METHOD: A quasi-experimental research design engaging a convenience sample of 196 undergraduate medical, nursing, and respiratory therapy students was completed in the 2010-2011 academic year. Multidisciplinary student teams participated in a simulation-based curriculum that included the completion of two acute illness management scenarios, resulting in 282 independent reviews by evaluators from medicine, nursing, and respiratory therapy. The authors investigated the underlying factors of the performance checklist and examined the performance scores of an experimental and a control team-training-curriculum group. RESULTS: Participation in the supplemental team training curriculum was related to higher team performance scores (P < .001). All teams at Time 2 achieved higher scores than at Time 1 (P < .05). The reliability coefficient for the total performance scale was α = 0.90. Factor analysis supported a three-factor solution (accounting for 67.9% of the variance) with an emphasis on roles and responsibilities (five items) and communication (six items) subscale factors. CONCLUSIONS: When simulation is used in acute illness management training, the KidSIM Team Performance Scale provides reliable, valid score interpretation of undergraduates' team process based on communication effectiveness and identification of roles and responsibilities. Implementation of a supplementary team training curriculum significantly enhances students' performance in multidisciplinary simulation-based scenarios at the undergraduate level.

Using simulation to improve the cognitive and psychomotor skills of novice students in advanced laparoscopic surgery: a meta-analysis.

Advances in simulation technologies have enhanced the ability to introduce the teaching and learning of laparoscopic surgical skills to novice students. In this meta-analysis, a total of 18 randomized controlled studies were identified that specifically looked at training novices in comparison with a control group as it pertains to knowledge retention, time to completion and suturing and knotting skills. The combined random-effect sizes (ESs) showed that novice students who trained on laparoscopic simulators have considerably developed better laparoscopic suturing and knot tying skills (d = 1.96, p < 0.01), conducted fewer errors (d = 2.13, p < 0.01), retained more knowledge (d = 1.57, p < 0.01) than their respective control groups, and were significantly faster on time to completion (d = 1.98, p < 0.01). As illustrated in corresponding Forest plots, the majority of the primary study outcomes included in this meta-analysis show statistically significant support (p < 0.05) for the use of laparoscopic simulators for novice student training on both knowledge and advanced surgical skill development (28 of 35 outcomes, 80%). The findings of this meta-analysis support strongly the use of simulators for teaching laparoscopic surgery skills to novice students in surgical residency programs.