Developing the Virtual Resus Room: Fidelity, Usability, Acceptability, and Applicability of a Virtual Simulation for Teaching and Learning.

PROBLEM: Physical distancing restrictions during the COVID-19 pandemic led to the transition from in-person to online teaching for many medical educators. This report describes the Virtual Resus Room (VRR)-a free, novel, open-access resource for running collaborative online simulations. APPROACH: The lead author created the VRR in May 2020 to give learners the opportunity to rehearse their crisis resource management skills by working as a team to complete virtual tasks. The VRR uses Google Slides to link participants to the virtual environment and Zoom to link participants to each other. Students and facilitators in the emergency medicine clerkship at McMaster University used the VRR to run 2 cases between June and August 2020. Students and facilitators completed a postsession survey to assess usability and acceptability, applicability for learning or teaching, and fidelity. In addition, students took a knowledge test pre- and postsession. OUTCOMES: Forty-six students and 11 facilitators completed the postsession surveys. Facilitators and students rated the VRR's usability and acceptability, applicability for learning and teaching, and fidelity highly. Students showed a significant improvement in their postsession (mean = 89.06, standard deviation [SD] = 9.56) compared with their presession knowledge scores (mean = 71.17, SD = 15.77; t(34) = 7.28, P < .001, with a large effect size Cohen's d = 1.23). Two perceived learning outcomes were identified: content learning and communication skills development. The total time spent (in minutes) facilitating VRR simulations (mean = 119, SD = 36) was significantly lower than time spent leading in-person simulations (mean = 181, SD = 58; U = 20.50, P < .008). NEXT STEPS: Next steps will include expanding the evaluation of the VRR to include participants from additional learner levels, from varying sites, and from other health professions.

Video in situ simulation for medical student education during the COVID-19 pandemic.

The COVID-19 pandemic has limited in-person experiences for medical students, especially in situations involving aerosol-generating procedures. We designed a video in situ simulation to orient students to critical steps in COVID-19 intubation algorithms. Small groups of students were paired virtually with facilitators (faculty and residents) and watched a video of an in situ simulation of emergency staff performing a protected intubation, with discussion points appearing on screen at discrete times. The simple design drives engagement, discussion and allows for scheduling flexibility with no risk to the learners. It can be adapted to several different scenarios or levels of training.

La pandémie de la COVID-19 a limité les expériences en personne pour les étudiants en médecine, en particulier les interventions qui produisent des aérosols. Nous avons conçu une simulation in situ par vidéo portant sur les étapes critiques des algorithmes de l'intubation dans les cas de COVID-19. De petits groupes d'étudiants, jumelés virtuellement avec des animateurs (enseignants et résidents), ont regardé une vidéo de la simulation in situ d'une intubation sécuritaire effectuée par une équipe d'urgence. À des moments précis de la simulation, des points de discussion apparaissaient à l'écran. Cette formule simple, sans risque pour les apprenants, favorise l'engagement et la discussion et elle permet la planification en toute souplesse. Elle peut être adaptée à plusieurs scénarios et à divers niveaux de formation.

Experiences of Participants During In Situ Simulation With a Learner Present.

BACKGROUND: While in situ simulation (ISS) provides robust value for health care teams, it is less clear how medical learners affect the experiences of other participants. METHODS: This was a single-center qualitative analysis of a community hospital's emergency department ISS program that included medical learners (medical students, family and emergency medicine residents). Focus groups were conducted before and after with nurses, staff physicians, and resident physicians. Phenomenologic analysis using a constructivist framework was used to examine themes. RESULTS: Fifty-two ISSs were held from February 2019 to March 2020. Of those simulations, 36 had learners present. Positive effects included creating an open learning environment and offering staff physicians a safe teaching space. Negative effects arose when objectives of ISS were highly team based or latent safety threat (LST) focused. All groups thought learners added value to ISS. CONCLUSION: Thought should be given to ISS objectives when considering how learners affect other participants. When including learners, review objectives, clarify expectations in prebriefing, and ensure that debriefing begins with LSTs and process objectives before diving into medical objectives. This study provides insight into the effect of medical learners on ISS.

Infographics, podcasts, and blogs: a multi-channel, asynchronous, digital faculty experience to improve clinical teaching (MAX FacDev).

Attendance at faculty development events are often limited to those with time and interest, but all clinical teachers should have access to continuing faculty development. A multi-channel, asynchronous, digital faculty experience strategy (MAX FacDev) was used to engage busy emergency medicine (EM) teachers associated with a distributed medical education network involving ten geographically distinct teaching sites. An evidence-informed education bundle on key principles for clinical teaching was developed. The education bundle included five topics, serialized via: an infographic series posted in distributed medical education EM departments, a podcast series and a blog. The target audience included 102 faculty members and 46 residents. Within 8 months of launching MAX FacDev, there were 1508 podcast listens and 7686 pageviews. An education bundle can efficiently deliver on-demand faculty development. Amplifying key messages via multiple channels increases the reach of faculty development and reinforces the messages.

RéSUMé: La participation aux activités de perfectionnement du corps professoral est souvent limitée à ceux qui ont du temps et de l'intérêt, mais tous les enseignants cliniciens devraient avoir accès au perfectionnement continu du corps professoral. Une stratégie multicanale, asynchrone et numérique de l'expérience du corps enseignant (MAX FacDev) a été utilisée pour engager des enseignants de la médecine d'urgence (MU) occupés, associés à un réseau d'éducation médicale régionalisée (EMR) impliquant 10 sites d'enseignement géographiquement distincts. Un ensemble de formation factuelle sur les principes fondamentaux de l'enseignement clinique a été élaboré. L'ensemble pédagogique comprenait cinq sujets, sérialisés via: une série d'infographie publiée dans les départements EMR et MU, une série de podcasts et un blog. Le public cible comprenait 102 membres du corps professoral et 46 résidents. Dans les 8 mois qui ont suivi le lancement de MAX FacDev, 1 508 podcasts ont été écoutés et 7 686 pages ont été consultées. Un ensemble pédagogique peut fournir efficacement la formation professorale à la demande. Accentuer les messages clés via plusieurs canaux augmente la portée du développement du corps professoral et renforce les messages.

Converting to Connect: A Rapid RE-AIM Evaluation of the Digital Conversion of a Clerkship Curriculum in the Age of COVID-19.

BACKGROUND: With the advent of the 2019 coronavirus pandemic, a decision was made to remove medical students from clinical rotations for their own safety. This forced students on a core emergency medicine (EM) rotation at McMaster University to immediately cease all in-person activities. An urgent need for a virtual curriculum emerged. METHODS: A virtual curriculum consisting of asynchronous case-based learning on Slack, ask-me-anything webinars, and online e-modules was created to fill the need. We describe a program evaluation using the RE-AIM framework and a social networking analysis of participants. RESULTS: Medical students (n = 23) and 11 facilitators (five residents, six faculty members) participated in this pilot study. Faculty members sent a mean (±SD) of 115 (±117) messages (n = 6), and mean (±SD) message counts for students and residents were 49.96 (±25; n = 23) and 39 (±38; n = 5), respectively. A total of 62,237 words were written by the participants, with a mean of 1,831 per person. Each message consisted of a mean (±SD) of 25 words (±29). Students rapidly acquitted themselves to digital technology. Using the RE-AIM framework we highlight the feasibility of a virtual curriculum, discuss demands on faculty time, and reflect on strategies to engage learners. CONCLUSIONS: The use of asynchronous digital curricula creates opportunities for faculty-resident interaction and engagement. We report the successful deployment of a viable model for undergraduate EM training for senior medical students in the COVID-19 era of physical distancing.

Something's missing from my education: Using a cross sectional survey to examine the needs and interest of Canadian medical students relating to their roles as teachers and educators.

BACKGROUND: Current theory in medical education emphasizes engaging learners as educators while tailoring teaching to their learning needs. However, little is known about learners' perceptions of their proposed roles as teachers and educators. METHODS: Canadian medical students were invited to complete an English language online questionnaire structured to include: teaching experience, participation and/or awareness of teacher development at their school and awareness and/or interest in further training in medical education. The survey was developed by the Canadian Association for Medical Education (CAME) Membership Subcommittee, and distributed via the Canadian Federation of Medical Students (CFMS) email list and the CAME twitter account in March 2014. RESULTS: Of the 169 undergraduate medical student respondents, 36% (n=61) reported a lack of prior teaching experience and 45% (n=73) were unsure if their school provided teaching instruction. Overall, 91% (n=150) indicated that they planned to incorporate teaching or medical education into their future careers. CONCLUSION: While the majority of medical student respondents are expecting or planning to teach, most report not having access to adequate training through medical school. Further effort is necessary to support medical students as teachers to prepare them for increased teaching responsibilities as residents and to expose them to potential careers in medical education.

Precepting at the time of a natural disaster.

BACKGROUND: Natural disasters strike communities that have varied degrees of preparedness, both physical and psychological. Rural communities may be particularly vulnerable as they often do not have the infrastructure or resources to prepare in advance. The psychological impact of a natural disaster is amplified in learners who may be temporary members of the community and therefore cannot draw on personal support during the crisis. They may turn to their clinical preceptors for guidance. CONTEXT: The Slave Lake fire (population 6782) in May 2011 and the High River flood (population 12 920) in June 2013 are examples of natural disasters that have occurred in rural Alberta, Canada. At the time of these critical incidents, three medical students and one family medicine resident from the two provincial medical schools were participating in rotations in these communities. INNOVATION: Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective. Accordingly, using a modified Delphi approach, we captured the experiences of learners that were then refined into two themes, each containing three recommendations: considerations for action during a natural disaster and considerations for action after the acute crisis has passed. Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective IMPLICATIONS: Our recommendations provide suggestions for practical solutions that build on the usual expectations of mentors and may benefit the student-teacher relationship at the time of a disaster and beyond. They are meant to initiate discussion regarding further study aimed towards creating recommendations for preceptor response that may cross disciplines.

Exploring the benefits of an optional theatre module on medical student well-being.

BACKGROUND: Medical students struggle with varied stressors and developing adequate coping mechanisms is essential. PURPOSE: This study examined medical student perceptions of the well-being impact of a theatre-based course. METHODS: Eighteen 1st-year medical students at the University of Alberta participated in 3 focus groups following the conclusion of a theatre-based module that was piloted in the first quarter of 2010. A semistructured protocol was used to guide the focus groups, which were audiotaped and transcribed. Along with general feedback, impact on personal development and student well-being were discussed. Thematic aspects of these discussions were qualitatively analyzed. FINDINGS: During the focus groups, medical students identified three aspects of the theatre-based module that contributed to their sense of overall well-being. These included (a) fun/relaxation, (b) enhanced relationships with each other, and (c) personal growth/resilience. CONCLUSION: Our findings suggest that participating in an optional theatre module can enhance medical student well-being. Our analysis suggests the need to consider novel, humanities-based curriculum offerings in relation to personal development and well- being.