An Evaluation of the Impact and Usefulness of Student-Led Surgery Interest GroupPresenter: Michael Otten View Presentation
Author(s): Michael Otten, Laura Newton, Marissa Lobl, Mark Ringle, Abbey Fingeret, MD
Background: Surgical program directors cite letters of recommendation and surgical clerkship performance as top influential factors for selecting residency applicants. Medical students are expected to foster meaningful relationships during limited clerkship and sub-internship rotations, and make career decisions with limited exposure to surgery. Preclinical medical student exposure to surgeons and surgical skills may improve mentorship and confidence in pursuing surgical residencies.
Methods: We performed a single-institution prospective survey of preclinical medical students who attended Surgery Interest Group (SIG) Events at baseline (August 2017) and follow-up (April 2018), assessing on a 5-point scale: connectedness, comfort, confidence, and technical skill (Table 1). Events included: weekly lunch sessions with surgical faculty, surgical case presentations by faculty related to current preclinical curricula, faculty-guided suture and sterile technique workshops, a 4-week summer rural surgical preceptorship between M1 and M2 years, and a final speed-dating style “Shopping for Surgical Specialties” event with representative faculty from major sub-specialties.
Results: Ninety medical students participated in SIG events and completed the survey. Respondents were 70 first-year students, 20 second-year students, 52 male, mean age of 23.4 years ±1.9. Following participation in SIG events, students reported statistically significant higher levels of connectedness, comfort with seeking mentorship, confidence in pursuing surgical residency, and confidence in suturing and sterile technique (Table 1).
Conclusion: SIG Event participation may improve preclinical students’ feelings of connectedness to surgical faculty including comfort in fostering mentorships, confidence in career decision, and technical skills of suturing and sterile technique. These factors may improve informed career decision-making, interpersonal relationships with mentors for personal letters of recommendation, and improved efficiency and performance on surgical rotations.
Intervention Fidelity in a Multi-Site Simulation Facilitation Study: Development of the SimFAC ModelPresenter: Beth Burbach, PhD, RN, CNE View Presentation
Background: This presentation examines methodological approaches to maximize intervention fidelity during a multi-site study comparing two simulation facilitation methods: situated coaching and a ‘hands off’ approach. Errors in intervention fidelity could profoundly affect study outcomes; therefore, great care was taken to maximize consistency of simulation delivery. Hands-off facilitation describes allowing students to provide un-interrupted care during the scenario; feedback is provided during structured debriefing. This method of facilitation is consistent with INACSL Standard: Facilitation of Simulation. Situated coaching describes ongoing facilitator to student coaching and feedback, addressing errors in care as they occur. No previous research has been located that compares these two facilitation methods. We learned components critical to intervention fidelity included: design of the simulation scenario, facilitator training, and delivery of the intervention. The simulation scenario was levelled to match performance expectations of a second-semester nursing student, and validated through expert review and pilot testing. Facilitator training was conducted on-site at each school and included facilitator practice sessions. Ongoing delivery quality was assessed through review of recorded videos and communication with the research team at each school. The intervention delivery was carefully developed and scripted to assure consistency. These measures resulted in a model for intervention fidelity for best practices in simulation research.
UNMC High School Alliance Immersion in Narrative and Lyric Medicine, Spring Semester, 2018: A ReviewPresenter: Steve Langan, MFA (UNO) View Presentation
Joining the UNMC High School Alliance (HSA) as poet-in-residence in January 2018, Mr. Langan has offered seven sessions that include literature and medicine, most of which have interactive elements, and all of which includes themes related to illness and health. In his presentation, he discusses the work they did together...and the effects this work has had on the students and their experience at UNMC and as a member of the HSA.
Using Infographics and Ed. Tech in Inter-Departmental EducationPresenter: Walker Thomas, BA, RDCS, FASE View Presentation
This presentation features a content delivery mechanism Mr. Thomas and colleagues have developed for professional learners (ie. residents, fellows, attending physicians). Several educational software platforms are integrated to create content that is dynamically consumable. This type of dynamic consumption is a form of "chunking" which provides the consumer autonomy. It works with all mobile devices and can be used virtually anywhere.
All Together Now! A Mixed-Methods Evaluation of Interprofessional Point-of-Care Ultrasound TrainingAuthor(s): Christopher J. Smith, MD, FACP, Tabatha Matthias, DO, MBA, FACP Elizabeth L. Beam, PhD, RN Kathryn Wampler, BS, RT(R), RDMS, RVT, Devin Nickol, MD, Lea Pounds, PhD, MBA, Ariana S. Crum, BSW, Kimberly K. Michael, MA, RT(R), RDMS, RVT, FSDMS
Background: Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound technology by clinicians to make real-time management decisions. POCUS training is rapidly expanding in both medical schools and internal medicine (IM) residency programs, but lack of trained faculty is a major barrier for many institutions. A potential solution is interprofessional education (IPE) in which experts from other health professions, such as diagnostic medical sonographers (DMS), participate in the training of medical providers.
Intervention: An interprofessional team developed a 3-hour workshop in which DMS students (n=6) from the College of Allied Health served as near-peer coaches to first-year IM residents (n=25) learning abdominal POCUS. Workshop content included pre-exam preparation and image acquisition of kidneys, bladder, and gallbladder. The course utilized a flipped-classroom approach with pre-course instructional videos used to maximize hands-on scanning time. Residents rotated between scanning stations facilitated by DMS student-coaches in which they practiced on live models. Faculty were available for technical problems, but otherwise did not participate in the hands-on training. Prior to the workshop, DMS student participated in a 2-hour train-the-trainer session in which they reviewed coaching and feedback strategies, followed by simulated cases highlighting common coaching scenarios.
Assessment: IPE workshops take place in March-April 2018 and will be assessed using a mixed-methods approach. Residents will complete an objective structured clinical exam to evaluate their image acquisition skills. Residents and DMS coaches will complete pre- and post-intervention surveys to assess their perceptions of interprofessional education, collaboration, and stereotypes using previously validated instruments. They will also participate in focus group interviews for qualitative analysis. Preliminary data will be available for the presentation.
Impact: IPE may allow broader adoption of POCUS in medical education, while dispelling stereotypes amongst health professionals and providing leadership development opportunities for DMS students.
Anatomical Dissection and Demonstration: Effects on Student Learning Outcomes and ConfidenceAuthor(s): Keely Cassidy, PhD, MS, Stephanie Cummings, MS
Abstract: The quantifiable and perceived values of student cadaveric dissection in anatomy education are essential to discussions evaluating curricular reform in medical and allied health curriculums. Content experts, students, and clinicians agree that cadaveric dissection concurrent with learning gross anatomy holds many positive roles in both the knowledge of anatomical structures and as an introduction to the inner workings of the human body and medicine. But when faced nationally with decreasing contact hours and increasing demands on the energies of students and faculty, the amount of time and effort spent on dissection must be assessed. This pilot study used mixed methods to assess the effect of dissection and demonstration on student practical examination grades and student confidence and comfort with the course material. Fifteen students in the Master of Science in Medical Anatomy program completed eight additional dissections and brief individual presentations when compared to their physician assistant and physical therapy colleagues enrolled in the same course in fall of 2016. The performance of the individual anatomical structures covered in the dissections on the four unit practical exams was compared both to the previous year’s cohort of graduate students and to the current year’s physician assistant and physical therapy cohorts. Surveys and two focus groups were conducted to collect the graduate students’ feedback on the efficacy and impact of the dissections on their education. Qualitative results displayed that the majority of students noted positive effects on their confidence in and comfort with anatomical knowledge during examinations and subsequent clinical shadowing experiences. The quantitative results showed no statistically significant correlation between the dissections and demonstrations and the students’ unit practical examination scores and final course grade. This study is continuing with data from the 2017 course and cohort.
Case Study-Based E-Learning Modules in Medical Education: A Delicate Balance of Innovation, Time, and Educational OutcomesAuthor(s): Tanya Custer, MS, R.T.(R)(T), Kimberly Michael, MA, RT(R), RDMS, RVT, FSDMS
Abstract:The higher education realm charges faculty with using or developing innovative and interactive educational tools to teach “old” material in a new way. To current participants in this educational evolution, it quickly becomes apparent that many outside factors affect this change. When designing a new teaching technology, one must consider computer software, faculty time, IT challenges, and diverse learners. This presentation will focus on each of those topics related to the development of case study-based E-Learning modules in the health professions curriculum.
Developing an Instrument to Assess the Clinical Learning Environment (CLE) at Nebraska MedicineAuthor(s): Kelly Caverzagie, MD, Kristy Carlson, PhD, Daniel Arkfeld, BM, Lea Pounds, PhD, MBA
Abstract: The Clinical Learning Environment (CLE) impacts practice and patient outcomes even after trainees have completed their training and serves as a source of continuous learning and professional growth for clinical faculty and staff. Published research on CLE focuses on the perspective of a single discipline or a single type of learner. However, no studies provide a framework for or create a CLE assessment tool designed to create actionable data for improvement for all stakeholders, including students, residents, clinical faculty, and staff. The purpose of this project was to develop a survey instrument that could be used to assess students, residents, clinical faculty, and staff perceptions of the clinical learning environment at Nebraska Medicine in a way that leads to actionable improvement plans. Using a qualitative research approach, we conducted focus groups composed of staff, clinical faculty, residents and students to answer the question: What factors or attributes contribute to an optimal clinical learning environment? The factors identified were grouped into domains used to formulate an initial set of assessment questions. The final survey includes 29 questions related to the CLE and is currently being distributed to all students, residents, clinical faculty, and staff at Nebraska Medicine hospitals and ambulatory clinics. Because the project focused on identifying actionable factors that contribute to an optimal CLE, the survey results can be used to develop feasible action plans to improve the CLE at Nebraska Medicine. Collecting the perspectives of all stakeholders within the CLE means that actions taken to improve the CLE will benefit clinical faculty and staff in terms of ongoing education and professional growth, which will, in turn, have a positive impact on their interactions with future students and residents. We believe that this assessment instrument can be adapted by other Academic Medical Centers to improve the CLE at their institutions.
Effectiveness of Blended Learning for Resident Education in Neurology: Experience from Movement Disorder CourseAuthor(s): Danish Bhatti, MD, John Bertoni, MD, Faye Haggar, MEd, Linda Love, EdD, Ryan Brennan, Peggy Moore, MSEd, Sachin Kedar, MD, Diego Torres-Russotto, MD
Objective: To evaluate feasibility and usefulness of Blended Learning for resident education in Neurology.
Background: Modern teaching tools and methodologies have not been commonly adopted for residents. Their impact and challenges of using them during residency are not clear.
Design/Methods: Neurology residents participated in a 5-week blended learning course including traditional face-to-face weekly lecture and online materials using Canvas learning management system. Coursework included weekly modules with required and optional reading material, task assignments (such as mind map, memory matrix), formative quizzes, discussion forums, twitter feeds and podcast. Course performance was evaluated with blinded pre-test and post-test questionnaire. Results: Of 16 residents 15 completed pre-test and 11 completed post-test for evaluation. There were 5777 online page views over 5 weeks (mean 385/resident, range 32-1319). Residents made 167 submissions with timely submission rate of 55% (CI 37-73, range 0-100%), completed 5 weekly quizzes with average score of 65.9% overall as a group (range 58.9-71.3%). There were 86 responses posted within 12 discussion topics. Eleven residents completed post-test with 100% showing an improvement on the score (average 23.8% CI 20.4-27.2, range 10-46%). Pre-test score average was 41% (n=15, range 2-72%) and post-test score average was 72.7% (n=11, range 48-86%). Combined Score for all assessments (total 410) for all 15 residents was 35.8% on average (mean 147, CI 113-180, range 1.2-80.8%) showing large spread of results due to variable participation. Improvement on post-test scores (n=11) show a correlation with timely assignment submission (coefficient 0.52, CI 0.6 to -0.11), weekly quiz scores (coefficient 0.5, CI 0.6 to -0.14) and number of page views (coefficient 0.48, CI 0.6 to -0.16).
Conclusions: Blended learning is a feasible and effective for training neurology residents. Online tracking allows formative assessment and detailed performance analysis. Factors influencing resident participation and adoption require further study.
Hospital Drawings of PatAuthor(s): Regina Emily Robbins, PhD, Mark Allan Gilbert, PhD
Abstract: This study explores the reflective processes of a husband/artist/caregiver, Norman Gilbert, in relation to drawings he created depicting his wife, Pat Gilbert, as she lay dying following an Alzheimer's-related stroke. Gilbert, 91, a professional artist who lives and works in Glasgow, Scotland, had drawn his wife regularly over their 65 year marriage; thus, it was natural for him to create a series of 25 end-of-life drawings of Pat for both personal and artistic reasons. One week after Pat died, Norman was interviewed to chronicle his reflections on the drawings. This presentation will share the visual narrative embedded in the drawings along with interview transcript dialogue. We will illustrate how Norman's reflection-in-action and reflection-on-action helped him draw in to and draw on from the week he spent in the hospital creating Hospital Drawings of Pat. Qualitative analysis of this case study explored reflections on death and loss through visual art, transforming a private experience between the patient and partner in care into a shared comprehension of end of life and bereavement.
Initial Assessments of E-learning Modules in Cytotechnology EducationAuthor(s): Maheswari Mukherjee, PhD, MS, BPT, CT (ASCP)CM
Background: Nine E-learning modules (ELMs) were developed in our program using Articulate software. This study assessed our cytotechnology (CT) students’ perceptions on the content of the ELMs, and the perceived influence of the ELMs on students’ performance during clinical rotations.
Methods and Material: All CT students watched nine ELMs before the related classroom lecture and group discussion. Following that, students completed nine pre-clinical rotation surveys. After their clinical rotations, students completed nine post-clinical rotation surveys.
Results: Statements on the content of the ELMs regarding the quality of the video and audio, duration, navigation, and the materials presented received positive responses from the majority of the students. While there were a few disagreements and neutral responses, most of the students responded positively saying that, the ELMs better prepared them for their role, as well as helped them to better perform their roles during the clinical rotation. The majority of the students recommended developing more EMLs for cytology courses in future.
Conclusions: This study has given hope that the ELMs have potential to enhance our online curriculum and benefit students, within the United States and internationally, who have no easy access to cytology clinical laboratories for hands-on training.
Interventions in Pathology Education: A Systematic Review of the LiteratureAuthor(s): Daniel Reiff, Andrew Braith, Erika Rothgeb, Yanwei Liu, Jonathan Ryder, Paige Scholer, Emily Zurbuchen, Sarah McBrien, MS, Geoffrey Talmon, MD
Methods: A literature search for papers related to pathology education was conducted. Only those describing interventions in undergraduate medical patholgy education were included. Data extracted from each included sample size, instructional aim, type of intervention, outcome measurement, significance of results, and strength of evidence, among others.
Results: Of 655 potential articles, 54 met inclusion criteria: The majority focused on preclinical interventions. Most represented new teaching technologies or curricular changes. Only 1 study was multi-institutional and none included analysis beyond preclinical education. Control groups were used in <50% of studies with statistical significance of results were reported in only 44%. Examination results or student confidence ratings were the tool used to assess effectiveness in 77% of cases.
Conclusions: For the widespread use of pathology educational interventions described in the literature, better study design is necessary.
Looking Through the WINDOW©: a Metacognitive Instrument to Teach Physical Exam to Pre-Clinical PA StudentsAuthor(s): Wayne A. Mathews, MS, PA-C, DFAAPA
Abstract: The initial transition from pre-clinical learning to clinical immersion is a significant and unique phase in a PA student’s education when students transition from spending more time learning in the classroom to experiential learning in the clinical setting. One essential component of that transition is the teaching of physical examination skills. The author introduces an instrument based on metacognitive theories of learning called WINDOW©. The instrument is evaluated using two consecutive PA student surveys employing a Mixed Methods approach. Student response gauged at two phases was positive: 79.31% agreed the WINDOW© instrument was relevant to clinical problem solving; 72.42% thought it was useful to their learning physical exam skills; and 72.41% thought it was a helpful adjunct to the rote format of the physical exam Green Sheet (n=59). Utilization of metacognitive techniques may be especially useful in the transition of learning physical exam to applying it in clinical phase of education.
Restructuring for Student-Centered Learning: Synchronous to Hybrid Course DeliveryAuthor(s): Tammy L. Webster, PhD, MPA, RT(R)(M)
The Use of Lightly Embalmed Cadavers in Ultrasound Guided Renal Biopsies: An IPE Activity between Sonography Students & Nephrology Fellows to Improve Interprofessional PracticeAuthor(s): Kathryn Wampler, BS, RT(R), RDMS, RVT, Jennifer Fillaus, DO, Kimberly Michael, MA, RT(R), RDMS, RVT, FSDMS
Objective: To use Interprofessional education (IPE) to improve the practice of ultrasound guided renal biopsies for Sonography students & Nephrology fellows.
Subjects & Methods: Subjects included Sonography students and Nephrology fellows on campus during the spring semester of academic years 2012-2016. Lightly embalmed cadavers were used to practice renal biopsy skills in a controlled environment. IPE activities included sterile technique, review of sonographic renal anatomy, and needle visualization during the procedure. Communication between the students and fellows was stressed.
Outcomes: Pre- and post-IPE surveys assessed the Sonography students’ perceived competence of assisting in an ultrasound guided renal biopsy. Pre-IPE surveys showed 0 of 39 students felt competent to assist in the procedure, while 30 of the 39 students (77%) felt competent after the IPE. Faculty noted that teamwork and communication improved between the participants during the activity and in the clinical setting.
Conclusion: The IPE activity had multiple benefits. Participants were better prepared to assist with renal biopsies. Nephrology fellows were able to practice performing biopsies without risk to patients. Both groups realized the importance of communication and working as a team to provide a shared service.
Use of MultiTaction iWall to Enhance Multi-Sensory LearningAuthor(s):Sue Wilhelm, PhD, RN, Beth Culross, PhD, RN, GCNS-BC, CRRN, Tiann Colwell, RN, APRN-BC, Missy Ofe Fleck, PhD, RN, Kirsten Curtis, MSN, RN, Jean Mortensen, MSN,RN
Abstract: Engaging millennial students who have learned in a digital environment is a current challenge. Multi-taction I-Walls are emerging as an ultimate touch technology that may help facilitate a complete multi-sensory and collaborative solution for these digital learners in multiple locations. Using a multi-sensory approach to engage the student in active learning requires knowledge and availability of technology, technology support, and faculty development time. The purpose of this research was to determine the effect of using multi-sensory learning technologies on retention of knowledge of a pediatric diabetic ketoacidosis case study simulation. Critical components of multi-sensory learning include: 1) make it real-time, 2) visualize in one place, 3) connect learners and technology, 4) showcase rich media, and 5) implement use of touch screens across multiple locations. In addition, the more modalities provided in the learning experience, the higher the retention rate of knowledge acquisition. Using the mulit-taction I-Wall, the students will have an interactive, real-time learning experience that utilizes current practice, up-to-date resources and real-world examples. In the learning session described, students from the UNMC College of Nursing Scottsbluff Campus and the Omaha campus will participate in a hands on collaborative case study developed to enhance knowledge and decision making skills using a multi-sensory teaching strategy.
Video-Directed Feedback for Quality Improvement of the Third Year Medical Student OSCEAuthor(s): David Brooks, MD, Aleisha Nabower, MD, Rebecca Martin, MD, Nathan Gollehon, MD
Objective: A quality improvement project aimed at evaluating the effectiveness of an interactive physical exam and video feedback on improving the perceived value of the third-year medical student pediatric clerkship observed structured clinical exam (OSCE).
Methods: Using the clinical simulation center, medical students on their third-year pediatric clerkship were presented with a common pediatric chief complaint. Students obtained a history of present illness and pertinent medical history from trained simulated patients portraying a parent. Students then presented the patient to the resident physician including an impression and plan. The students used an interactive mannequin to perform a focused cardiopulmonary physical exam. Starting with the second rotation of medical students, an iPad with a video recording of the encounter was used by the residents to give students video-directed feedback on their performance. Students were then asked to fill out a survey regarding their impression of the OSCE. Survey results were analyzed between each group of rotating students and used to implement improvements in the OSCE for subsequent clerkship groups. Results: Three groups of medical students completed the OSCE study with 21, 16, and 11 students in each group, respectively. Survey results demonstrated an increasing trend in students reporting an ability to apply feedback from the Pediatric OSCE to their performance on future third-year rotations (76%, 81%, and 100%). Survey results also indicated that the majority of students felt the OSCE accurately imitated their clinical pediatric experience (81-90%) and would recommend continuing to offer the OSCE to future classes (81%-91%).
Conclusions: Implementation of immediate video feedback in the pediatric OSCE has demonstrated an increase in students’ ability to apply feedback towards future rotations. This is consistent with a previous study of surgical medical students that demonstrated improved OSCE performance on communicative measures with video feedback when compared to oral feedback alone.1 1. Ruesseler M, Sterz J, Bender B, Hoefer S, Walcher F. The effect of video-assisted oral feedback versus oral feedback on surgical communicative competences in undergraduate training. Eur J Trauma Emerg Surg. 2017;43(4):461-466.