Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection.
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ABSTRACT:
SUBMITTER: Manning EP
PROVIDER: S-EPMC6165707 | biostudies-literature | 2018 Nov
REPOSITORIES: biostudies-literature
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Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection.
Manning Edward P EP Mishall Priti L PL Weidmann Maxwell D MD Flax Herschel H Lan Sam S Erlich Mark M Burton William B WB Olson Todd R TR Downie Sherry A SA
Anatomical sciences education 20180330 6
Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical student ...[more]
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Project description:BackgroundAlongside providing a knowledge base and practical skills, undergraduate medical education must prepare graduates to immediately begin practice as qualified doctors. A significant challenge is to provide safe learning opportunities that will optimise students' preparedness to start work. This study examined UK graduates' preparedness for clinical practice, and their exposure to real-life and simulated immediate care scenarios during final year placements.MethodA questionnaire measuring students' perceived preparedness, and their exposure to immediate care scenarios, was distributed to all new Foundation Year 1 doctors (F1s) attending an induction session in one region of the UK.Results356 F1s responded to the questionnaire (91% response rate; 89% of cohort) and data from 344 graduates of UK medical schools were analysed. Respondents were generally prepared for practice, but many reported few 'hands-on' experiences of providing immediate care during final year placements (a median of 1-2 experiences).Those who had 1-2 experiences reported no greater preparedness for acute management than those reporting no experience. Several exposures are necessary for a significant increase in perceived preparedness. Real-life experience was a better predictor of preparedness than simulated practice.ConclusionsGaps still remain in medical students' acute care experience, with a direct relationship to their perceived preparedness. The format and facilitation of placements may need to be addressed in order to enhance the quality of experience during final year.
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Project description:BACKGROUND:Objective structured clinical examinations (OSCEs) are a useful method to evaluate medical students' performance in the clerkship years. OSCEs are designed to assess skills and knowledge in a standardized clinical setting and through use of a preset standard grading sheet, so that clinical knowledge can be evaluated at a high level and in a reproducible way. OBJECTIVE:This study aimed to present our OSCE assessment tool designed specifically for radiology clerkship medical students, which we called the objective structured radiology examination (OSRE), with the intent to advance the assessment of clerkship medical students by providing an objective, structured, reproducible, and low-cost method to evaluate medical students' radiology knowledge and the reproducibility of this assessment tool. METHODS:We designed 9 different OSRE cases for radiology clerkship classes with participating third- and fourth-year medical students. Each examination comprises 1 to 3 images, a clinical scenario, and structured questions, along with a standardized scoring sheet that allows for an objective and low-cost assessment. Each medical student completed 3 of 9 random examination cases during their rotation. To evaluate for reproducibility of our scoring sheet assessment tool, we used 5 examiners to grade the same students. Reproducibility for each case and consistency for each grader were assessed with a two-way mixed effects intraclass correlation coefficient (ICC). An ICC below 0.4 was deemed poor to fair, an ICC of 0.41 to 0.60 was moderate, an ICC of 0.6 to 0.8 was substantial, and an ICC greater than 0.8 was almost perfect. We also assessed the correlation of scores and the students' clinical experience with a linear regression model and compared mean grades between third- and fourth-year students. RESULTS:A total of 181 students (156 third- and 25 fourth-year students) were included in the study for a full academic year. Moreover, 6 of 9 cases demonstrated average ICCs more than 0.6 (substantial correlation), and the average ICCs ranged from 0.36 to 0.80 (P<.001 for all the cases). The average ICC for each grader was more than 0.60 (substantial correlation). The average grade among the third-year students was 11.9 (SD 4.9), compared with 12.8 (SD 5) among the fourth-year students (P=.005). There was no correlation between clinical experience and OSRE grade (-0.02; P=.48), adjusting for the medical school year. CONCLUSIONS:Our OSRE is a reproducible assessment tool with most of our OSRE cases showing substantial correlation, except for 3 cases. No expertise in radiology is needed to grade these examinations using our scoring sheet. There was no correlation between scores and the clinical experience of the medical students tested.
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Project description:Active learning in college classes and participation in the workforce frequently hinge on small group work. However, group dynamics vary, ranging from equitable collaboration to dysfunctional groups dominated by one individual. To explore how group dynamics impact student learning, we asked students in a large-enrollment university biology class to self-report their experience during in-class group work. Specifically, we asked students whether there was a friend in their group, whether they were comfortable in their group, and whether someone dominated their group. Surveys were administered after students participated in two different types of intentionally constructed group activities: 1) a loosely-structured activity wherein students worked together for an entire class period (termed the 'single-group' activity), or 2) a highly-structured 'jigsaw' activity wherein students first independently mastered different subtopics, then formed new groups to peer-teach their respective subtopics. We measured content mastery by the change in score on identical pre-/post-tests. We then investigated whether activity type or student demographics predicted the likelihood of reporting working with a dominator, being comfortable in their group, or working with a friend. We found that students who more strongly agreed that they worked with a dominator were 17.8% less likely to answer an additional question correct on the 8-question post-test. Similarly, when students were comfortable in their group, content mastery increased by 27.5%. Working with a friend was the single biggest predictor of student comfort, although working with a friend did not impact performance. Finally, we found that students were 67% less likely to agree that someone dominated their group during the jigsaw activities than during the single group activities. We conclude that group activities that rely on positive interdependence, and include turn-taking and have explicit prompts for students to explain their reasoning, such as our jigsaw, can help reduce the negative impact of inequitable groups.
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Project description:BackgroundThe increased use of social media, cloud computing, and mobile devices has led to the emergence of guidelines and novel teaching efforts to guide students toward the appropriate use of technology. Despite this, violations of professional conduct are common.ObjectiveWe sought to explore professional behaviors specific to appropriate use of technology by looking at changes in third-year medical students' attitudes and behaviors at the beginning and conclusion of their clinical clerkships.MethodsAfter formal teaching about digital professionalism, we administered a survey to medical students that described 35 technology-related behaviors and queried students about professionalism of the behavior (on a 5-point Likert scale), observation of others engaging in the behavior (yes or no), as well as personal participation in the behavior (yes or no). Students were resurveyed at the end of the academic year.ResultsOver the year, perceptions of what is considered acceptable behavior regarding privacy, data security, communications, and social media boundaries changed, despite formal teaching sessions to reinforce professional behavior. Furthermore, medical students who observed unprofessional behaviors were more likely to participate in such behaviors.ConclusionsAlthough technology is a useful tool to enhance teaching and learning, our results reflect an erosion of professionalism related to information security that occurred despite medical school and hospital-based teaching sessions to promote digital professionalism. True alteration of trainee behavior will require a cultural shift that includes continual education, better role models, and frequent reminders for faculty, house staff, students, and staff.
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