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Author: Brian S McGowan, PhD

ABSTRACT: Virtual reality-based simulators for spine surgery: a systematic review

BACKGROUND CONTEXT:
Virtual reality (VR)-based simulators offer numerous benefits and are very useful in assessing and training surgical skills. Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery.

PURPOSE:
Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures. We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field.

STUDY DESIGN AND SETTING:
This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery.

METHODS:
Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery. A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes. Additionally, all included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool.

RESULTS:
The initial review identified 476 abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement. These studies had a low-to-medium methodological quality with a MERSQI mean score of 11.47 out of 18 (standard deviation=1.81).

CONCLUSIONS:
This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored. Higher-quality studies with patient-related outcome measures are needed. To establish further adaptation of VR-based simulators in spinal surgery, future evaluations need to improve the study quality, apply long-term study designs, and examine non-technical skills, as well as multidisciplinary team training.

via Virtual reality-based simulators for spine surgery: a systematic review. – PubMed – NCBI.

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ABSTRACT: Construction of Multiple Choice Questions Before and After An Educational Intervention

INTRODUCTION:
Khesar Gyalpo University of Medical Sciences of Bhutan, established in 2014, has ushered in a new era in medical education in Bhutan. Multiple Choice Questions are a common means of written assessment in medical education.

METHODS:
This was a quasi-experimental study conducted at the Faculty of Postgraduate Medicine, KGUMSB, Thimphu in December 2016. A total of 8 MCQs were prepared by four teaching faculties from different fields who had no prior training on construction of MCQs. It was delivered to a group of 16 randomly selected intern doctors. A 2 hours long workshop on construction of MCQs was conducted. After the workshop, the same MCQs were modified according to standard guidelines on developing MCQs and were tested in the same group of intern doctors. An analysis on the performance, difficulty factor, discrimination index and distractor analysis was done on the two sets of MCQs using Microsoft Excel and SPSS 20.0.

RESULTS:
For the pre- and post-workshop questions respectively, the pass percentage was 69.8% (11) and 81.3% (13), difficulty factor was 0.51 and 0.53, discrimination index was 0.59 and 0.47, distractor effectiveness was 83.3% and 74.9%.

CONCLUSIONS:
The workshop on MCQ development apparently seemed highly valuable and effective in changing the learning and performances of medical educators in the development of MCQs.

via Construction of Multiple Choice Questions Before and After An Educational Intervention. – PubMed – NCBI.

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ABSTRACT: How preferred learning approaches change with time: a survey of GPs and GP Specialist Trainees

Background The Approaches and Study Skills Inventory for Students (ASSIST) questionnaire assesses whether learners prefer a deep, strategic or surface approach to learning. This study aimed to establish the effect of time since qualification, gender and work role on ASSIST scores of General Practitioners (GPs) and GP Specialist Trainees (GPSTs). Methods An anonymous online questionnaire with demographic questions and the ASSIST survey was completed by 1005 GPs and GPSTs from across the United Kingdom. Results Of the 544 GPs and 461 GPSTs completing the survey, 96.5% preferred a deep and/or strategic approach to learning. There was a significant increase in the preference for a deep approach with time from graduation and significantly less preference for a surface approach. There was no significant change in any of the scores over the GPST years. Men had significantly higher scores for a deep approach than women. Conclusions GPs and GPSTs prefer deep and strategic approaches to a surface approach. While higher levels of GP experience are associated with a higher deep approach score and a lower surface approach score, this change is not seen during progression through GP training. Men have higher scores for a deep approach than women.

via How preferred learning approaches change with time: a survey of GPs and GP Specialist Trainees. – PubMed – NCBI.

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ABSTRACT: Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review

Several studies have been conducted to evaluate the implementation of interprofessional education (IPE) across the globe. By looking at the timeline of each previous study, it can be inferred that the implementation of IPE has been improving continuously. However, the effectiveness of IPE still cannot be easily generalized due to misconceptions regarding how interprofessional collaboration capabilities should be evaluated. This study aims to generalize the learning outcomes that were produced by IPE in a global context and analyse the contributing factors. A systematic review was conducted within seven online databases as well as paperback periodical publications to search for the intended articles. A set of four criterions were assigned prior to the study using the standard Population-Intervention-Context-Outcome (PICO) model to ensure the included articles matched the study objectives. The quality of studies were appraised using the Medical Education Research Study Quality Improvement (MERSQI). Each included article was analysed using the narrative method to obtain the relevant information. Sixteen articles included in this study showed that IPE improved interprofessional collaborative knowledge, skills, and behaviour based on objective measurements. Complexity of the learning material, appropriateness of the program design, and referral to a specific standard of competence were assumed to play significant role towards the effectiveness of interprofessional education. This study results in several recommendation for future development of IPE, including a specific suggestion for its development in Asia region.

via Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review. – PubMed – NCBI.

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ABSTRACT: Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence

Medical decision-making requires years of experience in order to develop an adequate level of competence to successfully engage in safe practice. While diagnostic and technical skills are essential, an awareness of the extent and limits of our own knowledge and skills is critical. The present study examines clinicians’ subjective awareness in a diagnostic cardiac ultrasound task. Clinicians answered diagnostic and treatment related questions for a range of pathologies. Following these questions, clinicians indicated their level of confidence in their response. A comparison of response accuracy and confidence revealed that clinicians were generally overconfident in their responses. Critically, we observed that a clinician’s overconfidence was negatively correlated with prior experience: clinicians that had more prior experience expressed less overconfidence in their performance such that some clinicians were in fact underconfident. We discuss the implications for training in medical education and decision-making.

via Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence. – PubMed – NCBI.

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ABSTRACT: The Use of Smartphones in Different Phases of Medical School and its Relationship to Internet Addiction and Learning Approaches

The use of smartphones is revolutionizing the way information is acquired, leading to profound modifications in teaching medicine. Nevertheless, inadvertent use can negatively affect student learning. The present study aims to evaluate smartphone use in the educational context as well as Internet addiction and its repercussions on surface and deep learning and to compare them during the different phases of medical students’ education. This is a cross-sectional study involving medical students in all phases of education. Sociodemographic data, type and frequency of smartphone use, degree of digital addiction (Internet Addiction Test – IAT), and surface and deep approaches to learning (Biggs) were analyzed. A total of 710 students were included. Almost all students had a smartphone and a total of 96.8% used it during lectures, classes, and meetings. Less than half of the students (47.3%) reported using a smartphone for more than 10 min for educational purposes, a usage that is higher among clerkship students. At least 95% reported using a smartphone in the classroom for activities not related to medicine (social media and searching for general information) and 68.2% were considered problematic Internet users according to the IAT. The most common reasons for noneducational use were that the class was uninteresting, students needed to receive or make an important call, and the educational strategy was not stimulating. The “frequency of smartphone use” and higher “internet addiction” were correlated to both higher levels of surface learning and lower levels of deep learning. Educators should advise and educate their students about conscientious use of this tool to avoid detrimental impact on the learning process.

via The Use of Smartphones in Different Phases of Medical School and its Relationship to Internet Addiction and Learning Approaches. – PubMed – NCBI.

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ABSTRACT: A Four-Week Reflective Writing Program in the Psychiatry Clerkship: Testing Effects on Reflective Capacity

OBJECTIVE:
Reflective capacity is the ability to review and reconstruct the importance, emotional impact, and outcomes of an experience to give it added meaning and context. In medicine, greater reflective capacity is associated with greater empathy and diagnostic accuracy. This project implemented a four-week reflective writing curriculum for third-year medical students during their psychiatric clerkship.

METHODS:
A single class of medical students participated in a pilot reflective writing program during their four-week Psychiatry Care Block. Students were provided with weekly writing prompts, and the reflective capacity of their writing assignments was assessed using the REFLECT rubric.

RESULTS:
Medical students who participated in the reflective writing course demonstrated a significant increase in Wald Rubric reflective writing scores across the four-week clerkship.

CONCLUSIONS:
These results suggest a short, four-week reflective writing curriculum can enhance reflective capacity in a class of third-year medical students.

via A Four-Week Reflective Writing Program in the Psychiatry Clerkship: Testing Effects on Reflective Capacity. – PubMed – NCBI.

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ABSTRACT: A cross-sectional study of learning styles among continuing medical education participants.

PURPOSE:Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants’ learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics.MATERIALS AND METHODS:Cross-sectional study of all participants (n = 393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data.RESULTS:A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p = 0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%).CONCLUSIONS:Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.

via A cross-sectional study of learning styles among continuing medical education participants. – PubMed – NCBI.

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ABSTRACT: Education to Improve Dementia Care: Impact of a Structured Clinical Reasoning Approach

BACKGROUND AND OBJECTIVES:
Dementia often goes undiagnosed. A workshop was developed to provide primary care clinicians with a structured clinical reasoning approach to dementia diagnosis and brain map tool to differentiate type of dementia. The purpose of this study was to examine the impact of this approach on self-perceived changes in knowledge, confidence, and ability to assess and manage memory problems and on self-reported application of learning to clinical practice.

METHODS:
Participants of 20 workshops (N=392) were invited to complete a reaction survey and of these, participants of 12 consecutive workshops (N=242) were invited to complete a 3-month follow-up survey to assess application of new learning to clinical practice and challenges experienced in doing so.

RESULTS:
In total, 355 reaction and 108 follow-up surveys were completed. Mean ratings of usefulness reflected that participants considered the clinical reasoning approach and brain map very useful to learning and knowledge transfer. At follow-up, the majority of respondents reported they were more confident (79%) and better able to assess (79%) persons with cognitive impairment and more confident (88%) and better able to manage (86%) persons with cognitive impairment. A number of practice changes and challenges were identified.

CONCLUSIONS:
These results add to a growing literature on strategies to improve dementia care with effective continuing medical education. A structured clinical reasoning approach to cognitive impairment is effective in improving confidence and ability to assess and manage patients with cognitive impairment, although participants continue to experience challenges in managing this complex condition.

via Education to Improve Dementia Care: Impact of a Structured Clinical Reasoning Approach. – PubMed – NCBI.

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