scholarly journals A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance

Author(s):  
Frank Battaglia ◽  
Victoria Ivankovic ◽  
Maria Merlano ◽  
Vishesh Patel ◽  
Céline Sayed ◽  
...  

Introduction: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. Methods: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. Results: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. Conclusion: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students’ transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.

2020 ◽  
Vol 129 (11) ◽  
pp. 1095-1100
Author(s):  
Brandon R. Rosvall ◽  
Zachary Singer ◽  
Kevin Fung ◽  
Christopher J. Chin

Objectives: Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions. Methods: Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions. Results: Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r = 0.267, P = .012). Conclusion: The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.


2017 ◽  
Vol 3 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Sinéad Lydon ◽  
Nadine Burns ◽  
Olive Healy ◽  
Paul O'Connor ◽  
Bronwyn Reid McDermott ◽  
...  

IntroductionA lack of preparedness for practice has been observed among new medical graduates. Simulation technology may offer one means of producing competency. This paper describes the application of a simulation-based intervention incorporating precision teaching (PT), a method of defining target skills, assessing individual progress and guiding instructional decisions, which is used to monitor learning and the development of behavioural fluency in other domains, to procedural skills training. Behavioural fluency refers to accurate and rapid responding that does not deteriorate with time, is resistant to distraction and can be adapted into new, more complex responses.MethodThis study used a between-groups design to evaluate the efficacy of a simulation-based intervention incorporating PT for teaching venepuncture among 11 medical students. The intervention consisted of timed learning trials during which participants carried out the skill in pairs and received corrective feedback. Two control groups of 11 untrained medical students and 11 junior doctors were also included in the study.ResultsIntervention group participants required an average of five trials and 21.9 min to reach the criterion for fluency. The intervention group demonstrated significantly higher accuracy in venepuncture performance than either control group. Improvements persisted over time, did not deteriorate during distraction, generalised to performance with patients and performance of an untargeted skill also improved.ConclusionsThe outcomes of this preliminary study support the application of PT within medical education. The implications of these data for clinical and procedural skills training are explored and suggestions are made for further research.


2018 ◽  
Vol 25 (1) ◽  
pp. e18-e24 ◽  
Author(s):  
Jiayu Liu ◽  
SherWin Wong ◽  
Gary Foster ◽  
Anne Holbrook

Evidence suggests that newly licensed physicians are not adequately prepared to prescribe medications safely. There is currently no national pre-licensure prescribing competency assessment required in North America. This study’s purpose was to survey Canadian medical school leaders for their interest in and perceived need for a nation-wide prescribing assessment for final year medical students. Method In spring of 2015, surveys were disseminated online to medical education leaders in all 17 Canadian medical schools. The survey included questions on perceived medication prescribing competency in medical schools, and interest in integration of a national assessment into medical school curricula and licensing. Results 372 (34.6 %) faculty from all 17 Canadian medical schools responded. 277 (74.5%) respondents were residency directors, 33 (8.9%) vice deans of medical education or equivalent, and 62 (16.7%) clerkship coordinators. Faculty judged 23.4% (SD 22.9%) of their own graduates’ prescribing knowledge to be unsatisfactory and 131 (44.8%) felt obligated to provide close supervision to more than a third of their new residents due to prescribing concerns. 239 (73.0%) believed that an assessment process would improve their graduates’ quality, 262 (80.4%) thought it should be incorporated into their medical school curricula and 248 (76.0%) into the national licensing process. Except in regards to close supervision due to concerns, there were no significant differences between schools’ responses. Conclusions Amongst Canadian medical school leadership, there is a perceived inadequacy in medical student prescribing competency as well as support for a standardized prescribing competency assessment in curricula and licensing processes.


CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S67
Author(s):  
F. Battaglia ◽  
M. Merlano ◽  
C. Sayed ◽  
M. McConnell ◽  
C. Ramnanan ◽  
...  

Introduction: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills. The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value <0.001), while the control group did not (p-value = 0.408). When assessing confidence, students who completed this program showed increased self-assessed knowledge and confidence in each of the program's assessed skills. An increased level of competency was achieved in each skill by each student as assessed by the expert physicians. Conclusion: There is evidence to suggest that implementation of this procedural skills training model within the Canadian medical school curriculum may improve student anxiety, confidence, and competency for success in clerkship and could be the foundation for developing milestones for EPAs.


Author(s):  
Laleh Khojasteh ◽  
Seyyed Ali Hosseini ◽  
Elham Nasiri

AbstractWriting as a multiple-step process is one of the most complex and demanding skills for graduate students to master. Foreign or second language learners who are required to write for academic purposes at the university level may even find it more demanding to master. One of the ways of decreasing the burden of mastering this skill for learners is mediation, using scaffolding techniques to teach writing. Hence, having a good understanding of the impact(s) of adopting mediating or scaffolding techniques in writing classes is absolutely indispensable. To this end, the present study employed an experimental research design to investigate the impact of mediation in the flipped writing classrooms of the students of medicine. To peruse this goal, 47 medical students were selected through purposive sampling and put into control and treatment groups. Medical students in the treatment group watched teacher-made video content(s) before their writing classes. The students in this group experienced organized-interactive writing group activities in their classes. Unlike the experimental group, the students in the control group received all the instructions in the classroom and were assigned homework. The findings obtained through the ANOVA and t-test indicated that the students in the experimental group significantly outperformed their counterparts in the control group in terms of their writing. A probable conclusion could be that by requiring students to study in advance and take responsibility for their learning, flipped classroom can provide the opportunity for learners to actively construct knowledge rather than receive the information passively in the classroom. Flipped classroom can also cultivate interactive class time for teachers and enable them to invest in more fruitful academic practices, instead of asking students to spend a substantial amount of time each week doing homework independently.


2016 ◽  
Vol 55 (6) ◽  
pp. 339 ◽  
Author(s):  
Hartono Gunadi ◽  
Rini Sekartini ◽  
Retno Asti Werdhani ◽  
Ardi Findyartini ◽  
Muhammad Arvianda Kevin Kurnia

Background Immunization is recognized as one of the strategiesto reduce vaccine preventable diseases. Competency related toimmunization are consequently important for medical students andthe medical school needs to assure the competence acquisition.Objective To assess competence related to immunization andits retention following lectures with simulations compared tolectures only.Methods A quasi-experimental study was conducted to the 5th yearstudents of University of Indonesia Medical School during the ChildAdolescent Health Module in 2012-2013. The intervention grouphad lectures with simulations and the control group had lecturesonly. Immunization knowledge was assessed with a 30 multiplechoice question (MCA) items performed before and after themodule. Competence retention was assessed by MCQ (knowledge)and OSCE (skills) 2-6 months afterwards.Results Sixty eight subjects for each group with similarcharacteristics were analyzed. There was significant differenceafter module MCQ score between two groups. Competenceretention in 2-6 months after module completion was betterin intervention group, both for the knowledge (median MCQscore of 70.00 (range 37-93) vs. mean score of 58.01 (SD 12.22),respectively; P<0.001) and skill (OSCE mean scores of 75.21 (SD10.74) vs. 62.62 (SD 11.89), respectively; P < 0.001). Proportionof subjects in the intervention group who passed both the MCQand OSCE were also significantly greater.Conclusion Lectures with simulations are proved to bemore effective in improving medical students’ immunizationcompetence as well as its retention compared to lectures onlyapproach.


2019 ◽  
Vol 29 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Marisa Gasparini ◽  
Shruti Jayakumar ◽  
Sarah Ayton ◽  
Marco N Nardini ◽  
Joel D Dunning

Abstract OBJECTIVES There has been declining interest in cardiothoracic surgery amongst medical graduates. This survey examines the exposure of British medical students to cardiothoracic surgery in various settings and its relationship with students’ interest in the speciality. METHODS A questionnaire composed of 14 quantitative and qualitative items was distributed amongst 162 medical students. The survey included questions on demographics, interest in cardiothoracic surgery, mechanisms of exposure to the speciality and desire to pursue a career in cardiothoracic surgery before and after exposure. RESULTS Amongst the surveyed students, 71.0% reported exposure to cardiothoracic surgery as part of their medical school curricula and 24.7% reported extracurricular exposure. Of the students, 46.7% reported clinical exposure. Overall, 27.1% of students reported interest in a career in cardiothoracic surgery, which was higher amongst students who had curricular (29.6%), clinical (35.5%) or extracurricular exposure (50.0%). Amongst interested students, 43.2% engaged in extracurricular cardiothoracic activities compared with 16.1% of students not interested in pursuing the speciality. Confidence in career choice after exposure increased more in interested students (20.4%) than not interested students (1.6%). Students rated exposure and mentorship as the most important factor in promoting a career in cardiothoracic surgery. CONCLUSIONS Medical students with an interest in cardiothoracic surgery are more likely to organize independent attachments in the speciality and attend extracurricular events; however, many students might fail to identify cardiothoracic surgery as an area of interest because of the lack of exposure at medical school.


2020 ◽  
Vol 1 (6) ◽  
pp. 1199-1204
Author(s):  
Armon Ayandeh ◽  
Xiao C. Zhang ◽  
Jay F. Diamond ◽  
Sarah H. Michael ◽  
Steven Rougas

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