Team leadership during medical emergencies like cardiac arrest resuscitation is cognitively demanding, especially for trainees. These cognitive processes remain poorly characterized due to measurement challenges. Using virtual reality simulation, this study aimed to elucidate and compare communication and cognitive processes-such as decision-making, cognitive load, perceived pitfalls, and strategies-between expert and novice code team leaders to inform strategies for accelerating proficiency development.

A simulation-based mixed methods approach was utilized within a single large academic medical center, involving twelve standardized virtual reality cardiac arrest simulations. These 10- to 15-minutes simulation sessions were performed by seven experts and five novices. Following the simulations, a cognitive task analysis was conducted using a cued-recall protocol to identify the challenges, decision-making processes, and cognitive load experienced across the seven stages of each simulation.

The analysis revealed 250 unique cognitive processes. In terms of reasoning patterns, experts used inductive reasoning, while novices tended to use deductive reasoning, considering treatments before assessments. Experts also demonstrated earlier consideration of potential reversible causes of cardiac arrest. Regarding team communication, experts reported more critical communications, with no shared subthemes between groups. Experts identified more teamwork pitfalls, and suggested more strategies compared to novices. For cognitive load, experts reported lower median cognitive load (53) compared to novices (80) across all stages, with the exception of the initial presentation phase.

The identified patterns of expert performance - superior teamwork skills, inductive clinical reasoning, and distributed cognitive strategiesn - can inform training programs aimed at accelerating expertise development.

We explored the influence of observing experienced or inexperienced demonstrators on a learner's own performance of a simple, interrupted suture.

Participants without suturing experience observed videos of an experienced or inexperienced demonstrator suturing, rated the performance, and then practiced the task; this was repeated twice more. Suturing performance was rated using a modified Objective Structured Assessment of Technical Skills (OSATS). We calculated participants' accuracy in rating the demonstrator's performances. Data were analyzed using mixed model analyses of variance (ANOVAs) and pairwise t-tests.

Participants who observed the experienced demonstrator significantly improved their suturing performance. Participants who observed the inexperienced demonstrator became significantly more accurate at rating the demonstrator's performance.

Learners who are new to suturing can improve their suturing performance through observation of an experienced demonstrator and physical practice. While the experiment itself was conducted in-person, learners could engage in this method of learning remotely.

Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.

First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.

Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; p < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (p < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; p < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; p = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; p = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; p = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; p = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; p = 0.041).

In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.

Phenomenon: On the Medical College Admission Test (MCAT), required for entry into all medical schools in the U.S. and many in Canada, average scores are typically lower for individuals from lower socioeconomic status (SES) backgrounds compared to their more advantaged peers, although individuals from every background score in the lower, middle, and upper ranges of the score scale. This achievement gap is potentially due in part to disparities in resource utilization and effective study strategies. Viewing this challenge through a socioecological systems lens can help identify potential systems-level opportunities to support students from these backgrounds to succeed in medicine. Approach: This investigation was the first large-scale review of MCAT preparation strategies, resource utilization, and challenges for examinees from lower-SES backgrounds, focusing on those who obtained higher versus lower MCAT scores. It aimed to examine differences in students' use of evidence-supported learning/studying strategies and challenges experienced in preparing for the MCAT exam. Survey data from the Association of American Medical Colleges Post-MCAT Questionnaire on MCAT preparation strategies and resources used and challenges experienced by 2021-2023 examinees were analyzed, focusing on the 3,240 survey respondents from lower-SES backgrounds. T-tests and chi-square analyses compared continuous variables and proportions between lower- and higher-scoring examinees from lower-SES backgrounds, using Cohen's h to estimate effect size. Findings: Higher-scoring examinees reported greater use of many evidence-supported effective test preparation and learning strategies, including discussing preparation strategies with advisors/peers, establishing baseline capabilities, practicing applying knowledge to practice questions, and evaluating readiness by taking a practice test. Utilization rates of high-value, free/low-cost MCAT resources were significantly higher among top scorers. Conversely, lower-scoring examinees were more likely to report challenges in obtaining reliable internet access, determining how to begin studying, and accessing concrete information about the MCAT exam. Insights: This study highlights critical differences in preparation approaches and challenges among examinees from lower-SES backgrounds. Identifying these gaps may provide insights regarding interventions to improve access to resources and potential improvement to MCAT performance. We provide systems-level ideas for how to better support students from lower-SES backgrounds. For example, learning specialists and advisors could use the findings from this study to screen and educate examinees about evidence-based MCAT preparation strategies and resources. This study identifies opportunities to inform interventions to help students from lower-SES backgrounds advance toward a career in medicine.

Left displaced abomasum (LDA) is a common condition in dairy cattle where the abomasum dilates and migrates to the left side of the abdomen. This condition causes significant economic losses for farmers and can result in life-threatening complications, so it is critical that veterinary students be taught to surgically correct a LDA before graduating and entering food animal practice. Models have been successfully used to teach students to perform other surgical procedures, but limited models exist to teach surgical skills to prospective dairy veterinary students. This study sought to develop and validate a bovine LDA reduction model and scoring rubric using a validity framework consisting of content evidence (expert opinion), internal structure evidence (reliability of rubric scores), and evidence showing the relationship with other variables (comparing expert to novice performance). Experienced veterinarians (n = 12) and novice veterinary students (n = 30) surgically deflated and reduced the model's LDA while being recorded. Videos were scored by a blinded expert. Participants completed a survey afterward. All veterinarians reported that the model was suitable for use in teaching and assessing students, offering content evidence for validation. Scores produced by the checklist had good reliability (α = .886), offering internal structure evidence. Veterinarians achieved higher checklist (p = .025) and global rating scores (p = .005) than students, offering relationship with other variables evidence. The development and use of food animal models promotes students' development of competence in performing food animal procedures, leading to better qualified new graduates entering food animal practice. The use of models also protects animal welfare during students' training.

Motion tracking has been shown to correlate with expert and novice performance but has not been used for skill development. For skill development, performance goals must be defined. We hypothesize that by using wearable sensor technology, motion-tracking outcomes can be identified in those deemed practice ready (PR) and used as benchmarks for precision learning.

At the American College of Surgeons Clinical Congress, surgeons and surgeons in training volunteered to wear motion-tracking sensors while performing intracorporeal suturing and knot tying, laparoscopic pattern cutting, and simulated laparoscopic cholecystectomy. Coach raters evaluated the participants using a modified SIMPL scale. Participants were divided into 2 groups based on coach ratings: PR and not PR. Motion results were compared. Benchmark performance for each motion-tracking outcome of the simulated laparoscopic cholecystectomy was set at the median (±median absolute deviation) of the PR cohort. For all participants, each motion-tracking outcome was compared with the benchmark.

A total of 94 participants were recruited. Fifty-three were rated PR. Differences between groups were identified in 2 of 10 metrics for intracorporeal suturing and knot tying, 4 of 10 metrics for pattern cutting, and 5 of 10 metrics for laparoscopic cholecystectomy. Set benchmarks for the metrics were compared with each participant's score for all individual metrics. A not PR individual was less likely to achieve the benchmarks (chi-square = 55.48, p < 0.00001).

Wearable sensor technology can identify differences between surgeons rated PR and not PR. More importantly, motion metric results can be used to develop benchmarks for training endpoints. This will allow for the development of an individualized report card and training protocol focused on areas in need of improvement instead of the current model of generalized training. Implementing such focused training may expedite competency and mastery of surgical skills.

From dual process to a family of theories known collectively as situativity, both micro and macro theories of cognition inform our current understanding of clinical reasoning (CR) and error. CR is a complex process that occurs in a complex environment, and a nuanced, expansive, integrated model of these theories is necessary to fully understand how CR is performed in the present day and in the future. In this perspective, we present these individual theories along with figures and descriptive cases for purposes of comparison before exploring the implications of a transtheoretical model of these theories for teaching, assessment, and research in CR and error.

The use of telehealth and remote exam devices for children with medical complexity (CMC) allows providers to engage with CMC in their home environment and alleviate caregiver burdens with in-person visits. The authors' objective was to increase the percentage of telehealth visits in which a remote exam device was used in a complex care center from 0% to 50% over a six-month period.

This improvement work targeted a pediatric complex care center. The multidisciplinary quality improvement team developed key drivers to design Plan-Do-Study-Act cycles. Key drivers included access to device, timely identification of patients with devices, ease of connection, strong provider coaching, and caregivers and providers who were knowledgeable and motivated in using the device. Interventions focused on increasing distribution of devices, streamlining the scheduling process, establishing a device registry, education for caregivers and providers on using the device successfully, translating materials into common languages, and providing remote Internet connections. The primary outcome measure was the percentage of telehealth visits completed using the remote exam device. The researchers also tracked the number of devices distributed. The active intervention period was June 2021 to December 2021, with continued data collection through April 2022.

The median percentage of telehealth visits using the remote exam device increased from 0% to 43% over the intervention period with non-special cause variation in device utilization in the subsequent four months. The most impactful intervention focused on increasing device distribution.

Quality improvement methods were used to increase the utilization of an in-home remote exam device for CMC.

Pediatric resuscitations involving shock and trauma are rare but they are high-stakes events in the pediatric emergency department (ED). Effective use of point-of-care ultrasound (POCUS) can expedite diagnosis and treatment in such cases. This study aimed to assess the impact of a longitudinal pediatric emergency medicine simulation curriculum and high-fidelity POCUS simulator on residents' clinical practice, comfort level, and motivation to learn resuscitative ultrasound.

This mixed-methods study involved 12 pediatric emergency medicine residents who participated in a 12-month simulation curriculum integrating resuscitative ultrasound. The POCUS simulator was integrated and made available for use during all simulations. Assessment and program evaluation occurred at multiple levels, according to Kirkpatrick's hierarchy, using both qualitative and quantitative methods. The residents were surveyed at baseline, 4, 8 and 12 months. Semi-structured interviews were conducted at the end of the 12-month study period.

Twelve residents participated in 23 simulation cases over the 12-month longitudinal curriculum. The hybrid POCUS simulator was used by participants in 18/23 (78.2%) cases. Comparing pre- and post-curriculum changes, large effect sizes were seen in residents' comfort using ultrasound in resuscitation (including in cases of trauma and undifferentiated shock). Accordingly, the mean number of POCUS scans performed per resident clinically on shift increased from a mean (SD) of 5.7 (± 2.3) scans/month to 12.4 (± 5.1) scans/month. Qualitative analysis highlighted several themes, including the value of simulation for teaching the integration of resuscitative ultrasound in high-acuity low-occurrence events and the effect of repeat exposures to resuscitative ultrasound.

Our study demonstrated that a longitudinal, simulation-based curriculum focused on resuscitative ultrasound increased residents' confidence, their motivation and likelihood of using these skills in the clinical setting. Repeated simulation exposures to resuscitative ultrasound can help participants translate this critical skill into use at the bedside, especially in high-acuity low-occurrence events.

With robotic technology's rapid growth and integration, an urgent need to bridge the educational gap in thoracic surgical training has emerged. This document, a result of consensus among a group of experts in the practice and training of robotic surgery from The Society of Thoracic Surgeons, aims to provide a framework for a standardized national robotic curriculum for thoracic surgery trainees.

The Society of Thoracic Surgeons Task Force on Robotic Thoracic Surgery and Workforce on E-learning and Educational Innovation assembled an expert group with the input of the Thoracic Surgery Director's Association. A focused literature review was performed, and expert consensus statements were developed using a modified Delphi process to address 3 major themes: (1) program expectations, (2) components of training, and (3) assessment and feedback.

A consensus was reached on 12 recommendations. These consensus statements reflect updated insights on developing a standardized robotics curriculum based on the latest literature and current educational experience, focusing on program expectations and educational guidelines to develop an optimal training curriculum.

The expert panel provides several key recommendations to provide a framework for developing a standardized national robotic thoracic curriculum, which would improve resident education and abridge any educational disparity that may exist among programs.

Virtual reality (VR) simulation has been established as an effective method of supplementing traditional surgical training. Learning curves can analyze skill acquisition over time in VR settings. Although previous studies explored learning curves of mastoidectomy performances on single specimen, this study analyzed learning curves on anatomically different virtual temporal bones across three expertise levels (novice, intermediate, and expert).

Thirty participants were divided into three groups: 10 medical students (novice), 10 ear, nose and throat (ENT) registrars (intermediate), and 10 senior ear surgeons (expert). They performed mastoidectomy on eight anatomically different temporal bones on the University of Melbourne Temporal Bone Surgery Simulator. A blinded senior ENT surgeon assessed the final products of the dissections using the Melbourne Mastoidectomy Scale (MMS). Learning curves of MMS scores, number of strokes, average force, drilling time, and total time were compared between groups using Friedman tests. Within-group analyses were conducted with Wilcoxon signed-rank tests.

All performance metrics showed significant differences across all groups. Only comparison between intermediate and expert groups for average force was not significant. Within-group analyses showed significant differences in expert group for total and drilling time, intermediate group for average force, and novice group for total time. Individual learning curves of intermediate group demonstrated varied learning behavior.

Trainee performance was not seen to reach the level of experts after eight repetitions on anatomically different specimens. Enhancing training with individualized feedback and increased repetitions may optimize skills acquisition.

Transitions during the careers of surgical trainees and surgeons may be associated with risks that have the potential to negatively impact delivery of safe and effective patient care and the professional standing of individuals involved in delivering care. Simulation-based education interventions that address specific needs during the transitions can be very helpful in mitigating the risks. These interventions should be based on contemporary educational frameworks and strategies relating to teaching, learning, and assessment. Simulation-based education programs should be used to address the broad range of cognitive, technical, and nontechnical skills, and highly individualized educational interventions, such as preceptoring, proctoring, mentoring, and coaching, employed to yield the best outcomes. The programs should include competency-based or mastery-based methods to ensure that surgical trainees achieve proficiency and surgeons achieve expertise leading to mastery, which should be the aspirational goal for all surgeons. Faculty development is key to supporting these educational endeavors. The American College of Surgeons Division of Education has developed and launched a spectrum of innovative simulation-based education programs that address transitions in the careers of surgical trainees and surgeons. These programs focus specifically on the transition from medical school to surgery residency, transitions during the core period of surgery training, the transition from surgery training to surgical practice, and transitions during the core period of surgical practice. An innovative program to accredit simulation centers has been established and is aimed at developing and implementing effective simulation-based education models, promoting collaboration among simulation educators and across institutions, advancing the field of surgical simulation through scholarship, and training future leaders in surgical simulation. These accredited simulation centers are called American College of Surgeons-accredited Education Institutes. An innovative American College of Surgeons Academy of Master Surgeon Educators has been established to recognize preeminent surgeon educators and engage them in advancing surgical education and providing mentorship to mid-career surgeon educators. Surgical simulation is a major domain of focus for the Academy. The simulation-based education programs of the Division of Education aim to promote excellence in surgery and continue to establish new standards and benchmarks.

The Script Concordance Test (SCT) is increasingly used in professional development to assess clinical reasoning, with linear progression in SCT performance observed as clinical experience increases. One challenge in implementing SCT is the potential burnout of expert reference panel (ERP) members. To address this, we introduced ChatGPT as panel members. The aim was to enhance the efficiency of SCT creation while maintaining educational content quality and to explore the effectiveness of different models as reference panels.

A quasi-experimental comparative design was employed, involving all undergraduate medical students and faculty members enrolled in the Ophthalmology clerkship. Two groups involved Traditional ERP which consisted of 15 experts, diversified in clinical experience: 5 senior residents, 5 lecturers, and 5 professors and AI-Generated ERP which is a panel generated using ChatGPT and o1 preview, designed to mirror diverse clinical opinions based on varying experience levels.

Experts consistently achieved the highest mean scores across most vignettes, with ChatGPT-4 and o1 scores generally slightly lower. Notably, the o1 mean scores were closer to those of experts compared to ChatGPT-4. Significant differences were observed between ChatGPT-4 and o1 scores in certain vignettes. These values indicate a strong level of consistency, suggesting that both experts and AI models provided highly reliable ratings.

These findings suggest that while AI models cannot replace human experts, they can be effectively used to train students, enhance reasoning skills, and help narrow the gap between student and expert performance.

Procedural sedation is practised by a heterogeneous group of practitioners working in a wide array of settings. However, there are currently no accepted standards for the competencies a sedation practitioner should have, the content of sedation training programmes, and guidelines for credentialing. The multidisciplinary International Committee for the Advancement of Procedural Sedation sought to develop a consensus statement on the following: which competencies should medical or dental practitioners have for procedural sedation and how are they obtained, assessed, maintained, and privileged. Using the framework of Competency-Based Medical Education, the practice of procedural sedation was defined as a complex professional task requiring demonstrable integration of different competencies. For each question, the results of a literature review were synthetised into preliminary statements. Following an iterative Delphi review method, final consensus was reached. Using multispeciality consensus, we defined procedural sedation competence by identifying a set of core competencies in the domains of knowledge, skills, and attitudes across physical safety, effectiveness, psychological safety, and deliberate practice. In addition, we present a standardised framework for competency-based training and credentialing of procedural sedation practitioners.

Formative feedback is essential for the optimal development of a physician. The narrative portion of the evaluation is uniquely poised to help guide the resident. However, the quality of the feedback may be highly variable, and evaluators may be hampered by both a lack of formal training as well as time pressures.

To determine best practices in providing narrative feedback for residents.

We conducted a narrative review of the literature around formative feedback in residency using a Pubmed search of articles written in English over the 30 year span 1993-2023.

Several themes were identified. Comments should be specific, both to the task and to the individual. Commentary should also be actionable, rather than a statement of what cannot be changed by the learner. Ideally, the narration should be constructive, and strike the proper tone. There are additional operational items, such as the structure of the evaluation form itself, that may help optimize narrative commentary.

There is limited but compelling evidence that narrative commentary can be improved in educational value by being specific, actionable, constructive, and written with the proper tone. Changes in the evaluation form may optimize quality and improve timing of delivery.

To educate physician trainees using simulation on best management of children with autism spectrum disorder who have neurocognitive and behavioral challenges when experiencing acute illness.

A simulation-based curriculum including baseline assessment, communication techniques, and use of calming resources was developed to educate residents in assessing children with sensory barriers. Traditional simulation and deliberate practice were used to teach this curriculum to second- and third-year pediatric and internal medicine-pediatric residents. Using alternating assignment, residents were placed into 3 groups: deliberate practice, traditional simulation-based debriefing, and control (no simulation training). The residents were assessed on the initial visit, 2 weeks and 4 to 6 months follow-up periods with a sensory assessment tool. Assessment scores were analyzed using a general linear mixed model with random intercept based on Poisson regression to approximate distribution of the total score.

Forty-three residents participated: 46.5% men, 53.5% women. There were 15, 16, and 12 residents in the control, deliberate practice and traditional simulation groups, respectively. Both teaching styles showed improved performance at 2 weeks follow-up. In addition, these groups demonstrated higher performance when compared with the control group. We were able to show that resident physicians were able to learn important principles and retain them during 4 to 6 months follow-up. However, there was not a difference between 2 teaching styles both in improvement and retention.

Simulation education, both deliberate and traditional, can be used to enhance teaching of key components in assessing children with sensory and communication barriers, including those with autism spectrum disorder when presenting with acute illness.

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes.

The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial (n = 1,835 patients; t = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback.

Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics.

FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Debriefing after simulation-based healthcare education (SBHE) is challenging. Educators' debriefing skills are essential to the success of learning. For debriefing skill training, we designed a simulation course with the standardized learner (SL) through video conference. The purpose of this study was to describe the implementation process of the SL simulation course and evaluate its effectiveness on educators' self-confidence and debriefing skills.

This simulation course involved six trainees and two trainers. After watching a 5-minute sample video of SBHE, each trainee conducted their role as a debriefer in this video and the trainer acted as a learner (SL) in this video. Following each simulation, individual feedback by the trainer was immediately implemented. To evaluate the course's effectiveness, trainees' self-confidence questionnaire was collected, and objective structured assessment of debriefing (OSAD) scores were evaluated.

After completing five SL simulation sessions in 2 weeks, the trainees' self-confidence level and OSAD scores improved significantly (estimate=0.114, standard error=0.020, p<0.001, and p=0.006).

This debriefer training course using SL simulation via video conference could improve self-confidence and debriefing skills of trainees. This SL simulation can be used as a new and flexible method for training debriefers.

Clinical reasoning skills are essential competencies for medical students; therefore, effective, evidence-informed teaching methodologies are needed worldwide. This study investigated the benefits of team-based learning (TBL) for developing the skills in medical students.

A mixed-methods sequential explanatory design was used to investigate the effectiveness of TBL for medical students acquiring clinical reasoning skills. The study participants comprised 92 fourth-year medical students at Yokohama City University School of Medicine, participating in TBL sessions that covered 10 major clinical symptoms identified in the core curriculum. Each session lasted 240 min. Before and after the educational intervention, student performance was measured using the script concordance test (SCT) on a 30-point scale, and self-assessed clinical reasoning competency was measured on a 7-point Likert scale. The SCT included pre-tests and post-tests of 30 questions each, with students randomly assigned to one of two test sets. Following the quantitative evaluation, a qualitative content analysis was conducted to explore the advantages of TBL for learning clinical reasoning skills. The analytic categories were set according to the six levels of Fink's taxonomy of significant learning.

Student performance improved significantly after the educational intervention (A test: 16.5 ± 4.4 to 18.7 ± 4.5, p = 0.019; B test: 18.1 ± 3.7 to 19.8 ± 4.4, p = 0.028). After the educational intervention, self-assessed clinical reasoning competency was significantly higher in "recalling appropriate physical examination and tests on clinical hypothesis generation," "recalling appropriate differential diagnosis from patient's chief complaint," "verbalizing points that fit/don't fit the recalled differential diagnosis appropriately," "verbalizing and reflecting appropriately on own mistakes," "selecting keywords from the whole aspect of the patient," and "practicing the appropriate clinical reasoning process" (all p < 0.001). The content analysis extracted 23 subcategories and 233 codes of the advantages of TBL for learning clinical reasoning skills, covering all six levels of Fink's taxonomy of significant learning: Foundational knowledge (7 codes); Application (40 codes); Integration (69 codes); Human dimension (89 codes); Caring (8 codes); and Learning how to learn (20 codes).

This study demonstrates that TBL supports the acquisition of critical clinical reasoning skills among medical students.

Bovine practitioners expect new graduates entering clinical practice to be able to place a caudal epidural. Teaching this task on models facilitates scheduled training sessions and sufficient practice to reach competency. This study sought to create and validate a bovine caudal epidural model and scoring rubric using a framework of content evidence, internal structure evidence, and relationship with other variables evidence. Veterinarians (n = 11) and students (n = 40) were video recorded while placing a caudal epidural on the model. Recordings were scored by a blinded rater. Participants completed a survey evaluating the model's features, ease of use, and anticipated best use. Veterinarians reported that the model was helpful for students to learn and practice the task and that the model had sufficient landmark features and realism (content evidence). Rubric scores achieved acceptable internal consistency after one item was dropped (α = .736; internal structure evidence), and there was no significant difference between veterinarians' and students' performance scores on the model (relationship with other variables evidence). Survey feedback indicated the task on the model was simple, allowing students to achieve scores similar to those of veterinarians. Therefore, the model and rubric were not able to be validated using this study's validity framework. However, there are simple clinical skills models used in veterinary education and other health care fields, and research suggests that learning does take place on these models. Educators must consider whether simple models that are helpful for students to practice their skills may still have value, even if they are not able to be validated.

The benefits of the totally laparoscopic right hemicolectomy have been established, but its adoption has been limited by the challenges of intracorporeal suturing. While simulation is effective for training advanced surgical skills, no dedicated simulation-based course exists for intracorporeal ileo-transverse anastomosis (ICA). This study aimed to develop and validate a simulation module for training in ICA.

This study employed a proof-of-concept design for an educational tool. Key aspects of the anastomosis were identified using the team's surgical experience, surgical videos, and existing evidence. Surgeons were recruited to test and refine successive simulation models through an iterative process until a functional prototype was achieved and assessed. Subsequently, surgeons with varying experience levels were invited to perform an ICA in the model. Performance was evaluated by two blinded surgeons through video recordings, utilizing a modified Objective Structured Assessment of Technical Skills (OSATS), a Specific Rating Score (SRS), and operative time measurements. Non-parametric descriptive and analytical methods were applied, with results presented as median [IQR].

An ex vivo based model was developed. Seventeen participants evaluated the model. Eighty-three percent declared acceptable or maximum fidelity regarding the colon. Resemblance to the surgical scenario in terms of ergonomic and anatomical similarity was highlighted. All participants found the model useful to train intracorporeal suturing. Thirteen subjects performed the ICA. Experts achieved significantly higher OSATS scores (22.3 [22-22.5] vs 18 [16-19.5]; p = .013), exhibited a trend toward higher SRS, and obtained shorter operative times (21.5 vs 36 min; p = .039).

An ex vivo simulation module for ICA was developed, demonstrating acceptable fidelity in replicating the surgical environment. The simulated scenario could successfully distinguish between levels of surgical experience, as evidenced by significant differences in OSATS scores and operative times, thereby confirming its construct validity.

To assess the impact of NRP virtual simulations (eSim™), video or no refresher training, on simulation performance, six months after a provider course; and to evaluate eSim™ acceptability.

In this multi-site randomized controlled trial, NRP providers from four U.S. institutions were randomized to receive refreshers every two months with NRP eSim™, NRP resuscitation video, or no refresher (control). Simulation performance was assessed immediately after an NRP course and six months later.

248 participants completed the baseline simulation and 148 completed the six-month follow-up simulation. The majority (71%) of subjects had a decline in resuscitation skills at 6 months. There were no differences in performance between the study groups, but participants who reported using either the video or eSim™ had less decline in performance at the 6-month follow-up (p < 0.05).

NRP refreshers with either eSim™ or NRP video may mitigate the decline in resuscitation skills after training.

Health professional education stands to gain substantially from collective efforts toward building video databases of skill performances in both real and simulated settings. An accessible resource of videos that demonstrate an array of performances - both good and bad-provides an opportunity for interdisciplinary research collaborations that can advance our understanding of movement that reflects technical expertise, support educational tool development, and facilitate assessment practices. In this paper we raise important ethical and legal considerations when building and sharing health professions education data. Collective data sharing may produce new knowledge and tools to support healthcare professional education. We demonstrate the utility of a data-sharing culture by providing and leveraging a database of cardio-pulmonary resuscitation (CPR) performances that vary in quality. The CPR skills performance database (collected for the purpose of this research, hosted at UK Data Service's ReShare Repository) contains videos from 40 participants recorded from 6 different angles, allowing for 3D reconstruction for movement analysis. The video footage is accompanied by quality ratings from 2 experts, participants' self-reported confidence and frequency of performing CPR, and the demographics of the participants. From this data, we present an Automatic Clinical Assessment tool for Basic Life Support that uses pose estimation to determine the spatial location of the participant's movements during CPR and a deep learning network that assesses the performance quality.

The Burn Therapist Certification (BT-C) was introduced in 2018 to acknowledge occupational therapists (OT) and physical therapists (PT) with specialized knowledge, skill, and experience in the promotion of quality burn rehabilitation. Currently, BT-Cs make up 11.7% of therapists working in burn rehabilitation (n = 39/333). The purpose of this review is to report on the contributions of BT-Cs to organizational leadership of the American Burn Association (ABA) and in the generation of new knowledge through peer-reviewed publications. Despite the small percentage of burn therapists who are certified, they have a disproportionately large involvement in leadership within the ABA and burn research in the Journal of Burn Care and Rehabilitation (JBCR). From 2018 to 2023, BT-Cs have contributed to nearly one-half (n = 26/56) of therapy authored publications in the JBCR and almost one-third (n = 65/202) of accepted abstracts at the ABA annual meeting. Certified burn therapists demonstrate substantial involvement throughout the ABA, including maintaining an 85% membership rate and, on average, serve in 53% (n = 31/59) of the therapy allotted committee positions. Therapist pursuit of certification can have a profound impact on the burn community through publication, leadership, and development of care standards. Although therapists have indicated a desire to pursue certification, barriers related to a lack of association and center support have been identified. The burn community has endorsed certification as a mark of excellence for nurses and physicians. Maximizing the value of a transdisciplinary approach to burn care is also dependent on the excellence of therapies. If the burn community desires improved engagement and contribution from therapies, it should support therapist certification.

To determine if surgical skills instructors' experience and qualifications influence students' learning of small animal ovariohysterectomy on a model (mOVH).

Second-year veterinary students (n = 105).

Students were randomized to three groups, taught by: (1) residency-trained surgeons with over 3 years' experience teaching mOVH, (2) general practitioners with over 3 years' experience teaching mOVH (GP >3), and (3) general practitioners with under 3 years' experience (GP <3). Students completed four 3-h laboratories where they performed mOVH under the supervision of one of the three types of instructors. Students were assessed performing mOVH using a validated 22-item rubric and completed a survey about their experience.

GP <3 group students achieved lower total rubric scores than GP >3 group students (p = .021). Surgeon-taught students' scores did not differ from those taught by GP >3 (p = .685) or GP <3 (p = .052). GP <3 group students were more likely to require remediation than those taught by surgeons (p = .001); there were no differences between the other groups (surgeons vs. GP >3 p = .44; GP <3 vs. GP >3 p = .11). Students reported similar satisfaction with their instruction. Instructors with over 3 years' experience teaching mOVH had better student learning outcomes compared to instructors with under 3 years of experience. While mOVH teaching experience did influence learning, the instructor's completion of a surgical residency did not.

The results of the study indicate a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

This study indicates a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

Surprisingly innovation process based on deliberate practice has rarely been unearthed that might explore the boundary conditions of the eco-friendly deliberate practice and eco-innovation performance relationship. Anchored on the organizational support theory and the social cognitive, the current study seeks to investigate the impacts of perceived organizational support (POS) and developmental leadership (DL) on eco-innovation performance (EP) through the mediating role of eco-friendly deliberate practice (EDP). In addition, the study explores the boundary effects of employee resilience (ER) on the relationship between EDP and EP. The study collects time-lagged (i.e., "three-wave") and multisource (i.e., "self-rated and supervisor-rated") data from 383 respondents working in the service sector organizations in Pakistan. The authors processed data in SmartPLS (v 4.0) to assess the measurement model and the structural model. The study finds that POS and DL have significant positive relationships with EDP. Further, EDP partially mediates the links between POS, DL, and EP. Moreover, ER intervenes the association between EDP and EP such that at high levels of ER, the relationship is stronger and vice versa. Despite growing interest in deliberate practice, the boundary conditions of EDP in the work context are rarely investigated. This is the first study that explores the contextual and individual factors that can underpin the influence of EDP on EP.

Surgical skills training is often conducted using a massed approach. However, using a distributed training schedule may have benefits and increase skill retention. This study aimed to review the evidence for distributed training vs. massed training and recommend how surgical training should be scheduled.

A systematic review was performed in three databases (MEDLINE, Web of Science, and EMBASE). Two authors screened the articles for inclusion according to the eligibility criteria. Data were extracted for each article, including general information, intervention, outcome, etc. A qualitative synthesis was performed, and the Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality.

Of 12,088 potential studies screened, 28 were included in the final synthesis. Nineteen of the studies directly compared a distributed and a massed schedule, and thirteen studies combined the massed vs. distributed with various distributed training schedules or only investigated different types of distributed schedules. Of the 19 studies which compared distributed and massed training, 15 found a positive effect of distributed training, and no studies found massed training to be superior. Of the 13 that compared different types of distributed schedules, 6 found a positive effect for one of the distributed schedules, while the remaining 7 studies found no difference between the various training schedules. Only 1 of the 28 studies examined training during different times of the day.

Distributed training is superior to massed training. The optimal distributed schedule seems to be with shorter intervals between sessions. The recommended schedule is one session per day, lasting a maximum of 2 h.

Operating room (OR) sterility and proficiency are paramount in medical education, yet a standardized curriculum remains elusive. This study investigates the impact of an OR skills training workshop, led by students and supervised by OR staff, on third-year medical students' confidence and comfort in the OR setting. Third-year students at Quillen College of Medicine in Johnson City, Tennessee, participated in pre- and post-workshop surveys assessing comfort levels with key OR procedures. The workshop facilitated practice in a low-pressure environment, enhancing students' confidence significantly across six fundamental OR skills (p < 0.05). Strengths of the workshop included facility tours, hands-on practice, and mentorship by OR staff, while recommendations focused on smaller group sizes and additional skill coverage. Ongoing data collection aims to assess the workshop's long-term impact on clerkship experiences. This study underscores the importance of structured curriculum enhancements in surgical medical education.

To promote public speaking skills, a pediatrics residency program developed a longitudinal public speaking curriculum grounded in deliberate practice and reflective practice.

Residents delivered annual presentations and received formal feedback. Audience evaluation forms from 2005 to 2017 were included for analysis. The form used five-point scales (5 =best) for specific presentation elements (clarity, eye contact/body language, pace, succinct text, minimally distracting delivery, clear conclusion, appropriate learning objectives, achieving learning objectives, and answering questions) and for overall quality. Longitudinal changes in scores were analyzed with paired t tests.

Overall, 5771 evaluations of 276 presentations given by 97 residents were analyzed. Between post-graduate year (PGY)-1 and PGY-3 presentations, mean overall rating increased from 4.38 to 4.59 (P < .001, d=0.51). The median percentage of five-point scores increased from 50.0% (IQR, 24.3%-65.4%) to 72.5% (IQR, 53.3%-81.2%). Eight of nine specific elements showed significant increases (median effect size 0.55). Residents whose initial presentations ranked in the bottom quartile had larger improvements than residents initially ranked in the top quartile.

After pediatric residents participated in a public speaking curriculum with targeted objectives, formal feedback, and repeated practice, their public speaking skills improved. Public speaking curricula can and should be adopted more broadly in graduate medical education.

Point-of-care ultrasound (POCUS) enhances diagnostic accurate, reduces time to diagnosis, and improves patient satisfaction. Competenties encompass indications, image acquisition, interpretation, and medical decision-making. Education involves didactic methods and hands-on practice with emphasis on longitudinal training and feedback. Assessment tools target knowledge, psychomotor, attitudinal domains. POCUS portfolios and quality assurance ensure competence and continued overarching POCUS oversight and feedback. Scan numbers are often used as a surrogate for competency; however, it is important to note that learning curves vary by POCUS application. Proper POCUS use requires understanding its diagnostic power and potential limitations. POCUS indications vary by clinical scenarios and beneficial applications for training and credentialing vary by medical niche. This text underscores the importance of standardized training and evidence-based practices in POCUS utilization.

Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities.

After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities.

We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations.

We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.

Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning.

A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors.

Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated.

All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.

The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.

In this retrospective case series, we present data from a quality improvement initiative aimed at integrating available evidence for bedside tunneled dialysis catheter placement with electrocardiograph (ECG) tip positioning, to expedite care, improve patient safety outcomes, and reduce healthcare costs associated with the procedure.

Most patients in the study had end-stage renal disease (59%) or acute kidney injury (37%) and were receiving placement for the first time (91%). The right jugular vein was cannulated in 84% of the placements and rates of post-insertion complications were <1%, regardless of the vessel cannulated. Performing bedside tunneled dialysis catheter placement resulted in a cost savings of $385,938.76 over a 2-year period.

The placement of ultrasound guided tunneled dialysis catheters at the bedside following a pre-procedural evaluation of the right jugular, brachiocephalic, and femoral veins is a safe option resulting in expedited patient care, decreased resource utilization, and significant cost savings. Non-bedside techniques performed in interventional radiology, or the operating room should remain a consideration for patients requiring left sided venous access, signs of central stenosis, a history of multiple tunneled catheters, or patients requiring moderate sedation outside of the ICU.

Students in STEM know well the stress, challenge, and effort that accompany college exams. As a widely recognizable feature of the STEM classroom experience, high-stakes assessments serve as crucial cultural gateways in shaping both preparation and motivation for careers. In this essay, we identify and discuss issues of power around STEM exams to further the understanding of exam practices that can unjustly hold students back. Through theory and practical examples, we consider the numerous ways in which power manifests both on and off the pages of the exams themselves, as well as ways in which power is consolidated away from students through logistical norms and tradeoffs. Centering the "rules of the culture of power" as delineated by Dr. Lisa Delpit, we reflect on exam practices that prioritize faculty voice and faculty convenience above student learning and student identity. We share some of what we have learned from our students as part of a call to improve STEM education by relinquishing some of our exam-related power over students, redistributing it to students so that they have more power to shape their own education.

Clinical skills are traditionally taught face-to-face with a focus on hands-on learning. The COVID-19 pandemic forced institutions to adjust their teaching and assessment. This project investigated how veterinary schools adapted clinical skills teaching and assessment, and identified resulting changes and innovations that will progress clinical skills teaching in the future. An online survey was developed and disseminated using QuestionPro. The survey was written in English, translated into French, Spanish and Chinese to encourage international participation, and was open from December 2021 to May 2022. Data were analyzed descriptively and using thematic analysis. Responses came from 91 institutions from 48 countries. During COVID-19, most institutions (70.3%) used a combination of face-to-face and synchronous online classes. Classes were cancelled at certain times by 50.5% of institutions. Almost all institutions (92.3%) provided additional support, including self-directed online learning (e.g., flipped classroom), packs of equipment for students to use at home, online peer tutoring and 'bootcamp' or catch-up sessions. Three themes were identified for beneficial changes to clinical skills teaching that will be kept: the use of the flipped classroom, students having equipment at home for practice and smaller group sizes where possible. During COVID-19, 86.8% of institutions made changes to clinical skills assessments. The use of videos for assessments was identified as a benefit that some institutions would keep. Significant challenges were experienced by teachers, including a high workload. The pandemic inevitably resulted in changes in clinical skills teaching and assessment, but the experiences gained have potential to result in long-term benefits.

Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner's errors and sets goals to improve performance. The main hypothesis was that using DP for learning would result in faster and/or greater progress than using NP.

The objective of this work was to compare the evolution of the learning curve for clavicle locking plate placement on a sawbone model of a clavicle fracture, by surgical trainees learning via two different methods; NP and DP.

Ten surgical residents, divided into 2 groups of 5, each placed 6 plates. The 6 trials were filmed. The NP group saw an expert video before each placement. The DP group saw this video once and then received personalized advice from the expert for improvement, by analyzing their own video after each subsequent trial. Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-evaluation of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated by heart rate recording, from 0 to 100).

The mean OP at the last trial of clavicle plate placement was 41.8 (NP group) and 48.2 (DP group), with a mean progression from the first to last trials of 0.8 in the NP group, and 5.1 in the DP group. The mean progression in self-evaluation between the first and last trials was 3.4 (NP group) and 4.6 (DP group). The mean progression of the ANI between the first and last trials was -4.5 (NP group) and +5 (DP group).

The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice. The progression in self-evaluated performance was better with deliberate practice, but with a higher stress level.

Deliberate practice is a technique for learning the surgical procedure which complements companionship and experience. It shortens the learning curve and improves the level of performance of surgical trainees.

IV; non-interventional research.

This study aims to assess the effectiveness of training medical students to perform two clinical procedures using unsupervised simulation with remote asynchronous feedback, compared to an intensive workshop with in-person feedback.

Third-year medical students were recruited and randomized into 2 groups: Thoracentesis or paracentesis. Within each group, participants were further randomized into either unsupervised simulation with remote asynchronous feedback (experimental group; EG) or a 2-hour workshop (control group; CG). The EG underwent two unsupervised 20-minute training sessions and received remote asynchronous feedback. The CG had a 2-hour workshop where they received in-person feedback. After training, students were assessed using the objective structured assessment of technical skills (OSATS) scale. Twenty students in thoracentesis and 23 in paracentesis training completed the 2 training sessions with remote and asynchronous feedback, and 30 students for both thoracentesis and paracentesis groups completed the 2-hour workshop.

The EG achieved a significantly higher passing rate than the CG on both procedures (thoracentesis 80% vs. 43%, paracentesis 91% vs. 67%, p-value< 0.05).

The asynchronous educational method allowed EG students to achieve higher performance than CG students. This novel modality allowed students and instructors to train and assess at their own pace.

Castration is one of the most common surgeries performed in equine practice. Veterinary students require deliberate practice to reach competence in surgical procedures including equine castration, but availability of patients limits students' practice opportunities. A recumbent equine castration model was created and evaluated using a validation framework consisting of content evidence (expert opinion), internal structure evidence (reliability of scores produced by the accompanying rubric), and evidence of relationship with other variables, specifically the difference in scores between experts and students. A convenience sample of third-year students who had never performed equine castration (n = 24) and veterinarians who had performed equine castration (n = 25) performed surgery on the model while being video recorded. Participants completed a post-operative survey about the model. All veterinarians (100%) agreed or strongly agreed that the model was suitable for teaching students the steps to perform equine castration and for assessing students' skill. The checklist produced scores with good internal consistency (α = 0.805). Veterinarians performed the castration faster than the students (p = .036) and achieved a higher total global rating score (p = .003). There was no significant difference between groups in total checklist score or individual checklist items, except veterinarians were more likely to check both sides for bleeding (p = .038). The equine castration model and rubric validated in this study can be used in a low-stress clinical skills environment to improve students' skills to perform what is otherwise a challenging field procedure. Model use should be followed with live animal practice to complete the learning process.