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Nurse Education Today Jul 2015The problem of nurses' professional identity continues to be seen in the disjunction between theoretical training and clinical placements. Moreover, it is not known how...
BACKGROUND
The problem of nurses' professional identity continues to be seen in the disjunction between theoretical training and clinical placements. Moreover, it is not known how nursing students perceive these contradictions or how this discrepancy influences the construction of professional identity.
OBJECTIVE
To gain insight into nursing students' perception of their theoretical and practical training and how this training influences the process of constructing their professional identity.
DESIGN
Qualitative, ethnographic study.
PARTICIPANTS/SETTINGS
Third-year nursing students at the l'Escola Universitària d'Infermeria Vall d'Hebron de Barcelona.
METHODS
Participant observation was conducted in the hospital setting and primary care. Discussion groups were held. The constant comparative method was used for the analysis. The study adhered to the criteria of credibility, transferability, dependability and confirmability.
RESULTS
Students believed that both theoretical and practical trainings were indispensable. Nevertheless, clinical placements were considered essential to confer sense to the theory and to shape their identity, as they helped student nurses to experience their future professional reality and to compare it with what they had been taught in theoretical and academic classes. The role of the clinical placement mentor was essential. With regard to theory, the skills developed in problem-based learning gave novice nurses' confidence to approach the problems of daily practice and new situations. Equally, this approach taught them to reflect on what they did and what they were taught and this ability was transferred to the clinical setting.
CONCLUSIONS
For students, both strategies (theory and practice) are vital to nursing education and the construction of a professional identity, although pride of place is given to clinical placements and mentors. The skills developed with problem-based learning favor active and reflective learning and are transferred to learning in the clinical setting.
Topics: Attitude of Health Personnel; Clinical Competence; Education, Nursing, Baccalaureate; Humans; Mentors; Nurse's Role; Nursing Education Research; Preceptorship; Problem-Based Learning; Qualitative Research; Social Identification; Students, Nursing
PubMed: 25863650
DOI: 10.1016/j.nedt.2015.03.014 -
World Journal of Urology Jul 2020With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A... (Review)
Review
PURPOSE
With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A growing number of training courses are emerging and some NTS curricula have also been created. Many different training methods are described in the literature but there is still uncertainty with regards to their optimum combination within a curriculum.
METHODS
A literature review of the electronic database Medline was performed. All articles published before December 2018 were screened by abstract and included if deemed relevant by the author. The included articles' reference lists were also screened for further relevant studies.
RESULTS
Simulation training is accepted as the most effective way to train NTS. Within simulation training, it is shown that the 'igloo' full immersion/distributed simulation environment is appropriate for teaching NTS in urological scenarios where a designated operating room or space is not available. The use of multiple settings, for example wards and clinics as well as the operating room, is advantageous, as is training in an interprofessional team. Classroom teaching also plays a role in NTS training as an adjunct to simulation, with evidence that it improves some parameters of NTS. All levels, including qualified surgeons, benefit from NTS training; however, adaptation to both trainee level and specialty is important. Although less time consuming, training juniors and seniors together mainly benefits juniors, and training NTS at the same time as technical skills detracts from the quality of teaching. Debriefing is an important part of training and should be well structured; there are many debriefing models in existence, allowing for choice of method based on examiner preference and participant demographic. Furthermore, examiners should be well briefed in their task and trained in NTS assessment.
CONCLUSION
To move forward, studies should combine tried and tested learning techniques into a curriculum covering all training levels, which should then be validated and followed up long term to ensure a positive impact on patient safety.
Topics: Curriculum; Educational Measurement; Humans; Simulation Training; Urology
PubMed: 31529246
DOI: 10.1007/s00345-019-02920-6 -
Danish Medical Journal Apr 2017When laparoscopy was first introduced, skills were primarily taught using the apprenticeship model. A limitation of this method when compared to open surgery, was that... (Review)
Review
When laparoscopy was first introduced, skills were primarily taught using the apprenticeship model. A limitation of this method when compared to open surgery, was that it requires more time to practise and more frequent learning opportunities in clinical practice. The unique set of skills required in laparoscopy highlighted the need for new training methods that reduce the need for supervision and do not put the patient at risk. Simulation training was developed to meet this need. The overall purpose of this thesis was to explore simulation-based laparoscopic training at home. The thesis consists of five papers: a review, a validation study, a study of methodology, a randomised controlled trial and a mixed-methods study. Our aims were to review the current knowledge on training off-site, to develop and explore validity for a training and assessment system, to investigate the effect of take-home training in a simulation-based laparoscopic training programme, and to explore the use of take-home training. The first paper in this thesis is a scoping review. The aim of the review was to explore the current knowledge on off-site laparoscopic skills training. We found that off-site training was feasible but that changes were required in order for it to become an effective method of training. Furthermore, the select-ed instructional design varied and training programmes were designed using a variety of educational theories. Based on our findings, we recommended that courses and training curricula should follow established education theories such as proficiency-based learning and deliberate practice. Principles of directed self-regulated learning could be used to improve off-site laparoscopic training programmes. In the second study, we set out to develop and explore validity evidence of the TABLT test. The TABLT test was developed for basic laparoscopic skills training in a cross-specialty curriculum. We found validity evidence to support the TABLT test as a summative test in a basic laparoscopic training programme. We also established a credible pass/fail level using the contrasting groups method. We concluded that the TABTL test could be used to assess novice laparoscopic trainees across different specialties and help trainees acquire basic laparoscopic competencies prior to supervised surgery. In the third study, we aimed to explore the consequences of the choice of standard setting method and whether there is a difference in terms of how high a score experienced and novice laparoscopic surgeons expect that novices should achieve during training. We used three different standard setting methods and found that pass/fail levels vary depending on the choice of standard setting method. We also asked experienced and novice laparoscopic surgeons how high a score they expected a novice laparoscopic surgeon should achieve on a test during training. We found a significant difference, with experienced surgeons setting a lower pass/fail level. We concluded that an established standard setting method supported by evidence should be used when setting a pass/fail level. In the first and second papers of this thesis, we found that off-site training is feasible and explored validity for the TABLT test. We used this knowledge in the fourth study to design a randomised controlled trial. The aim of the trial was to investigate the effect of take-home training in a simulation-based laparoscopic course. We hypothesised that training at home could help trainees plan their training according to their own schedule and thereby increase the effect of training. We found that participants had a distributed training pattern; they trained more frequently and in shorter sessions. We also found that participants were able to rate their own performance during unsupervised training and that selfrating was reliable. The fifth and final study of the thesis was a mixed-methods study that aimed to explore the use of take-home training. To meet this aim, we recruited participants from the intervention arm in our randomised controlled trial. All participants had access to the simulation centre and were given a port-able trainer to train on at home. Participants were asked to use a logbook during training. At the end of the course, they were invited to take part in focus group interviews and individual interviews. Based on data from logbooks, a descriptive statistical analysis was conducted and data from interviews were analysed using a content analysis. We found that participants took an individualised approach to training when training at home. They structured their training according to their needs and external requirements. We concluded that mandatory training requirements and testing help determine when and how much participants train. We also found that self-rating can guide unsupervised training by giving clear goals to be reached during training. From the papers included in the thesis, we found that the literature describes training at home as a feasible method of acquiring laparoscopic skills. Nonetheless, changes to current training programmes are needed in order to make this method effective. We then developed and explored validity evidence for the TABLT test. We also established a reasonable pass/fail level and went on to explore the immediate consequences of the pass/fail level. Using our knowledge from the review, we conducted a randomised controlled trial and a mixed-method study. Based on these studies we found that training at home allows for distributed learning, that self-rating guides unsupervised training, and that mandatory training requirements and testing strongly influence training patterns. Access to training, guidance during training, and mandatory training requirements will make take-home training not just feasible but also effective.
Topics: Clinical Competence; Computer Simulation; Curriculum; Education, Medical; Humans; Laparoscopy; Models, Educational; Program Development; Program Evaluation
PubMed: 28385174
DOI: No ID Found -
JPMA. the Journal of the Pakistan... May 2020Apprentice-mentor is the traditional method for training surgical residents, but with the advent of time, advanced techniques have been developed to train residents.... (Review)
Review
Apprentice-mentor is the traditional method for training surgical residents, but with the advent of time, advanced techniques have been developed to train residents. Simulation training is a time-effective method for training residents and is being used globally, but the majority of training hospitals in Pakistan have been practising apprenticeship model since it came into being. This review was planned to demonstrate the results of studies comparing the efficacy of trainees trained via the traditional apprenticeship model versus simulator-based training. Pubmed and Google Scholar were searched. Keywords used were 'simulation-based training', 'laparoscopic simulators' and 'surgical teaching methods'. Articles published between 1995 and 2017 were selected for review. The search was limited to articles published in English language. The review advocates implementation of simulation for training as well as assessment. This can be a magnificent step towards upgrading our healthcare system.
Topics: Computer Simulation; General Surgery; Humans; Internship and Residency; Models, Educational; Pakistan; Simulation Training; Teaching
PubMed: 32400750
DOI: 10.5455/JPMA.282116 -
Anesthesiology Clinics Dec 2021Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of... (Review)
Review
Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.
Topics: Anesthesiology; COVID-19; Clinical Competence; Female; Humans; Obstetrics; Pandemics; Patient Simulation; Pregnancy; SARS-CoV-2; Simulation Training
PubMed: 34776102
DOI: 10.1016/j.anclin.2021.08.001 -
Annals of Global Health Aug 2018Education and training in Occupational and Environmental Health (OEH) play an important role in building global capacity and contribute to safer working conditions. The...
INTRODUCTION
Education and training in Occupational and Environmental Health (OEH) play an important role in building global capacity and contribute to safer working conditions. The shortage of occupational health professionals, the lack of knowledge and a high number of occupational accidents and diseases stress the demand for providing further education and training in OEH. This need is especially urgent in low and middle-income countries. Three international courses on OEH provide valuable insights on how to develop successful trainings in the field and how to contribute to the creation of healthy and safe workplaces.
METHODOLOGY AND RESULTS
The courses "Global Occupational and Environmental Determinants of Diseases: a multidisciplinary and multicultural approach for prevention" (University of Brescia, Italy), "Advanced International Training Course in OEH" (Chulabhorn Research Institute, Bangkok, Thailand) and "Teaching interventions crossing borders" (Ludwig-Maximillians-Universität, Munich, Germany) offer a unique networking opportunity for health professionals from low-, middle- and high-income countries. Three main characteristics of learning were identified as successful for adult learning in OEH: Interdisciplinary learning allows exchanging skills and knowledge and therefore closes gaps between the several disciplines within OEH. Experiential learning enables participants to reflect on their personal experiences, e.g. through workplace visits. Finally, active learning empowers the learner to take the leading role in the learning process using e.g. problem- or project-based learning approaches.
CONCLUSION
Training and education in OEH should become a higher priority by including it in the standard public health and medical curricula. For this, train the trainer approaches are essential in many countries. Any OEH training should follow the interdisciplinary, experiential and interactive learning approach and should be accessible to participants from all regions.
Topics: Capacity Building; Clinical Competence; Curriculum; Developing Countries; Environmental Health; Germany; Global Health; Humans; Interdisciplinary Communication; Italy; Models, Educational; Needs Assessment; Occupational Health; Occupational Medicine; Problem-Based Learning; Thailand
PubMed: 30835392
DOI: 10.29024/aogh.2328 -
Cardiology in the Young Feb 2022Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of... (Review)
Review
Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution, but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot towards a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists, a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as "technology enhanced learning" may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in the Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.
Topics: COVID-19; Cardiologists; Cardiology; Curriculum; Education, Medical; Humans; SARS-CoV-2
PubMed: 33843546
DOI: 10.1017/S1047951121001645 -
Veterinary Surgery : VS Jul 2022Veterinary minimally invasive surgery (MIS) is rapidly developing, and most surgeons are performing MIS in their clinical practice. The technical skills of presented... (Review)
Review
BACKGROUND
Veterinary minimally invasive surgery (MIS) is rapidly developing, and most surgeons are performing MIS in their clinical practice. The technical skills of presented surgical techniques are increasingly complex. Required training of American College of Veterinary Surgeons (ACVS) surgical residents in soft tissue MIS (laparoscopy/thoracoscopy) are limited to traditional apprentice training. Unfortunately, such training has been found insufficient to create competent MIS surgeons.
AIM OF THE REVIEW
This review discusses development of MIS training for Doctor of Medicine (M.D.) residents in context of veterinary applicability and investigates comparative evidence for how to best train veterinary residents in soft tissue MIS.
CONCLUSIONS
A structured curriculum, with validated tasks and clear training goals have been found imperative for training success. Such a curriculum includes both didactic sessions and manual skills training, with video tutorials and reading material to inform and motivate the residents.
IMPLICATIONS OF KEY FINDINGS
ACVS residents and diplomates may benefit if a MIS curriculum was developed and made available to all training programs.
Topics: Animals; Clinical Competence; Curriculum; Humans; Internship and Residency; Laparoscopy; Minimally Invasive Surgical Procedures; Surgeons; United States
PubMed: 35906954
DOI: 10.1111/vsu.13850 -
Orthopaedics & Traumatology, Surgery &... Dec 2022Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training...
BACKGROUND
Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France.
HYPOTHESIS
Nationwide, SBT is not used to its full capacity for teaching OTS in France, and differences in opinions about SBT may exist between surgeon educators and residents.
STUDY DESIGN
Nationwide questionnaire survey in France.
MATERIALS AND METHODS
We built two specific self-questionnaires then e-mailed them between December 2020 and February 2021 to the surgeon educators who were members of the national university council and to the residents specialising in OTS during the current academic year. The questions were about the 2018-2019 academic year, before the COVID-19 pandemic. Two classes of residents who were still medical students during this period were not included, leaving three classes for the analysis.
RESULTS
The participation rates were 57% (67/117) for the educators and 24% (87/369) for the three classes of residents. Of the 67 educators, 47 (70%) reported being involved in SBT and identified the university (70%) and industry (53%) as the main funders of this teaching modality. The educators indicated that the mean number of SBT laboratories in their region was 1.4±0.9 (range, 0-4). The main types of simulators were saw bones (77%); cadavers (85%); and commercial simulators (74%), notably for the knee (87%) and shoulder (78%). The educators estimated that they had achieved a mean of 33%±23% (range, 0%-100%) of the teaching objectives set out in the OTS curriculum and that the main obstacles were insufficient funding (81%) and lack of time (67%). Only 21% of educators reported conducting SBT research. The residents reported that they accessed SBT via the OTS teaching module (28/87, 32%), local university degrees (23/87, 26%), their hospital department (17/87, 18%), or the industry (15/87, 17%); 25/87 (29%) had never received SBT. On a 0-10 scale (0, completely disagrees; 10, completely agrees), the mean score for SBT effectiveness was 8.6±2.1 for residents and 7.1±3.0 for educators (p<0.001); the corresponding values for the quality of SBT integration in the region were 1.5±1.8 and 3.8±2.6, respectively (p<0.001).
CONCLUSION
SBT is not yet used to its full potential for teaching OTS in France. Insufficient funding and lack of time were identified by the educators as the main obstacles to greater use of SBT. Both the residents and the educators felt that SBT mightbe beneficial for training.
LEVEL OF EVIDENCE
IV, nationwide survey.
Topics: Humans; Clinical Competence; COVID-19; Curriculum; Internship and Residency; Orthopedics; Pandemics; Simulation Training; Surgeons; Surveys and Questionnaires; Traumatology
PubMed: 35688379
DOI: 10.1016/j.otsr.2022.103347 -
Ureteroscopy and cystoscopy training: comparison between transparent and non-transparent simulators.BMC Medical Education Jun 2015Simulators have been widely used to train operational skills in urology, how to improve its effectiveness deserves further investigation. In this paper, we evaluated... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Simulators have been widely used to train operational skills in urology, how to improve its effectiveness deserves further investigation. In this paper, we evaluated training using a novel transparent anatomic simulator, an opaque model or no simulator training, with regard to post-training ureteroscopy and cystoscopy proficiency.
METHODS
Anatomically correct transparent and non-transparent endourological simulators were fabricated. Ten experienced urologists provided a preliminary evaluation of the models as teaching tools. 36 first-year medical students underwent identical theoretical training and a 50-point examination of theoretical knowledge. The students were randomly assigned to receive training with the transparent simulator (Group 1), the non-transparent simulator (Group 2) or detailed verbal instruction only (Group 3). 12 days after the training session, the trainees' skills at ureteral stent insertion and removal were evaluated using the Uro-Scopic Trainer and rated on an Objective Structured Assessment of Technical Skills (OSATS) scale.
RESULTS
The new simulators were successfully fabricated in accordance with the design parameters. Of the ten urologists invited to evaluate the devices, 100% rated the devices as anatomically accurate, 90% thought both models were easy to use and 80% thought they were good ureteroscopy and cystoscopy training tools. The scores on the theoretical knowledge test were comparable among the training groups, and all students were able to perform ureteral stent insertion and removal. The mean OSATS scores of groups 1, 2 and 3 were 21.83 ± 3.64, 18.50 ± 4.03 and 15.58 ± 2.23 points, respectively, (p = 0.001).
CONCLUSIONS
Simulator training allowed students to achieve higher ureteroscopic and cystoscopic proficiency, and transparent simulators were more effective than non-transparent simulators.
Topics: Adult; Clinical Competence; Computer Simulation; Cystoscopy; Education, Medical, Continuing; Education, Medical, Undergraduate; Educational Measurement; Equipment Design; Female; Humans; Internship and Residency; Male; Middle Aged; Ureteroscopy; Urology
PubMed: 26032174
DOI: 10.1186/s12909-015-0380-8