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Surgeons require advanced psychomotor skills, critical decision-making and teamwork skills. Much of surgical skills training involve progressive trainee participation in supervised operations where case variability, operating team interaction and environment affect learning, while surgical teachers face the key challenge of ensuring patient safety. Using a theoretical framework of situated learning including cognitive apprenticeship, we explored teachers' and trainees' beliefs and values about intra-operative training and reasons for any differences. A qualitative case study method was used where five teacher-trainee pairs participating in an observed teaching operation were separately interviewed about the same operation. Thematic analysis of transcribed interviews and observations was performed with iterative refinement and a reflexive approach was adopted throughout the study. We found that in all cases, teachers and trainees had shared recognition of learning about technical skills whereas they differed in three cases regarding non-technical skills such as surgical reasoning and team management. Factors contributing to teacher and trainee satisfaction with the process were successful trainee completion of operation without need for surgeon take-over, a positive learning environment and learning new things. Teaching-learning behaviours observed and discussed were modeling, coaching and scaffolding, while exploration, reflection and articulation were less common. Our study reveals differing teacher and trainee perspectives of some aspects of intra-operative training and surfaces new reasons other than amount of feedback and autonomy given. Factors contributing to different perspectives include teacher and trainee abilities, values and situational influences. Targeted teaching-learning strategies could enhance intra-operative learning.

Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance., (© 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Distributed simulation (DS) is the concept of high-fidelity immersive simulation on-demand, made widely available wherever and whenever it is required. DS provides an easily transportable, self-contained 'set' for creating simulated environments within an inflatable enclosure, at a small fraction of the cost of dedicated, static simulation facilities. High-fidelity simulation is currently confined to a relatively small number of specialised centres. This is largely because full-immersion simulation is perceived to require static, dedicated and sophisticated equipment, supported by expert faculty. Alternatives are needed for healthcare professionals who cannot access such centres. We propose that elements of immersive simulations can be provided within a lightweight, low-cost and self-contained setting which is portable and can therefore be accessed by a wide range of clinicians. We will argue that mobile simulated environments can be taken to where they are needed, making simulation more widely available. We develop the notion that a simulation environment need not be a fixed, static resource, but rather a 'container' for a range of activities and performances, designed around the needs of individual users. We critically examine the potential of DS to widen access to an otherwise limited resource, putting flexible, 'just in time' training within reach of all clinicians. Finally, we frame DS as a 'disruptive innovation' with potential to radically alter the landscape of simulation-based training.

Background: Immersive simulations can enable surgeons to learn complex sets of skills required for safe surgical practice without risk to patients. However, recruiting healthcare professionals to support surgeons training as members of an operating theatre (OT) team is challenging and resource intensive., Aim: We developed a training programme for actors to take on the role of an OT team to support validation studies in a simulated environment. This article describes the evaluation of the programme., Methods: The programme comprised of written materials, video discussion and experiential activities. Evaluation methods consisted of post-simulation interviews and questionnaires with actors and surgeons. Participants were recruited by convenience sampling. Quantitative data were analysed using descriptive statistics and interviews were analysed using thematic extraction., Results: Three actors participated in the programme. Twelve surgeons completed simulations. All data suggest that the training was successful. Actors were perceived as realistic. Suggestions were made to improve training., Conclusion: After a brief training, actors can realistically portray members of an OT team in simulations designed to support surgeon training. This article highlights factors that contributed to success and suggests improvements. Although there are limitations with the study, its findings have relevance to training and assessment that focuses on individual clinician's functioning as a member of an OT team.

Background: High fidelity simulations within the operating theatre (OT) require physical infrastructure and a full OT team. Such teams place heavy demands on clinical service. Research and training programmes in our surgical department were often compromised by the late cancellation of anaesthetists., Aims: This paper describes and evaluates a training programme in which actors were trained as simulated anaesthetists., Methods: The training programme was developed, piloted and implemented in a surgical education programme. Evaluation consisted of interviews with actors after the series of simulations. Surgical participants were not informed that the anaesthetist was an actor until after the simulation when they completed an interview and a 10-point authenticity scale (1 = not at all to 10 = highly authentic)., Results: Three actors played the role of anaesthetists in 34 scenarios with 17 surgeons in simulations of carotid endarterectomy. Although initially anxious about their role, actors found the training programme valuable and came to feel confident. Mean ratings of anaesthetist authenticity was 8.1 (Range 2-10). Surgeons' comments showed that in most scenarios they found the anaesthetist's performance highly authentic., Conclusions: Although this study demonstrates the feasibility of using actors as anaesthetists in high fidelity surgical simulations, there are also limitations. Factors contributing to success included: selective actor recruitment; written training materials; formal OT orientation, audio link between the control room and the actor; the opportunity to rehearse; and, structured observations.

Effective methods for teaching patient-centred interviewing skills are resource intensive. Providing students the opportunity to work in small groups with simulated patients is highly valued and has demonstrable long-term benefits. Expanding cohorts of medical students and diminishing faculty resources led to the implementation of a peer assisted learning (PAL) project in patient-centred interviewing skills. The paper reports the evaluation of a PAL project on student tutors. The methodology included direct and indirect measures of student tutors' skills in facilitation and patient-centred interviewing. The self-report evaluations strongly suggest that participating in a PAL project has substantial benefits for student tutors that included both interviewing and facilitation skills. Objective measures revealed no change in patient-centred interviewing skills after participating in the project. The study concludes that formalizing PAL may tap a valuable resource within the medical school and provide benefits for student tutors. Careful consideration needs to be given to ways in which student tutors are supported before, during and after the project.

Peer tutoring is a potentially valuable resource in higher education. There are few published accounts of the impact of peer tutoring in medical education. College-wide experience of peer tutoring together with difficulties recruiting medical teachers for a communication programme led to the development of a peer-tutoring project. This paper reports the impact on first-year medical students of peer tutoring in patient-centred interviewing. After attending a preparatory workshop, third-year medical students co-facilitated their first-year colleagues in a session:Interviewing a Simulated Patient. First-year students completed written evaluations immediately after the session and two months later randomly selected students were assessed in patient-centred interviews. The impact of the peer-tutoring experience was evaluated by comparing these outcomes for students in groups co-facilitated by peer tutors with those who worked in groups facilitated by medical teachers. The eight learning objectives were completely met by more than 56% of students. However, there were statistically significant differences for four objectives with more students in groups facilitated by medical teachers completely meeting these objectives. Although the seven educational techniques used in the session were rated favourably by all students, two were rated as more effective in achieving the learning objectives by students in groups facilitated by medical teachers. Free-text comments revealed no differences between groups. Two months after the session, there were no differences between students in terms of interviewing skills as rated by trained observers and simulated patients, whilst simulated patients were more satisfied with interviews from students facilitated by peer tutors (p <0.02). Peer tutors can support the acquisition of basic patient-centred interviewing skills in first-year medical students when contributing to one session of a structured programme. First-year students were receptive and willing to learn from their senior colleagues.

The aim of this study was to assess the feasibility of a scenario-based approach to learning minor surgery skills. After learning component technical skills for ellipse excision and wound closure, nurses were provided with an opportunity to integrate these skills with communication skills and contextual factors in a quasi-clinical environment. Feasibility was assessed using observation of procedures and a group interview with participants, simulated patients and tutors. The scenario-based approach to teaching and learning about technical and communication skills proved feasible and was valued by participants in this course on minor surgery. Although all participants expressed anxiety about integrating skills in the quasi-clinical setting, they valued the opportunity to undergo a formative assessment prior to working in supervised settings with real patients. Learners valued highly the opportunity to reflect on their performance and to receive feedback on technical and communication skills. Future courses should include focused teaching on communication skills prior to the scenario-based exercise. Limitations of the study centre on the small numbers of participants and the novelty of the course. Repeating the evaluations on a subsequent course will provide insight into the ways in which nurses acquire and integrate new skills.

Actors are widely used in medical education as simulated patients. In this session, the role of actors was extended to 'simulated students' and facilitators in an introductory communication session. After an initial activity with the entire cohort of first-year students, groups of 20 students worked with either an actor or medical teacher in three activities. The activities aimed to raise students' awareness of the range of communication challenges in medical education and practice. After the session, students completed evaluation forms based on their experiences in the session. The results revealed no difference between students who were facilitated by actors or medical teachers in relation to meeting the learning objectives and their ratings of the usefulness of the activities to support learning. The actors who participated in this session were experienced in working with medical students. Their enhanced role provides students with an opportunity to identify with and reflect on the expertise of a lay teacher and to consider extending their definition of a learning opportunity to more informal encounters.

The article offers some insights into teaching and learning gynecology examination with hybrid simulation. Hybrid simulations involve the combination of simulators with a simulated patient across a range of clinical procedures. Simulated patients help students to integrate the skills needed when dealing with real patients.

Context: Written communications have a long history in medicine. Today, doctors spend a significant part of their work time completing paper work. Although the importance of accurate written communications is acknowledged, medical curricula rarely include focused teaching on this topic. Objectives: The aim of this paper is to assess the feasibility of a teaching session for second-year medical students aimed at raising their awareness of written communications in the context of health care. Methods: Immediately after the session, students and tutors completed written evaluations of their experiences. Four months after the session the entire cohort completed a knowledge test, and scores of attendees and non-attendees were compared. Findings: Three of four learning objectives were completely met by at least half of the students and the exercises were rated as helpful. Students' and tutors' comments identified specific aspects of the session that require improvement, in particular, developing the exercise on patient-centred written communications. Students who attended the session scored significantly higher in a relevant knowledge test than non-attendees. Discussion: The session provided students with the knowledge to identify patient-centred written communications and other features of effective writing in the context of medical care. Conclusions: Introducing the topic early in the medical curriculum may prove valuable in establishing effective practice. Providing students with opportunities to revisit this important topic throughout their medical education may also be beneficial. The long-term impact of the session needs to be evaluated. [ABSTRACT FROM AUTHOR]

Context Performing a clinical procedure requires the integration of technical clinical skills with effective communication skills. However, these skills are often taught separately. Objectives To explore the feasibility and benefits of a new conceptual model for integrated skills teaching. Design A qualitative observation and interview-based study of undergraduate medical students. Methodology Medical students performed technical and communication skills in realistic clinical scenarios (urinary catherization and wound closure), using latex models connected to simulated patients (SPs). Procedures were observed, videorecorded and assessed by tutors from an adjoining room. Students received immediate feedback from tutors and SPs, before engaging in a process of individual feedback through private review of their videotapes. Group interviews explored the response of students, SPs and tutors. Data were analysed using standard qualitative techniques. Subjects Fifty-one undergraduate students were recruited from the Faculty of Medicine, Imperial College, London. Results The scenarios provided a realistic simulation of two common clinical situations and proved feasible in terms of time, facilities and resources within this institution. Students found the opportunity to integrate communication and technical skills valuable, challenging and an appropriate learning experience. Immediate feedback was especially highly valued. Some students found difficulty integrating technical and communications skills, but benefited from conducting two procedures in the same session. Conclusion The integrated model was feasible and was perceived to be valuable. Benefits include the opportunity to integrate, within a safe environment, skills which are often taught separately. Promoting reflective practice may enable the successful transfer of these integrated skills to other procedures. [ABSTRACT FROM AUTHOR]

Reveals a scenario-based technique for medical students where they integrate technical and communication skills in a quasi-clinical setting. Analysis of the need for such a technique; Development of a rating scale; Procedure adopted for the study.

This presentation will explore contemporary approaches to teaching psychomotor skills drawing on evidence and theory from different disciplines. Although I focus on the present, I'll invite participants to reflect on recent history before sharing best evidence that supports the development of psychomotor skills. The origins of contemporary models will be considered briefly such as the 5-level Dave taxonomy with progressive stages of Imitation, Manipulation, Precision, Articulation , and Naturalization. I then move to the work of Sawyer et al (2015) who propose an evidence-based pedagogical framework for procedural skill training using simulation. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skills training in medicine. The 6-step pedagogical framework: Learn, See, Practice, Prove, Do , and Maintain will be illustrated. In the Prove phase, trainees demonstrate competence in simulation prior to performing the procedure on a patient (Do). I'll also make reference to a research programme on simulation-based mastery learning led by McGaghie at Northwestern and the popularized theoretical notion of deliberate practice (Ericsson, 2015). Finally, we'll consider the art (and human) side of teaching psychomotor skills. [ABSTRACT FROM AUTHOR]

Presents a letter regarding an integrated approach to teaching and learning clinical skills for medical students. Questions how students can acquire clinical skills without practicing on patients; Need of technical skill during vaginal examinations; Use of clinical teaching associates.

Informs that a virtual reality (VR) endoscopy device was used to enhance students confidence and experience in performing a medical procedure. Reasons for using VR endoscopy; Methodology of familiarizing students with the VR endoscopy procedure; Number of students participating in the program; Views of students on simulated patient consultation approach.

Abstract: Background: The Integrated Procedural Performance Instrument (IPPI) uses various bench-top models positioned to standardized patients (SP) to recreate realistic clinical encounters. This study assessed the effectiveness of using an IPPI format as a teaching tool for communication skills. Method: Thirty-two participants underwent 2 videotaped IPPI scenarios before randomization into 2 groups—experimental (SP-led feedback) or control (no feedback). Participants then completed 2 further IPPI format scenarios. Videotapes were scored by 2 blinded independent raters using validated assessment scales (communication and technical). Results: The experimental group performed significantly better on the communication scores following feedback compared with the control group (mean 77% vs 66%, P < .05). No difference in scores for technical skills post-intervention were demonstrated (checklist: experimental mean = 64% vs control = 59%, P = .40; global ratings: experimental mean = 66% vs no control = 62%, P = .37). Conclusions: The IPPI is an effective tool for teaching communication skills in residents and medical students and should be considered for incorporation into undergraduate and surgical curricula. [Copyright &y& Elsevier]