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This online survey study examined the most frequently performed and most important clinical procedural skills (CPSs) and location of CPSs training in a sample of 102 primary care nurse practitioners across a 6 state/jurisdiction region of the United States. Results indicated that 7 CPSs were reported as being performed at least once a week by > 30% of participants, and the same 7 CPSs were reported as very important by > 50% of participants. Results facilitate formation of a list of core CPSs for primary care nurse practitioners for standardization of CPSs curricular requirements.

الملخص: أهداف البحث: تم إجراء الدراسة لتقييم التعلم بمساعدة الأقران لتدريس المهارات السريرية في طب العيون لطلاب السنة الثانية من طلاب الطب الجامعيين من خلال زملائهم الأطباء المتدربين. طرق البحث: تم تضمين المتدربين في قسم طب العيون كمعلمين بعد توعية وتقييم أوليين. تم تضمين طلاب المرحلة الجامعية في السنة الثانية كمتعلمين. تم إجراء جلسات للمهارات السريرية المحددة مسبقا على دفعات من 3-5 طلاب متعلمين في كل مجموعة. تم التقييم من خلال إدراك المعلمين والمتعلمين على سلم قياس ليكرت المكون من 5 نقاط (مستوى كيركباتريك -1). تم تقييم المعلمين من خلال المهارات الإجرائية الخاضعة للمراقبة المباشرة، وتقييم المتعلمين من خلال الدرجات قبل وبعد الجلسة وأداء المهارات السريرية ذات الصلة (مستوى كيركباتريك-2). النتائج: استجاب ما مجموعه 21 من 24 معلم و82 من أصل 100 متعلم على استبيان التقييم. يرى المعلمون أنفسهم على أنهم على دراية ومفيدون كمعلمين أساسيين؛ كان هناك تحسن كبير في جلسة المهارات الإجرائية الخاضعة للمراقبة المباشرة الثانية بالمقارنة مع الأولى في جميع المهارات السريرية. وجد المتعلمون أن جلسات التعلم بمساعدة الأقران فعالة لتعلم المهارات السريرية؛ وكان هناك تحسن كبير في درجات ما قبل وبعد الاختبار وتم أداء جميع المهارات السريرية بشكل مرضي في نهاية الامتحان. الاستنتاجات: كان إدراك المتعلمين والمعلمين نحو التعلم بمساعدة الأقران جيدا فيما يتعلق بفعاليتها كطريقة تعليمية للتعلم، وتم تحقيق جميع المهارات السريرية بشكل جيد. يمكن أن يكون التعلم بمساعدة الأقران بمثابة مساعد مفيد للتدريس التقليدي للتدريب السريري للمجموعات الصغيرة، ويمكن أن يساعد في تخفيف ضغوط التدريس على أعضاء هيئة التدريس السريرية المثقلة بالفعل في الكليات الطبية الهندية. Abstract: Objective: This study aims to formally evaluate near-peer-assisted learning (NPAL) for teaching clinical ophthalmology skills to second-year undergraduate medical students through their fellow medical interns. Methods: Interns posted at the department of ophthalmology were included as tutors after an initial sensitization and assessment. Second-year undergraduate students were included as tutees. Sessions were conducted for pre-identified clinical skills in batches of 3–5 tutees each. Perceptions of tutors and tutees were captured on a 5-point Likert scale (Kirkpatrick level-1) and evaluated. Tutors were assessed by directly observed procedural skills (DOPS) and tutees by pre- and post-session scores and performance of the respective clinical skills (Kirkpatrick level-2). Results: A total of 21 of 24 tutors and 82 of 100 tutees responded to the evaluation questionnaire. Tutors perceived themselves as knowledgeable and useful as instructors; scores of second DOPS session significantly improved compared to the first (p = 0.001) for all clinical skills. Tutees found the NPAL sessions effective for learning clinical skills. Pre- and post-test scores significantly improved (p = 0.001), and all clinical skills were satisfactorily performed in the end-of-term exam. Conclusion: NPAL was perceived as an effective teaching-learning method by both tutees and tutors, and all clinical skills were performed successfully. NPAL can serve as a useful adjunct to traditional teaching for clinical training of small groups and can help alleviate teaching pressures on already burdened clinical faculty in Indian Medical colleges.

BACKGROUND Over the past decade, there has been an increase in the number of Vascular Surgery Educational Courses (VSEC) provided by academic institutions, regional and national vascular surgical societies, as well as industry partners. Each course has its own curriculum and how these curricula align with the modern needs of vascular surgery trainees are unclear. As such, there is a lack of unified content, syllabus, and trainee evaluations/feedback of these courses. The Education Committee for the Association for Program directors in Vascular Surgery (APDVS) was tasked to survey vascular surgery Program directors (PDs) and Associate Program directors (APDs) across the country to investigate the educational value, utility, and feedback provided from these VSEC. METHODS A comprehensive list of vascular surgery educational courses across the country was generated. A 21-question survey was constructed and forwarded to all members of APDVS. The survey was directed at obtaining data from the vascular surgery program director/associate program directors about their understanding of the VSEC and what they valued as critical for their trainees. In addition, we sought to gauge the feedback provided by these courses to the vascular surgery trainees, and their PD/APDs. RESULTS The survey was sent to 170 active members of APDVS with an overall response rate of 41%. The majority of the respondents 57 (81%) were PDs. Of all the PD/APDs, 5 (7%) reported that they knew of less than 5 such programs, 26 (37%) reported knowledge of 6-10 courses, 20 (29%) reported 11-20 courses, and 19 (27%) reported knowing more than 20 such programs. 49 (70%) of those surveyed reported that their trainees benefit from these courses. Statisticallysignificant factors impacting the decision to make adjustments to the individual training program included PGY-5 residents attending the educational courses, feedback from VSEC, and positive feedback from trainees attending the courses (all P < 0.05). When asked about their wants of VSEC, 35% desired mock oral exams, and 31% looked for cadaver dissections. Of the 24 PD/APD's who made adjustments to their program based on the feedback from the educational programs, those who held the title for 5-10 years were the most willing to make any changes 13 (54%), and those with more than ten years of experience 2 (8%), were the least willing to make any changes (P < 0.05). The majority of the PD/APDs 32 (46%) felt that the regional societal meetings are the best place to hold educational courses. 38 (55%) of PD/APD's received no feedback from the VSEC course directors. 41 (59%) of the programs provide some financial support for their trainees to attend these courses and 65 (92%) of the PD/APDs suggest that industry partners should provide the financial support for attending VSEC. CONCLUSIONS This unique survey explores the attitude of vascular surgery educators about outside vascular surgery educational courses offered by various groups and industry. It is important to create standardized curricula for vascular surgery educational courses with collaborative oversight by educational/simulation key opinion leaders, PD/APD's, course directors and industry partners. Exploring benchmarks for standardization of the curricula offered by these outside educational opportunities would streamline the needs of our vascular surgery trainees and minimize time away from home institutions. Feedback identifying vascular trainees' strengths and areas for improvement to PD/APDs would be of great educational value and is currently a missed opportunity.

Objective The Surgical Skills and Technology Elective Program (SSTEP) is a one-week, simulation-based procedural skills bootcamp for preclinical medical students. Using cognitive load (CL) as a useful framework for understanding simulation in medical education, our aims were to (1) examine the ability of SSTEP to decrease medical students’ CL during procedural skills training and (2) determine the impact of SSTEP on secondary learning. Methods In this prospective cohort study, twenty SSTEP participants and twenty controls were recruited. CL was assessed during a simple suturing task and a clinical vignette multitasking activity, where participants were required to suture and concurrently listen to a clinical vignette. CL was measured using the validated Subjective Rating of Mental Effort (SRME) and its impact on working memory was assessed using a knowledge test about the clinical vignette. Results Participants reported lower SRME scores while suturing following SSTEP, which persisted at 3 months (p = 0.002) and were significantly lower than controls (p = 0.031). Participants also reported lower SRME scores during the clinical vignette multitasking activity (p = 0.011), despite no improvement among controls (p = 0.63). Participants significantly outperformed controls on the clinical vignette knowledge test (p = 0.02). Conclusions Surgical skills training through SSTEP was associated with lower reports of mental effort and increased performance on secondary learning tasks. Procedural skills bootcamps may better prepare students for the complex learning environments encountered during clinical clerkship.

Rationale and Objectives To determine if deliberative practice with novel ultrasound guidance targeting tasks improves simulated procedural skill. Materials and Methods In a nonrandomized interventional trial first year medical students practiced the previous described dowel and straw targeting tasks 1 hour a week for 4 weeks (training group) or had no training (controls). Afterward, they each performed a simulated amniocentesis (AMN) and chorionic villus sampling (CVS) procedure. Procedures were scored using a global rating scale (GRS) and compared between groups with Mann-Whitney U tests. Two-way random effects intraclass correlation coefficients for the inter- and intra-rater variability were calculated for each item in both GRS's. Results The training group (n = 22) had higher scores on several aspects and overall performance of AMN compared to controls (n = 15). There were no differences between groups for CVS. The inter-rater and intra-rater reliability of the GRS's for both AMN and CVS ranged from 0.16 to 0.89 with most values demonstrating good to excellent agreement. Conclusion This study demonstrates validity evidence in the content and internal structure domains for the AMN and CVS simulators and their accompanying GRS's. Repetitive practice of the targeting tasks improved student performance in simulated AMN, but modifications are needed for it to be relevant to other procedures such as CVS.

We explore the utility of social media platforms as marketing tools in dermatology, providing a summary of how these sites are used by the public and dermatologists alike and demonstrating ways these findings may be applied for professional and business development. Recent studies reveal that 80% of patients use the Internet to acquire medical information, yet only 15% of dermatologists employ social media for professional purposes. Use of social media by patients seeking dermatologic care is overlooked among clinicians who are marketing their practices. Unique advertising niches exist among social media platforms, which must be understood by dermatologists for maximal benefit. Facebook offers the greatest engagement with educational content, YouTube allows dermatologists to demonstrate procedural skills, while the most popular dermatology influencers utilize Instagram for promotion. Ultimately, social media represents an avenue for dermatologists to reach a global audience and garner esteem among physicians and the general public.

In 2010 a mathematics curriculum was introduced in Irish second level schools entitled ‘Project Maths’ (PM). It aimed to refocus second level mathematics teaching and learning away from an over emphasis on procedural mathematics towards problem solving and real understanding [Department of Education and Skills (DES). (2010). Report of the Project Maths implementation support group. https://www.education.ie/en/Publications/Policy-Reports/Report-of-the-Project-Maths-Implementation-Group.pdf]. This paper aims to examine the performance of 1st year undergraduate students’ procedural and problem solving skills after the introduction of PM. A diagnostic test was developed to determine students’ skills in each area and findings demonstrated that students perform statistically significantly better in the procedural skills in mathematics when compared to problem solving skills. These findings raise concerns around the lack of anticipated improved problem solving skills of a cohort of students exposed to this style of teaching and learning. The paper raises discussion surrounding the intended and actual teaching and learning taking place in second level classrooms along with consideration for the potential role of learned helplessness and the literacy issues. Recommendations are made for follow up qualitative research with stakeholders in mathematics education to better understand the ‘why’ of the results presented here.

Changes to surgical training programmes in the UK has led to a reduction in theatre time for trainees, and an increasing reliance on simulation to provide procedural experience. Whilst simulation offers opportunity for repetitive practice, the effectiveness of simulation as an educational intervention for developing procedural surgical skills is unclear.A systematic literature review was undertaken to retrieve all studies describing simulation-based medical education (SBME) interventions for the development of procedural surgical skills using the MEDLINE, PsycINFO, CINAHL, EMBASE and PUBMED databases. Studies measuring skill retention or demonstrating transferability of skills for improving patient outcomes were included in the review.SBME is superior to no training and can lead to improvement in procedural surgical skills, such that skills transfer from simulated environments into theatre. SBME results in minimal skill degradation after 2 weeks, although more significant decay results after90 days. Many studies recruited10 participants, used a variety of methods and were restricted to endoscopic surgical techniques. All studies did not compare interventions with non-SBME teaching methods for developing procedural surgical skills. No studies compared the curriculum design of different surgical training programmes.SBME interventions are effective for developing procedural skills in surgery. SBME interventions are also effective for preventing the decay of procedural surgical skills. Although no studies demonstrate non-inferiority of SBME interventions compared to time in theatre developing skills, SBME interventions do enable the transfer of skills into theatre, and the potential for improving patient outcomes.

Sachin Tushar Patel,1 Syed Shah,1 Rhiya Prem Sood,2 Zohaib Siddiqui,1 Iain McKay-Davies1 1ENT Department, Tunbridge Wells Hospital, Tunbridge Wells, Kent, TN2 4QJ, UK; 2Leeds University School of Medicine, Leeds, LS2 9JT, UKCorrespondence: Sachin Tushar PatelENT Department, Tunbridge Wells Hospital, Tunbridge Wells, Kent, TN2 4QJ, UKTel +447886829357Email s.patel28@nhs.netPurpose: Medical education has faced new challenges with the recent coronavirus pandemic. Traditional teaching methods for face-to-face learning have shifted towards the delivery of digital teaching. The difficulty arises in specialties, such as otorhinolaryngology, where clinical procedural skills are necessary for diagnosis and management. This article aims to determine the impact of a clinical skills video on the confidence of postgraduate ENT trainees when managing nasal fractures.Patients and Methods: Postgraduate ENT trainees completed a baseline questionnaire, declaring their subjective confidence across 5 domains relating to nasal fractures using a 10-point Likert scale. They were then given a lecture, and this questionnaire was repeated. Lastly, trainees were shown a clinical skills video, and the questionnaire was repeated once more. The qualitative data was analysed using Kruskal–Wallis testing.Results: There was poor overall confidence in the management of nasal fractures prior to focused teaching. There was a marked statistically significant (P < 0.01) improvement in subjective confidence following the lecture intervention. There was further statistically significant improvement across all domains following the introduction of the clinical skills video.Conclusion: This study confirms that clinical skills videos are a useful accessible learning tool in medical education. We advocate their use in the postgraduate setting, to mirror their current use in undergraduate medical education.Keywords: confidence, ENT, clinical skills, video, postgraduate

Postgraduate orthopaedic programs for physician assistants (PAs) and nurse practitioners (NPs) number 14 as of 2020. To better understand the characteristics of these programs a census was undertaken. The result is that most programs are 1 year in duration and in 2019 produced 40 graduates. The role of the orthopaedic PA and NP fellow is to gain an understanding of a wide range of musculoskeletal disorders, develop procedural skills, first assist in the operating room, and facilitate management of patients and discharge throughput. PA and NP fellows work alongside categorical orthopaedic physician residents. The number of graduates from PA orthopaedic training programs is estimated at 200, spanning 20 years. The other 11,145 + PAs (99%) are trained on-the-job. For hospital systems, the employment of orthopaedic postgraduate PA and NP fellows provides value through cost management and billable services.

Direct observation of procedure skills (DOPS) is one of the workplace-based assessment methods supposed to be effective in enhancing learning surgical skills of the trainee doctors. Keeping in view the changing scenario in medical training, we undertook the present study to assess feasibility and effectiveness as a learning tool to enhance suturing skills among students and to know the perception of the students and faculty. This study involved 30 surgical trainees who were assessed over a period of 4 months. Assessments were scheduled in operation theatre, and assessors’ observations were recorded, and structured feedback was given before the next session. Assessment continued till desired competency was achieved. Student and assessor response was collected at the end in predesigned questionnaire using 5-point Likert scale. The data was analysed using descriptive and inferential statistics (paired t-test and Friedman test with post hoc analysis). DOPS encounter ranged from 9 to 14 min, and feedback time was 3 to 8 min. 96.6% trainees needed 3 sessions to attain desired competency. The mean time taken for completing the procedural skill reduced with successive DOPS encounters, and the difference was statistically significant (p

The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.

Background The Royal College of Physicians’ Acute care toolkit 8 recommends procedural training for medical registrars at all hospitals. We aimed to determine the interest and need, and to pilot the delivery of such training in the procedures outlined by the Joint Royal Colleges of Physicians Training Board (2017). Methods An online survey was sent to general internal medicine (GIM) trainees within the Thames Valley Deanery in January 2019. This identified a need for procedure skills training. Ninety per cent of trainees felt simulation training would improve their confidence in the outlined procedures. We trialled a simulation programme for GIM registrars between September 2019 and October 2019. Sessions lasted 3–3.5 hours and trainees rotated through four stations. Feedback was obtained from trainees and trainers during each pilot session. Results Thirty-two trainees attended across both sites. Excellent feedback was obtained and trainee confidence improved by visual analogue scale scoring post-training for all procedures. Almost 90% of trainees felt the sessions would improve safety on GIM on calls. Conclusion Simulation training is an effective way to improve trainee confidence in procedural skills and this pilot shows such training is desired and necessitated in higher specialty training. Further work will assess its impact on maintaining trainee skillsets and impact on patient safety.

We establish the development of a unique immersive clinical skills bootcamp for third-year medical students, with formal teaching under five key themes: procedural skills day, examinations, imaging, data interpretation and prescribing. Lastly a simulation event was developed to allow the participants to bring the different themes together, in order to successfully manage an acutely unwell patient for their stage of learning using the newly learnt skills. A 4-week bootcamp was developed and delivered to students. A curriculum was developed based on student's precourse answers to specific questions. Pre and post bootcamp questionnaires were used to assess participants confidence and knowledge using a 5-point Likert scale. A combination of objective structured examination, didactic lectures and group-based discussions were utilised. Tutors' teaching performance was also analysed. A focus group was held post bootcamp. Bootcamp was delivered to 15 students. Feedback was overwhelmingly positive. Students were more confident in all of the five key domains post bootcamp. All students feel more equipped to take opportunities that arise on medical wards as a result of the skills learnt. Participants were receptive to the combination of teaching methods used. All students would recommend this course to their peers. Early-year clinical students successfully received an immersive goal-directed course with formal teaching. The near-peer teaching model improved participants educational experience. We were able to successfully demonstrate that near-peer teaching is effective when it is goal directed, and further when it addresses areas of medical education whereby there is a disparity in the formal teaching available.

In this paper, we extend the notion of noticing during the planning of a lesson to examine what and how teachers notice concerning the affordances of typical problems, such as examination-type or standard textbook questions. Teachers in examination-oriented educational systems generally use these types of problems to develop procedural skills. However, the affordances of such problems for developing conceptual understanding have been largely untapped. Here, we present an exemplifying case of a mathematics teacher, Alice, who used typical problems effectively in her classroom to deepen students’ understanding of mathematics. We argue that Alice productively noticed the affordances of these typical problems beyond their usual use, and we suggest recommendations for supporting mathematics teachers in providing high-quality learning experiences for all students.

Aim: To describe work place based assessment (WPBA) and their possible application in dental education- an overview. The dental students need to develop and master the clinical procedural skills in preclinical and clinical postings. The dental education imparted to these students is from cognitive as the psychomotor domain. Going through the curriculum of the dentistry at undergraduate and post graduate level, the students have to master the complex procedural skills. Can we take their formative assessment as workplace-based assessment? The WPBA is performed in clinics with real patients. Workplace-based assessments target the highest level of the Miller’s pyramid by collecting information about how doctors perform in their normal practice and how they behave in their real life on a day-to-day basis. WPBA help in evaluating students, from all aspects the cognitive, psychomotor, communication skills, management and professionalism. The formative assessment systems being used today are taken in clinics in all clinical subjects, but they are not structured. Norcini JJ in his article on work place based assessment described various assessments in working place. These include mini-CEX, CEC, CWS, BPE, DOPS, CbD, MSF(360 0 ). Although awareness of these techniques is increasing, very few dental faculties from various dental schools have carried out the studies of these WPBA. This article is aimed at detailing the various WPBA methods available. The author has searched the literature for articles describing these techniques to concise these. These are used in medical education in few institutes as per literature. This overview of WPBA will help the dental educators to utilize these WPBA in their institutes. Conclusion: This article reviewed the WPBA from the literature. The dentistry being a procedure based, the trainees can be benefitted from this formative assessment. The dental education in our country can implement WPBA for the competency of trainees and improved dental health care. Keywords: Work place based assessment, DOPS, Dental education, Three sixty degree assessment.

This article explores high-fidelity simulation in anesthesiology education and provides strategies for its use to improve management of critical events. Educational theories that underlie the use of simulation are described. High-fidelity simulation is useful in teaching technical (diagnostic and procedural) and nontechnical (communication and professionalism) skills, including crisis resource management (CRM) skills. The practice of CRM is fundamental to ensuring patient safety during critical events and to the safe practice of anesthesiology, and its critical elements are presented. A discussion of the use of high-fidelity simulation to learn to combine highly complex procedural skills and CRM is also provided.

Background It is well recognised that medical students need to acquire certain procedural skills during their medical training, however, agreement on the level and acquisition of competency to be achieved in these skills is under debate. Further, the maintenance of competency of procedural skills across medical curricula is often not considered. The purpose of this study was to identify core procedural skills competencies for Australian medical students and to establish the importance of the maintenance of such skills. Methods A three-round, online Delphi method was used to identify consensus on competencies of procedural skills for graduating medical students in Australia. In Round 1, an initial structured questionnaire was developed using content identified from the literature. Respondents were thirty-six experts representing medical education and multidisciplinary clinicians involved with medical students undertaking procedural skills, invited to rate their agreement on the inclusion of teaching 74 procedural skills and 11 suggested additional procedures. In Round 2, experts re-appraised the importance of 85 skills and rated the importance of maintenance of competency (i.e., Not at all important to Extremely important). In Round 3, experts rated the level of maintenance of competence (i.e., Observer, Novice, Competent, Proficient) in 46 procedures achieving consensus. Results Consensus, defined as > 80% agreement, was established with 46 procedural skills across ten categories: cardiovascular, diagnostic/measurement, gastrointestinal, injections/intravenous, ophthalmic/ENT, respiratory, surgical, trauma, women’s health and urogenital procedures. The procedural skills that established consensus with the highest level of agreement included cardiopulmonary resuscitation, airway management, asepsis and surgical scrub, gown and gloving. The importance for medical students to demonstrate maintenance of competency in all procedural skills was assessed on the 6-point Likert scale with a mean of 5.03. Conclusions The findings from the Delphi study provide critical information about procedural skills for the Clinical Practice domain of Australian medical curricula. The inclusion of experts from medical faculty and clinicians enabled opportunities to capture a range of experience independent of medical speciality. These findings demonstrate the importance of maintenance of competency of procedural skills and provides the groundwork for further investigations into monitoring medical students’ skills prior to graduation.