Trained student teachers can be as good as associate professors in teaching clinical skills.

Dyad training of pre-clerkship medical students' patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.

Training in pairs (dyad practice) has been shown to improve efficiency of clinical skills training compared with single practice but little is known about students’ perception of dyad practice. The aim of this study was to explore the reactions and attitudes of medical students who were instructed to work in pairs during clinical skills training. A follow-up pilot survey consisting of four open-ended questions was administered to 24 fourth-year medical students, who completed four hours of dyad practice in managing patient encounters. The responses were analyzed using thematic analysis. The students felt dyad practice improved their self-efficacy through social interaction with peers, provided useful insight through observation, and contributed with shared memory of what to do, when they forgot essential steps of the physical examination of the patient. However, some students were concerned about decreased hands-on practice and many students preferred to continue practising alone after completing the initial training. Dyad practice is well received by students during initial skills training and is associated with several benefits to learning through peer observation, feedback and cognitive support. Whether dyad training is suited for more advanced learners is a subject for future research.

Background and purpose — Orthopedic surgeons must be able to perform internal fixation of proximal femoral fractures early in their career, but inexperienced trainees prolong surgery and cause increased reoperation rates. Simulation-based virtual reality (VR) training has been proposed to overcome the initial steep part of the learning curve but it is unknown how much simulation training is necessary before trainees can progress to supervised surgery on patients. We determined characteristics of learning curves for novices and experts and a pass/fail mastery-learning standard for junior trainees was established. Methods — 38 first-year residents and 8 consultants specialized in orthopedic trauma surgery performed cannulated screws, Hansson pins, and sliding hip screw on the Swemac TraumaVision VR simulator. A previously validated test was used. The participants repeated the procedures until they reached their learning plateau. Results — The novices and the experts reached their learning plateau after an average of 169 minutes (95% CI 152–87) and 143 minutes (CI 109–177), respectively. Highest achieved scores were 92% (CI 91–93) for novices and 96% (CI 94–97) for experts. Plateau score, defined as the average of the 4 last scores, was 85% (CI 82–87) and 92% (CI 89–96) for the novices and the experts, respectively. Interpretation — Training time to reach plateau varied widely and it is paramount that simulation-based training continues to a predefined standard instead of ending after a fixed number of attempts or amount of time. A score of 92% comparable to the experts’ plateau score could be used as a mastery learning pass/fail standard.

Early clinical trials of therapies to treat Duchenne muscular dystrophy (DMD), a fatal genetic X-linked pediatric disease, have been designed based on the limited understanding of natural disease progression and variability in clinical measures over different stages of the continuum of the disease. The objective was to inform the design of DMD clinical trials by developing a disease progression modelbased clinical trial simulation (CTS) platform based on measures commonly used in DMD trials. Data were integrated from past studies through the Duchenne Regulatory Science Consortium founded by the Critical Path Institute (15 clinical trials and studies, 1505 subjects, 27,252 observations). Using a nonlinear mixedeffects modeling approach, longitudinal dynamics of five measures were modeled (NorthStar Ambulatory Assessment, forced vital capacity, and the velocities of the following three timed functional tests: time to stand from supine, time to climb 4 stairs, and 10 meter walk-run time). The models were validated on external data sets and captured longitudinal changes in the five measures well, including both early disease when function improves as a result of growth and development and the decline in function in later stages. The models can be used in the CTS platform to perform trial simulations to optimize the selection of inclusion/ exclusion criteria, selection of measures, and other trial parameters. The data sets and models have been reviewed by the US Food and Drug Administration and the European Medicines Agency; have been accepted into the Fit-for-Purpose and Qualification for Novel Methodologies pathways, respectively; and will be submitted for potential endorsement by both agencies.

Background: Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis. Methods: A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list. Results: During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities. Conclusions: The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum. Clinical Relevance: This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology.

in the curriculum are assessed using a variety of methods. For example, assessment of information management competence can be integrated into clinical skills assessments to determine how well students understand the use of information to share decisions with patients. Evaluation of the results or impact A recent pilot test of a comprehensive history and physical examination was conducted in which 106 second-year students participated and 103 gave their permission to report their aggregated scores. Average performance as rated by the standardised patients (SP) was 91% with a standard deviation of 6 points. The high average score may indicate the need for further SP training in order to discriminate student performance better.With the gateway assessment, students will have a better understanding of their skills as well as their knowledge. The same students who do well on traditional knowledge examinations are not necessarily the students who would do well on the new multilevel examinations with communication skills rigorously assessed. We will be able to assess students on areas that the College values, such as communication skills and doctor-patient relations. The College will also be able to identify and monitor student performance deficits it could not previously. Context and setting The medical curriculum at Copenhagen University includes a number of short, mandatory skills training courses in the skills lab at the Centre for Clinical Education. A group of medical students, at present 18, are employed at the skills lab, where they fulfil a dual role as practical assistants as well as instructors or co-instructors in skills training scenarios. The group is self-administering in that it plans, teaches and trains newly hired students. In recent years, this group of students has, on its own initiative, established a number of extracurricular courses, which it offers on a voluntary basis to student peers. The objective structured clinical examination (OSCE) was established at our university only very recently; this report focuses on evaluation of the voluntary courses prior to the implementation of OSCEs.Why the idea was necessary Proper training and assessment of clinical skills have been emphasised repeatedly in several studies demonstrating insufficient competence in this area among students and younger doctors. However, clinical skills training is a time-and resource-demanding teaching modality and incorporating a sufficient amount of skills training into an often heavily packed curriculum is difficult. Furthermore, implementation of skills training can be a strain on the already limited time of clinical teachers and senior clinicians often lack enthusiasm for teaching basic clinical skills. Using medical students as facilitators is therefore an appealing alternative, which in this case has made extracurricular voluntary courses possible. What was done The voluntary extracurricular courses include neurological examination, advanced resuscitation, gastric tube insertion and a combi-course covering suturing, bla...

Background: Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks. Purpose: To explore and compare the effects of basic psychomotor skills training versus procedural skills training on novice surgeons’ subsequent simulated knee arthroscopy performance. Study Design: Controlled laboratory study. Methods: Overall, 22 novice orthopaedic surgeons and 11 experienced arthroscopic surgeons participated in this study, conducted from September 2015 to January 2017. Novices received a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group or a procedural skills training group. Each group performed 2 sessions on a computer-assisted knee arthroscopy simulator: The basic skills training group completed 1 session consisting of basic psychomotor skills modules and 1 session of procedural modules (diagnostic knee arthroscopy and meniscal resection), whereas the procedural skills training group completed 2 sessions of procedural modules. Performance of the novices was compared with that of the experienced surgeons to explore evidence of validity for the basic psychomotor training skills modules and the procedural modules. The effect of prior basic psychomotor skills training and procedural skills training was explored by comparing pre- and posttraining performances of the randomized groups using a mixed-effects regression model. Results: Validity evidence was found for the procedural modules, as test results were reliable and experienced surgeons significantly outperformed novices. We found no evidence of validity for the basic psychomotor skills modules, as test scores were unreliable and there was no difference in performance between the experienced surgeons and novices. We found no statistical effect of basic psychomotor skills training as compared with no training ( P = .49). We found a statistically significant effect of prior procedural skills training ( P < .001) and a significantly larger effect of procedural skills training as compared with basic psychomotor skills training ( P = .019). Conclusion: Procedural skills training was significantly more effective than basic psychomotor skills training regarding improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotor skills modules lacked validity evidence. Clinical Relevance: On the basis of these results, we suggest that future competency-based curricula focus their training on full knee arthroscopy procedures. This could improve future education programs.