Introduction: The hidden curriculum is a set of ethical, moral, and value-based teachings communicated to doctors-in-training, providing a basis for their future interactions with patients, peers, and colleagues. The aim of our study is to introduce the concept of the hidden curriculum to a cohort of third-year medical students and to subsequently evaluate their understanding. In particular, we sought to measure and benchmark the degree of hidden curriculum recognition within a Canadian medical education context. With the help of student feedback, we elicited ideas for future directions.Methods: One hundred and fifty-four third-year medical students completing their obstetrics and gynaecology core clinical rotation attended a workshop on the hidden curriculum. Students completed two sets of evaluations; a voluntary anonymous pre- and post-workshop questionnaire evaluating their knowledge and opinions regarding the hidden curriculum, and a mandatory workshop evaluation. Answers to pre- and post-workshop questionnaires were compared using Mann-Whitney U test, and thematic analysis was used to code the students’ comments to identify common themes.Results: A standardized workshop on the hidden curriculum significantly improved students’ understanding and highlighted the importance of the hidden curriculum. Voluntary student comments (N = 108) were categorized according to five themes: 1) Students who were not sensitized to the hidden curriculum (8; 7.4%); 2) students who were sensitized but unaware of the hidden curriculum (12; 11.1%); 3) students who were sensitized and aware of the hidden curriculum (34; 31.5%); 4) comments on teaching methodologies/environment (43; 39.8%); and 5) suggestions for enhancement (11; 10.2%).Conclusions: A simple, cost-effective intervention, such as a workshop, can effectively assess and address the hidden curriculum. Many students are highly sensitized to and are aware of the positive and negative effects of role modeling on their development. The students are calling for similar interventions to be directed at the postgraduate and faculty level.
Electronic consultations were effective at reducing the number of traditional consults requested over 3.5 years. This initiative has potential to reduce current wait times for traditional consultation in Canada and to make the consultation process more effective. The service was feasible and well-received by primary care providers.
Simulation-based educational activities are happening in the clinical environment but are not all uniform in terms of their objectives, delivery, or outputs. While these activities all provide an opportunity for individual and team training, nuances in the location, timing, notification, and participants impact the potential outcomes of these sessions and objectives achieved. In light of this, there are actually many different types of simulation-based activity that occur in the clinical environment, which has previously all been grouped together as “in situ” simulation. However, what truly defines in situ simulation is how the clinical environment responds in its’ natural state, including the personnel, equipment, and systems responsible for care in that environment. Beyond individual and team skill sets, there are threats to patient safety or quality patient care that result from challenges with equipment, processes, or system breakdowns. These have been labeled “latent safety threats.” We submit that the opportunity for discovery of latent safety threats is what defines in situ simulation and truly differentiates it from what would be more rightfully called “on-site” simulation. The distinction between the two is highlighted in this article, as well as some of the various sub-types of in situ simulation.
Distractions in the operating room may have a profound impact on patient safety on the wards. While multitasking in a simulated setting, the majority of residents made at least one unsafe clinical decision. Pager distractions also hindered surgical residents' ability to complete a simulated laparoscopic task in the allotted time without affecting other variables of surgical performance.
High-fidelity TEE simulators are an effective training adjunct for the acquisition of basic TEE psychomotor skills. There was no difference in improvement between the different modalities of instruction. Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct.
This article was migrated. The article was marked as recommended. Preparations for the COVID-19 pandemic required healthcare teams to practice known skills, such as intubation, with renewed consideration for safety, as well as develop new Standard Operating Procedures (SOPs) for health care delivery. In these conditions, translational simulation based-education (SBE) is a well-known tool that supports health care teams to improve the system using design thinking methods such as walkthroughs and team-based simulation. However, the pandemic has introduced two stressors on translational SBE simultaneously. Firstly, the need for rapid upskilling of front-line staff and rapid change to SOPs. Secondly, the need for social or physical distancing at work, such that it quickly became inappropriate for large groups of individuals to practice in-situ SBE and debrief together in close proximity. An educational approach that brings the best of translational SBE while minimizing contact and maximizing experiential learning is needed.Digital learning has been rapidly adopted by much of medical education during the pandemic. Focusing on a strong alignment between learning goals with intended clinical performance change outcomes we sought to leverage a digital education format that allowed for low barriers to adoption, yet supported the experiential, dynamic reality of translational SBE. In the absence of the ability to quickly train large numbers of people due to the need for social distancing, an immersive experience that can only be provided by virtual reality (VR) videos was the next best thing. VR, using 360-degree video, supported the creation of instructional videos from SBE events in the hospital which allow the learner to immerse and explore multiple points within the scenario. We describe how the very act of recording a video assisted in the rapid development of SOPs through translational simulation. We then describe the use of VR to stay true to the spirit of simulation for experiential learning and nearly hands-on training.
In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another. Emotions are also powerful: they guide ongoing cognitive processes in order to direct attention, memory and judgment towards addressing the stimulus that triggers the emotion. This occurs in a predictable way. The purpose of this paper is to present a narrative overview of the research on emotions, cognitive processes and learning, in order to inform the simulation community of the potential role of emotions during simulation-based education.
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