Wearable technology and live video conferencing: The development of an affordable virtual teaching platform to enhance clinical skills education during the COVID-19 pandemic Technologie portable et vidéoconférence en direct : élaboration d'une plateforme d'enseignement virtuel abordable pour améliorer l'enseignement des habiletés cliniques pendant la pandémie de la COVID-19

Background: Young people often face barriers to psychiatric care and are increasingly seeking crisis services for mental health issues through the emergency department (ED). Urgent psychiatric care models provide youth in crisis with rapid access to time-limited mental health care on an outpatient basis. This scoping review aims to evaluate the impact of such urgent psychiatric services for youth aged 13-25 on patient and health system outcomes. Methods: We conducted a literature search on PubMed, EMBASE, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews for studies published from inception to November 20, 2020. We included studies that described outpatient psychiatric services designed for youth aged 13 to 25, took place in a clinical setting, and offered any combination of assessment, treatment, and referral. We excluded studies describing suicide intervention programmes. Results: Our search yielded six studies, four of which were descriptive studies and two of which were randomized controlled trials. Most studies found that access to urgent psychiatric care for youth was associated with reduced ED volumes, fewer health system costs, and fewer hospitalizations. None of the studies presented evidence that urgent psychiatric services are associated with improved patient symptomatology or functioning. Conclusions: The results of this scoping review highlight the scarcity of robust evidence evaluating the effectiveness of urgent care for youth mental health. Further experimental studies and a set of standardized quality measures for evaluating these services are needed to bridge this critical gap in mental health care for youth in crisis. Key Practitioner Message• Youth in acute mental health crisis often seek psychiatric care through the emergency department (ED), but this type of care can be resource-intensive and limited in effectiveness. • Urgent care models are being developed to provide short-term, outpatient interventions to youth in mental health crisis who are referred from the ED or primary care. • The presence of urgent psychiatric care for youth may be linked to lower ED volumes, healthcare costs, and hospitalizations. • It is still unclear whether urgent care interventions are associated with sustained clinical improvement in this age group. • Clinicians and researchers may collaborate to develop more rigorous experimental studies and a standardized set of quality measures to assess the effectiveness of urgent care programmes for youth mental health.

Background: Trauma resuscitation skills are an essential part of medical training. Airway management skills are often learned via simulation-based training, but physical distancing restrictions have forced medical schools to transition their preclinical curricula to a virtual format. A wearable, point-of-view (POV), live streaming tool was piloted in a virtual airway management workshop to preclinical medical students to address limitations in the standard online curriculum. Methods: An anesthesiologist instructor donned a chest-mounted smartphone that captured POV video as it was connected to a Zoom video conference call. Simultaneously, a second camera view from a different angle was streamed from a laptop webcam. Preclinical medical student attendees watched the facilitator demonstrate airway management and resuscitation skills on a simulation mannequin. Student perceptions of the workshop were assessed via standardised course evaluations administered through the online student portal and a questionnaire distributed by the course representative. Results: Qualitative and quantitative course evaluation data showed that although this platform may not completely substitute in-person learning, students appreciated the alternative teaching style, particularly the use of POV video and multiple camera views. Generally, students believed that the learning objectives were achieved. Camera stability, camera positioning, and the distracting nature of the virtual student-instructor interactions were identified as areas for improvement. Conclusions: Moving forward, this innovative workshop format can act as a valuable framework for other institutions that wish to bridge gaps in current virtual education methods and enhance technical skills training in medical learners.

Implication Statement We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.