Simulation-based training for flexible cystoscopy – A randomized trial comparing two approaches

Abstract

Background: Simulation-based training allows trainees to experiment during training and end-of-training tests could increase motivation and retention. The aim of this trial was to determine if a simulation-based training program including directed self-regulated learning and post-testing improved clinical outcomes compared to a traditional simulation-based training program.Methods: A randomized trial was conducted involving 32 participants without prior experience in endoscopic procedures. The intervention group practiced independently in a simulation centre and got a post-test whereas the control group received traditional instructions and demonstrations before being allowed to practice. Three weeks after the intervention the participants performed cystoscopies on two consecutive patients. Clinical performance was assessed using a global rating scale (GRS) with established evidence of validity. Independent samples t-test, Cronbach's α, Pearson's r, and paired samples t-test were used for statistical analysis.Results: Twenty-five participants performed two cystoscopies on patients. There was no significant difference between the two study groups with respect to mean GRS of performance (p ¼ 0.63, 95 % CI; -2.4-3.9). The internal consistency of the global rating scale was high, Cronbach's α ¼ 0.91. Participants from both study groups demonstrated significant improvement between the first and second clinical procedures (p ¼ 0.004, 95 % CI, 0.8-3.5). Eight (32%) and 15 (60%) participants demonstrated adequate clinical skills in their first and second procedure, respectively. Conclusions: No significant differences were found on the clinical transfer when comparing the two programs. Neither of our training programs was able to ensure consistent, competent performance on patients and this finding could serve as an important argument for simulation-based mastery learning where all training continues until a pre-defined level of proficiency is met. Trial registrations: The trial was submitted before enrolment of participants to the Regional Scientific Ethics Committee of the Capital Region which established that ethical approval was not necessary (H-4-2014-122). The trial was registered at Clinicaltrials.gov (NCT02411747).

Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review

“…The studies included first year to sixth year medical students and were published between 2001 and 2020. In terms of the topic or area of study, 53% (34/64) of the studies focused on laparoscopic surgery [ 22 , 24 , 27 , 31 , 35 - 38 , 40 , 41 , 45 - 48 , 50 - 52 , 54 , 56 - 66 , 69 , 78 , 81 - 83 ]; 16% (10/64) on surgery [ 25 , 28 , 53 , 55 , 67 , 68 , 71 , 74 , 76 , 77 ]; 8% (5/64) on orthopedic surgery [ 39 , 42 , 73 , 79 , 84 ]; 8% (5/64) on ureteroscopy [ 30 , 33 , 34 , 80 , 85 ]; 5% (3/64) each on ophthalmology [ 26 , 70 , 75 ] and intravenous cannulation [ 29 , 32 , 72 ], and 2% (1/64) each on endoscopy [ 49 ], colonoscopy [ 23 ], shoulder-joint clinical anatomy [ 44 ], and empathic communication skills [ 43 ].…”

“…Of the 62 studies that reported on participants’ postintervention skills, 11 (18%) reported change score from baseline for the skills outcome [ 25 , 50 , 56 , 58 , 68 , 73 , 76 - 78 , 80 , 85 ] and 1 (2%) reported change score from baseline for the satisfaction outcome [ 68 ]. Regarding retention, 7.8% (5/64) of the studies assessed skills retention at 2-4 weeks after the intervention [ 25 , 31 , 33 , 40 , 83 ]. The remaining studies did not report retention outcomes.…”

The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression

“…In this phase of the selection process 405 records were excluded. The full-texts of the remaining 37 records were assessed for eligibility and 23 records were excluded with the following reasons: 12 records reported an intervention, which was not eligible for inclusion ( Bode et al, 2012 ; Bube, Konge & Hansen, 2017 ; Craven et al, 2018 ; Custers et al, 1999 ; Handley & Handley, 1998 ; Hill et al, 2010 ; Holmes et al, 1998 ; Krautter et al, 2015 ; Liu & Hunt, 2017 ; Velmahos et al, 2004 ; Wirth et al, 2018 ; Yoganathan et al, 2018 ); 8 records used a study design, which was not eligible for inclusion ( Easton, Stratford-Martin & Atherton, 2012 ; Mishra & Dornan, 2003 ; Nikendei et al, 2014 ; Schroder et al, 2017 ; Skrzypek et al, 2018 ; Smith et al, 2019 ; Sopka et al, 2012 ; Tommaso, 2016 ); 2 records were excluded because of missing data ( Archer, Van Hoving & De Villiers, 2015 ; Seymour-Walsh et al, 2015 ) and 1 record did not use the specified primary outcome assessment for procedural skills ( Greif et al, 2010 ). Finally, 14 studies were included into this systematic review.…”

Simulation-based procedure training (SBPT) in rarely performed procedures: a blueprint for theory-informed design considerations

“…It is important to note that we are not exclusively suggesting a ML approach for all procedures; an appropriate pedagogical framework should be linked to the underlying objectives. There is, however, emerging evidence that clinical outcomes between SBPT using traditional instruction compared with demonstration and unsupervised independent practice are not significantly different suggesting a ML approach would be best suited for all procedure-based training to keep learning in line with explicit standards [ 45 ]. Instructional design and deliberate practice (DP) are core components of ML that aid the practical implementation of the framework [ 46 , 47 ] centred around upskilling individuals to a desired standard with task-specific feedback, facilitated by use of a checklist.…”