Craig Nesbitt

Randomized Trial to Assess the Effect of Supervised and Unsupervised Video Feedback on Teaching Practical Skills

BACKGROUND Feedback is a vital component of the learning process; however, great variation exists in the quality, quantity, and method of delivery. Video feedback is not commonly used in the teaching of surgical skills. The aim of this trial was to evaluate the benefit of 2 types of video feedback-individualized video feedback (IVF), with the student reviewing their performance with an expert tutor, and unsupervised video-enhanced feedback (UVF), where the student reviews their own performance together with an expert teaching video-to determine if these improve performance when compared with a standard lecture feedback. METHODS A prospective blinded randomized control trial comparing lecture feedback with IVF and UVF was carried out. Students were scored by 2 experts directly observing the performance and 2 blinded experts using a validated pro forma. Participants were recorded on video when performing a suturing task. They then received their feedback via any of the 3 methods before being invited to repeat the task. RESULTS A total of 32 students were recruited between the 3 groups. There was no significant difference in suturing skill performance scores given by those directly observing the students and those blinded to the participant. There was no statistically significant difference between the 2 video feedback groups (p = 1.000), but there was significant improvement between standard lecture feedback and UVF (p = 0.047) and IVF (p = 0.001). CONCLUSION Video feedback can facilitate greater learning of clinical skills. Students can attain a similar level of surgical skills improvement with UVF as with teacher-intensive IVF.

The role of simulation in the development of endovascular surgical skills

Endovascular trainees in the National Health Service still largely rely on the apprentice-apprenticeship model from the late 19th century. As the scope for endovascular therapy increases, due to the rapid innovation, evolution and refinement of technology, so too do patients’ therapeutic options. This climate has also opened the door for more novel training adjuncts, to address the gaps that exist in our current endovascular training curriculum. The aim of this paper is to present a succinct overview of endovascular simulation, synthesizing the trials and research behind this rapidly evolving training as well as highlighting areas where further research is required. The authors searched MEDLINE and EMBASE for relevant manuscripts on all aspects of endovascular simulation training. A comprehensive Google search was also undertaken to look for any relevant information on endovascular training courses available and any unpublished work that had been presented at relevant scientific meetings. Papers were categorized into the four models: synthetic, animal, virtual reality and human cadaver, and separate searches for evidence of skill transfer were also undertaken. Authors of novel research projects were contacted for further details of unpublished work and permission granted to report such findings in this manuscript.

Maintenance of Hemodialysis Vascular Access and Prevention of Access Dysfunction: A Review

BACKGROUND Current Renal Association guidelines recommend the creation of an arteriovenous fistula as the first choice for hemodialysis access, with artificial grafts kept in reserve. However, maintaining working access comes with significant difficulties, as well as an estimated annual cost to the National Health Service of greater than £84 million. Multiple methods of improving the successful creation of hemodialysis access, improving access maintenance and preventing access dysfunction therefore exist. The aim was to review these methods, including surgical, radiological, and pharmacological techniques. METHODS The literature was reviewed up to March 2016 for reports of surgical, radiological, and pharmacology approaches to improve maturation, maintain function, and prevent dysfunction of arteriovenous fistulas and artificial access grafts. RESULTS Access function has been related to fistula and graft configuration and anastomotic technique. Novel surgical approaches include the use of early-cannulation grafts and biological grafts. Preoperative radiological vessel mapping and access surveillance have both been studied, and once stenosis or thrombosis has occurred, endovascular management techniques for thrombolysis and thrombectomy, along with angioplasty and stenting, are common. Pharmacological trials include the use of antiplatelets, ACE inhibitors, statins, along with perivascular therapies, and other more novel drug targets. CONCLUSIONS The evidence for the strategies that can be used to maintain access function is highly variable, with many small, observational, and retrospective studies. In the future, the more widespread use of early cannulation grafts, hybrid surgical and endovascular procedures, and the further pursuit of both biological grafts and biological perivascular therapies may yield improvements in vascular access function.

Design of a Pulsatile Fresh Frozen Human Cadaver Circulation Model for Endovascular Training

BACKGROUND The objective of this project was to create a model capable of training endovascular skills using a freshly frozen human cadaver (HC). We present the results of our experience creating a cadaveric model for endovascular skills training. We undertook a unique cadaver laboratory-based research project. METHODS We favor a minimally invasive surgical technique with inflow into the right common carotid artery and outflow through the left common femoral and right superficial femoral arteries. Endovascular access was through the right common femoral artery. RESULTS Through this technique, the arch, thoracic, abdominal, and iliac vessels are all accessible. We perfuse the model through an open pulsatile flow circuit at varying rates to maximize angiographic image capture while minimizing cadaveric edema thus expanding the models longevity. CONCLUSIONS A fresh frozen pulsatile human cadaver training model is a feasible and credible training model that has exciting potential for endovascular skills training.

Student Views on the Use of 2 Styles of Video-Enhanced Feedback Compared to Standard Lecture Feedback During Clinical Skills Training.

BACKGROUND Feedback plays an important role in the learning process. However, often this may be delivered in an unstructured fashion that can detract from its potential benefit. Further, students may have different preferences in how feedback should be delivered, which may be influenced by which method they feel will lead to the most effective learning. The aim of this study was to evaluate student views on 3 different modes of feedback particularly in relation to the benefit each conferred. METHODS Undergraduate medical students participating in a surgical suturing study were asked to give feedback using a semi-structured questionnaire. Discrete questions using a Likert scale and open responses were solicited. Students received either standard lecture feedback (SLF), individualized video feedback (IVF), or enhanced unsupervised video feedback (UVF). RESULTS Students had a strong preference for IVF over UVF or SLF. These responses correlated with their perception of how much each type of feedback improved their performance. However, there was no statistical difference in suturing skill improvement between IVF and UVF, which were both significantly better than SLF. CONCLUSION Students have a strong preference for IVF. This relates to a perception that this will lead to the greatest level of skill improvement. However, an equal effect in improvement can be achieved by using less resource-demanding UVF.

Letter in response to Singh et al: A Randomized Controlled Study to Evaluate the Role of Video-based Coaching in Training Laparoscopic Skills.

To the Editor: We congratulate Singh et al1 on their valuable study evaluating video-based coaching to aid training. Indeed, with a shift to fewer working hours2,3 for surgical trainees such technology is going to be vital to enable them to learn and consolidate skills. We commend the authors on the

O7 Direct expert involvement is not required for providing effective video feedback in the acquisition of clinical skills: a randomised trial

Introduction Mounting financial and time pressures on universities and healthcare organisations makes providing individual feedback increasingly difficult. Feedback is an important aspect of the learning process and debate prevails over the most effective delivery method. Video technology is increasingly used to assist in clinical skills teaching. This study aims to compare direct expert feedback (DEF), where a recording of the student’s performance is reviewed with an expert, to unsupervised video feedback (UVF), where a student compares their recorded performance to an expert video, in order to improve feedback provision in clinical skills teaching. Methods A randomised blind trial comparing DEF with UVF to assess performance improvement in simulated cannulation, urinary catheterisation and suturing was conducted at Newcastle Medical School. Each clinical skill was assessed by providing students with a standardised lecture before recording them performance the skill. Students were randomised to DEF or UVF and were recorded re-performing the skill. Two blinded experts scored each anonymised pre- and post-feedback recording using a validated proforma for each clinical skill. Results Seventy-one medical students were recruited. A significant improvement in cannulation scores was noted using UVF compared to scores using DEF (9.5% vs 4.3%, p = 0.44). Students demonstrated a 13.2% improvement in their suturing scores with UVF and a 15.6% improvement with DEF (p = 0.54). Catheterisation scores improved with both feedback modalities (UVF 8.9%, DEF 8.7%, p = 0.96). A significant improvement from baseline scores was demonstrable in every case (p < 0.5). Conclusion Video feedback provides significant improvement in the acquisition of clinical skills in novices. There is no significant benefit from individual expert involvement when utilising video feedback. Providing students with their recorded performance and a standardised expert video allows them to develop clinical skills at their own pace and may ease demand on faculty.

15 Medical students are strategic participants in educational trials

Background Medical educational methods have changed greatly over the last 20 years. Attempts have been made to move towards adopting more evidence-based practices. The challenges associated with recruiting suitable students and guaranteeing equity across the board, and ensuring validity and reliability of the trials, remain numerous. Medical schools may be reluctant to allow students to participate in medical education trials for fear of burdening them. This study aimed to explore the reasons why medical students partake in studies in order to inform future practice. Methodology Medical students at Newcastle Medical School were invited to participate in a study looking at video-enhanced feedback on learning cannulation, catheterisation and suturing. Participants completed a questionnaire with nine questions based on a visual analogue scale on reasons for participating. Free text reasons were also solicited and thematically analysed. Results A total of 72 responses (100%) were received. Thematic analysis revealed students (a) enjoyed practical skills, (b) felt participation would help with exams and long term career aspirations and (c) felt participation was an opportunity to learn a new skill. Pre-clinical students were more likely to attend to learn new skills, while clinical students wanted to improve weak areas or consolidate skills previously learnt (all P < 0.0001, unpaired t-test). Conclusions and recommendations Medical students participate in educational trials for varying reasons, the driving forces of which are a genuine interest in practical procedures as well as the desire to do well in upcoming exams. Medical schools worry about overusing students in educational trials; students, however, have a genuine interest in participation and are able to be strategic. Medical students are a valuable resource in curriculum design and development and should not be overlooked when designing medical educational trials nor when considering inviting them to participate in trials aiming to evidence best practice in medical education.