Jeffrey J. H. Cheung

The creation of an objective assessment tool for ultrasound-guided regional anesthesia using the Delphi method.

Background and Objectives The assessment of technical skills in ultrasound-guided regional anesthesia is currently subjective and relies largely on observations of the trainer. The objective of this study was to develop a checklist to assess training progress and to detect training gaps in ultrasound-guided regional anesthesia using the Delphi method. Methods A 30-item checklist was developed and then e-mailed to 18 reviewers for feedback. The checklist was modified on the basis of their feedback. This process of iteration was repeated until no further feedback was received, and a consensus was reached on the final composition of the checklist. A global rating scale (GRS) was introduced as a result of the feedback. Results Three rounds of feedback were required to reach consensus on the composition of the checklist and the GRS. The final checklist contains 22 items, and the GRS contains 9 categories. Conclusions Using the Delphi method, a checklist and GRS were developed. These tools can serve as an objective means of assessing progress in ultrasound technical skills acquisition.

A Scoping Review of the Evidence for Teaching Ultrasound-Guided Regional Anesthesia

Abstract A scoping review was performed to assess published evidence regarding how best to teach ultrasound-guided regional anesthesia (UGRA). The literature search yielded 205 articles, of which 35 met the inclusion criteria. Current literature on the topic can be divided into 3 main themes: the development of motor skills, learning and teaching sonoanatomy, and understanding of the requirements for establishing a UGRA education program and evaluation. We discuss the current status and future direction of research on UGRA training.

What we call what we do affects how we do it: a new nomenclature for simulation research in medical education

Rapid technological advances and concern for patient safety have increased the focus on simulation as a pedagogical tool for educating health care providers. To date, simulation research scholarship has focused on two areas; evaluating instructional designs of simulation programs, and the integration of simulation into a broader educational context. However, these two categories of research currently exist under a single label—Simulation-Based Medical Education. In this paper we argue that introducing a more refined nomenclature within which to frame simulation research is necessary for researchers, to appropriately design research studies and describe their findings, and for end-point users (such as program directors and educators), to more appropriately understand and utilize this evidence.

Thrive or overload? The effect of task complexity on novices' simulation-based learning.

Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices’ cognitive resources become overloaded.

Preparation With Web-Based Observational Practice Improves Efficiency of Simulation-Based Mastery Learning.

Introduction Our current understanding of what results in effective simulation-based training is restricted to the physical practice and debriefing stages, with little attention paid to the earliest stage: how learners are prepared for these experiences. This study explored the utility of Web-based observational practice (OP) —featuring combinations of reading materials (RMs), OP, and collaboration— to prepare novice medical students for a simulation-based mastery learning (SBML) workshop in central venous catheterization. Methods Thirty medical students were randomized into the following 3 groups differing in their preparatory materials for a SBML workshop in central venous catheterization: a control group with RMs only, a group with Web-based groups including individual OP, and collaborative OP (COP) groups in addition to RM. Preparation occurred 1 week before the SBML workshop, followed by a retention test 1-week afterward. The impact on the learning efficiency was measured by time to completion (TTC) of the SBML workshop. Web site preparation behavior data were also collected. Results Web-based groups demonstrated significantly lower TTC when compared with the RM group, (P = 0.038, d = 0.74). Although no differences were found between any group performances at retention, the COP group spent significantly more time and produced more elaborate answers, than the OP group on an OP activity during preparation. Discussion When preparing for SBML, Web-based OP is superior to reading materials alone; however, COP may be an important motivational factor to increase learner engagement with instructional materials. Taken together, Web-based preparation and, specifically, OP may be an important consideration in optimizing simulation instructional design.

Practising what we preach: using cognitive load theory for workshop design and evaluation

Theory-based instructional design is a top priority in medical education. The goal of this Show and Tell article is to present our theory-driven approach to the design of instruction for clinical educators. We adopted cognitive load theory as a framework to design and evaluate a series of professional development workshops that were delivered at local, national and international academic conferences in 2014. We used two rating scales to measure participantsʼ cognitive load. Participants also provided narrative comments as to how the workshops could be improved. Cognitive load ratings from 59 participants suggested that the workshop design optimized learning by managing complexity for different levels of learners (intrinsic load), stimulating cognitive processing for long-term memory storage (germane load), and minimizing irrelevant distracters (extraneous load). Narrative comments could also be classified as representing intrinsic, extraneous, or germane load, which provided specific directions for ongoing quality improvement. These results demonstrate that a cognitive load theory approach to workshop design and evaluation is feasible and useful in the context of medical education.

A critical narrative review of transfer of basic science knowledge in health professions education

‘Transfer’ is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies.

Performance Assessment of Arthroscopic Rotator Cuff Repair and Labral Repair in a Dry Shoulder Simulator

PURPOSE To evaluate the use of dry models to assess performance of arthroscopic rotator cuff repair (RCR) and labral repair (LR). METHODS Residents, fellows, and sports medicine staff performed an arthroscopic RCR and LR on a dry model. Any prior RCR and LR experience was noted. Staff surgeons assessed participants by use of task-specific checklists, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), and a final overall global rating. All procedures were video recorded and were scored by a fellow blinded to the year of training of each participant. RESULTS A total of 51 participants and 46 participants performed arthroscopic RCR and LR, respectively, on dry models. The internal consistency or reliability (Cronbach α) using the total ASSET score for the RCR and LR was high (>0.9). One-way analysis of variance for the total ASSET score showed a difference between participants based on year of training (P < .001) for both procedures. The inter-rater reliability for the ASSET score was excellent (>0.9) for both procedures. A good correlation was seen between the ASSET score and the year of training, as well as the previous number of sports rotations. CONCLUSIONS The results of this study show evidence of construct validity when using dry models to assess performance of arthroscopic RCR and LR by residents. CLINICAL RELEVANCE The results of this study support the use of arthroscopic simulation in the training of residents and fellows learning arthroscopic shoulder surgery.

Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair

Background: Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills in a safe environment. Purpose: The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 47 participants including orthopaedic surgery residents (n = 37), sports medicine fellows (n = 5), and staff surgeons (n = 5) performed arthroscopic hip labral repair on a dry model. Prior arthroscopic experience was noted. Participants were evaluated by 2 orthopaedic surgeons using a task-specific checklist, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task completion time, and a final global rating scale. All procedures were video-recorded and scored by an orthopaedic fellow blinded to the level of training of each participant. Results: The internal consistency/reliability (Cronbach alpha) using the total ASSET score for the procedure was high (intraclass correlation coefficient > 0.9). One-way analysis of variance for the total ASSET score demonstrated a difference between participants based on the level of training (F3,43 = 27.8, P < .001). A good correlation was seen between the ASSET score and previous exposure to arthroscopic procedures (r = 0.52-0.73, P < .001). The interrater reliability for the ASSET score was excellent (>0.9). Conclusion: The results of this study demonstrate that the use of dry models to assess the performance of arthroscopic hip labral repair by trainees is both valid and reliable. Further research will be required to demonstrate a correlation with performance on cadaveric specimens or in the operating room.

Educational blasphemy? Questioning the (w)holiness of whole-task curricula

Editor – Dr Dolmans’ recently published paper presents some interesting possibilities and advantages to a whole-task curricular approach. It raises critical issues with which medical educators must grapple with respect to resourcing and supporting curricula. However, we argue that the differentiation of the ‘part-task’ and ‘whole task’ presents a false dichotomy for education. Although we agree with Dolmans on the importance of using meaningful representations of real tasks in instruction (and thus in the curriculum), we disagree on how this might be accomplished and question the utility of selecting learning tasks based on their wholeness when designing instruction and curricula.