Nishan Sharma

Surgery 101: evaluating the use of podcasting in a general surgery clerkship.

Background: Provision of learning resources online is rapidly becoming a feature of medical education. Aims: This study set out to determine how medical students engaged in a 6-week clerkship in General Surgery would make use of a series of audio podcasts designed to meet their educational objectives. Methods: Patterns of use and student learning styles were determined using an anonymous survey. Results: Of the 112 students, 93 responded to the survey (83%); 68% of students reported listening to at least one podcast (average number: six). While students reported listening in a variety of time and places, the majority of students reported listening on a computer in dedicated study time. Of the listeners, 84% agreed the podcasts helped them learn core topics, and over 80% found the recordings interesting and engaging. Conclusions: This study demonstrates that podcasts are an acceptable learning resource for medical students engaged in a surgery clerkship, and can be integrated into existing study habits. We believe that podcasting can help us cater to busy students with a range of learning styles. We have also shown that a free online resource developed by one school can reach a global audience many times larger than its intended target: to date, the ‘Surgery 101’ podcast series has been downloaded more than 160,000 times worldwide.

Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis

Summary Background Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the rise of antibiotic resistance globally. We did a systematic review and meta-analysis to summarise the effect that interventions to reduce antibiotic use in food-producing animals have on the presence of antibiotic-resistant bacteria in animals and in humans. Methods On July 14, 2016, we searched electronic databases (Agricola, AGRIS, BIOSIS Previews, CAB Abstracts, MEDLINE, Embase, Global Index Medicus, ProQuest Dissertations, Science Citation Index) and the grey literature. The search was updated on Jan 27, 2017. Inclusion criteria were original studies that reported on interventions to reduce antibiotic use in food-producing animals and compared presence of antibiotic-resistant bacteria between intervention and comparator groups in animals or in human beings. We extracted data from included studies and did meta-analyses using random effects models. The main outcome assessed was the risk difference in the proportion of antibiotic-resistant bacteria. Findings A total of 181 studies met inclusion criteria. Of these, 179 (99%) described antibiotic resistance outcomes in animals, and 81 (45%) of these studies were included in the meta-analysis. 21 studies described antibiotic resistance outcomes in humans, and 13 (62%) of these studies were included in the meta-analysis. The pooled absolute risk reduction of the prevalence of antibiotic resistance in animals with interventions that restricted antibiotic use commonly ranged between 10 and 15% (total range 0–39), depending on the antibiotic class, sample type, and bacteria under assessment. Similarly, in the human studies, the pooled prevalence of antibiotic resistance reported was 24% lower in the intervention groups compared with control groups, with a stronger association seen for humans with direct contact with food-producing animals. Interpretation Interventions that restrict antibiotic use in food-producing animals are associated with a reduction in the presence of antibiotic-resistant bacteria in these animals. A smaller body of evidence suggests a similar association in the studied human populations, particularly those with direct exposure to food-producing animals. The implications for the general human population are less clear, given the low number of studies. The overall findings have directly informed the development of WHO guidelines on the use of antibiotics in food-producing animals. Funding World Health Organization.

Team-based assessment of medical students in a clinical clerkship is feasible and acceptable.

Background: This study describes the development, implementation and evaluation of a team-based, multi-source method of assessment in which students on a clinical clerkship were provided with feedback on their performance as observed by physicians, residents, nurses, peers, patients and administrators. Methods: The instrument was developed by reviewing existing assessment items and by obtaining input from assessors and students. Numerical data and written comments provided to students were collected, internal consistency was estimated and interviews and focus groups were used to determine acceptability to assessors and students. Results: A total of 1068 assessors completed 3501 forms for 127 students. Internal consistency estimates for each assessment form were acceptable (Cronbachs alpha 0.856–0.948). Each student received an average of 188 words of written feedback divided into an average of 26 ‘Areas of Excellence’ and 5 ‘Areas for Improvement’. Interviews revealed that the majority of students and assessors interviewed found the method acceptable. Conclusions: This study demonstrates that a team-based model of assessment based on the principles of multi-source feedback is a feasible and acceptable form of assessment for medical students learning in a clinical clerkship, and has some advantages over traditional preceptor-based assessment. Further studies will focus on the strengths and weaknesses of this novel assessment technique.

Measuring competence in central venous catheterization: a systematic-review

ObjectivesCentral venous catheterization is a complex procedural skill. This study evaluates existing published tools on this procedure and systematically summarizes key competencies for the assessment of this technical skill.MethodsUsing a previously published meta-analysis search strategy, we conducted a systematic review of published assessment tools using the electronic databases PubMed, MEDLINE, Education Resource Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica, and Cochrane Central Register of Controlled Trials. Two independent investigators abstracted information on tool content and characteristics.ResultsTwenty-five studies were identified assessing a total of 147 items. Tools used for assessment at the bedside (clinical tools) had a higher % of items representing “preparation” and “infection control” than tools used for assessment using simulation (67 ± 26% vs. 32 ± 26%; p = 0.003 for “preparation” and 60 ± 41% vs. 11 ± 17%; p = 0.002 for “infection control”, respectively). Simulation tools had a higher % of items on “procedural competence” than clinical tools (60 ± 36% vs. 17 ± 15%; p = 0.002). Items in the domains of “Team working” and “Communication and working with the patient” were frequently under-represented.ConclusionThis study presents a comprehensive review of existing checklist items for the assessment of central venous catheterization. Although many key competencies are currently assessed by existing published tools, some domains may be under-represented by select tools.

Podcasting: a technology, not a toy

Podcasting is not a toy; rather, it is simply a technology that allows for the distribution of information over the internet. Zanussi et al. seem to confuse the message with the medium, forgetting that the same powerful mobile computing technology which can be used for amusement can also be used for more serious purposes. In characterizing podcasting as a ‘‘toy’’, the authors are at risk of overlooking the power of this new technology; similar objections were voiced to the introduction of other information-dissemination technologies such as radio, television and indeed the phonograph. Each of these technologies has been utilized to disseminate educational materials (e.g. the Open University’s use of teaching by television), and it is natural that podcasting is now being used in the same way. Podcasting has been rapidly adopted by educators in many fields including medical education (Lee 2007; Meade et al. 2009), and many of the world’s universities provide access to courses through podcasts available at iTunes University. This technology allows

“Who writes what?” Using written comments in team-based assessment to better understand medical student performance: a mixed-methods study

BackgroundObservation of the performance of medical students in the clinical environment is a key part of assessment and learning. To date, few authors have examined written comments provided to students and considered what aspects of observed performance they represent. The aim of this study was to examine the quantity and quality of written comments provided to medical students by different assessors using a team-based model of assessment, and to determine the aspects of medical student performance on which different assessors provide comments.MethodsMedical students on a 7-week General Surgery & Anesthesiology clerkship received written comments on ‘Areas of Excellence’ and ‘Areas for Improvement’ from physicians, residents, nurses, patients, peers and administrators. Mixed-methods were used to analyze the quality and quantity of comments provided and to generate a conceptual framework of observed student performance.Results1,068 assessors and 127 peers provided 2,988 written comments for 127 students, a median of 188 words per student divided into 26 “Areas of Excellence” and 5 “Areas for Improvement”. Physicians provided the most comments (918), followed by patients (692) and peers (586); administrators provided the fewest (91). The conceptual framework generated contained four major domains: ‘Student as Physician-in-Training’, ‘Student as Learner’, ‘Student as Team Member’, and ‘Student as Person.’ConclusionsA wide range of observed medical student performance is recorded in written comments provided by members of the surgical healthcare team. Different groups of assessors provide comments on different aspects of student performance, suggesting that comments provided from a single viewpoint may potentially under-represent or overlook some areas of student performance. We hope that the framework presented here can serve as a basis to better understand what medical students do every day, and how they are perceived by those with whom they work.

Putting the ghost in the machine: exploring human-machine hybrid virtual patient systems for health professional education

Background: Virtual patient authoring tools provide a simple means of creating rich and complex online cases for health professional students to explore. However, the responses available to the learner are usually predefined, which limits the utility of virtual patients, both in terms of replayability and adaptability. Using artificial intelligence or natural language processing is expensive and hard to design. This project description lays out an alternative approach to making virtual patients more adaptable and interactive. Methods: Using OpenLabyrinth, an open-source educational research platform, we modified the interface and functionality to provide a human-computer hybrid interface, where a human facilitator can interact with learners from within the online case scenario. Using a design-based research approach, we have iteratively improved our case designs, workflows and scripts and interface designs. The next step is to robustly test this new functionality in action. This report describes the piloting and background as well as the rationale, objectives, software development implications, learning designs, and educational intervention designs for the planned study.