Long-Term Skills Retention Following a Randomized Prospective Trial on Adaptive Procedural Training

Abstract

OBJECTIVE Cumulative sum (CuSum) is a real-time proficiency-monitoring tool adapted for simulation-based training. This study’s objective was to investigate long-term outcomes of a double blinded, randomized control trial conducted with medical students assessing CuSum-guided curriculum against volume-based standards. The trial found a nearly 20% reduction in practice time to reach proficiency using the CuSum curriculum but long-term effects of decreased practice volume on proficiency is unknown. DESIGN Prior participants completed a survey assessing confidence, exposure, and feedback at 12 to 18 months following trial completion. They underwent retention testing of suturing, intubation, and central venous catheter placement (CVC), which was video-recorded and assessed by an expert evaluator. Baseline characteristics among repeat subjects were compared using chi-squared tests. Retention and initial trial outcome were compared using paired parametric statistical methods. SETTING The study was conducted at a major tertiary care center and training hospital. PARTICIPANTS Medical students, which completed the initial randomized control trial were eligible for enrollment. A total of 30/46(65%) responded to the survey, whereas 33/46(72%) completed retention testing. RESULTS Average scores and decay in procedural tasks over time for suturing, intubation and CVC were 91.6% (−4.7%), 86.1% (−4.1%), and 76.2% (−14.8%), respectively. Compared to the control group, the CuSum group mean difference in retention evaluation scores was −5.6% (p = 0.12). Confidence was not associated with initial or retention testing performance in any procedural task. Higher confidence was associated with additional exposure to the procedural task in suturing and intubation (p = 0.03 and p = 0.02, respectively). For intubation, higher confidence was reported by participants who received positive feedback (p = 0.01), and those assigned to the volume-based training arm (p = 0.03). CONCLUSION CuSum-guided training was equivalent to conventional training for suturing, intubation, and CVC. These findings importantly suggest medical students can retain competency in invasive surgical tasks with modest decay in proficiency over time regardless of initial training method.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

“…The concept of IM motivation refers to the spontaneous tendency of individuals to explore novel approaches to learn and engage in an activity as it is perceived to be interesting (Ten Cate et al, ; Rosenman et al, ) and satisfying (Melin‐Johansson et al, ). Educators have long recognized the importance of enhancing IM in students toward improving their educational experience (Everly et al, ; Deci and Ryan, ; Ramirez et al, ), since it has been demonstrated to be associated with deep learning (Sinclair et al, ) and improved academic performance (Desy et al, ). Reports have also indicated that students who were intrinsically motivated had higher self‐esteem (Yilmaz et al, ), greater personal control of their lives (Pandey et al, ), and exhibited psychological well‐being (Cook and Artino, ; Raza et al, ).…”

“…It rather involves active involvement of the educator in providing structure to a session (Bernstein and Bhugra, 2011;Hew and Lo, 2018), by directing students along the right learning path (O'Mahony et al, 2016;Ciliberto et al, 2018). It also involves taking definitive steps when sessions do not proceed in the intended direction (Evans and Cuffe, 2009;Emerson, 2017;Ramirez et al, 2018). Therefore, educators need to recognize that autonomy to students only implies a change in the format of teaching, and not the content (Walker et al, 2016;Chen et al, 2017).…”

“…Thus, educators should be prepared to relinquish some control of the classroom (Archer, 2010;Zielezinski and Karlowski, 2015;Woolley and Fishbach, 2018), and realize that they are not the sole providers of knowledge (Evans and Cuffe, 2009;Emerson, 2017) as current students also have access to other sources of information (Magalhães et al, 2012;Min, 2018). It is also important for educators to realize that in the modern educational environment, they are largely the custodians of information (Jordan and Foster, 2016;Ramirez et al, 2018;Riley, 2018), and their role is to guide students in the acquisition and honing of academic knowledge (Dingwall, and Allen, 2001;Evans and Cuffe, 2009;Emerson, 2017;Streilein et al, 2018).…”

“…The two most common and successful approaches in health care education include Task‐Based Learning (TBL) and Project‐Based Learning (PBL). In TBL, the central focus is on completion of the task itself (Ramirez et al, ), which is reliant on proper learning (Bakon et al, ; Persky and McLaughlin, ) and understanding of the material (Brass et al, ). The instructions therefore become an instrument of communication (Eriksson and Wallerstedt ) to help students to complete the task (Lopes et al, ; Brown et al, ), and can be integrated in varying extents into the existing syllabus (Vandewaetere et al, ; Gauer and Jackson, ).…”

Intubation Types among Paramedic and Anesthesia Students

“…There are some limitations to use ETI in prehospital settings, even though EETI is a lifesaving and important procedure to secure the airway. Therefore, appropriate guidelines of ETI indicate that it should be performed by skillful, current, and expert personnel such as paramedics or practitioners [8]. In contrast, such personnel lack due to financial crisis in most of the emergency settings, specifically in rural and suburban areas [9].…”