Perception variables in chronic psychophysiolgical insomnia

Interical and ictal dipole modelling in epilepsy surgery candidates

The application of cobalt as a Ca-analogon in nuclear neurology

The use of human cadavers and virtual reality simulation in endovascular training: A questionnaire of patient and professional opinion

Acute stress has been linked to impaired clinical performance in healthcare settings. However, few studies have measured experienced stress and performance simultaneously using robust measures in controlled experimental conditions, which limits the strength of their findings. In the current study we examined the relationship between acute stress and clinical performance in second-year medical students undertaking a simulated ECG scenario. To explore this relationship in greater depth we manipulated two variables (clinical urgency and cognitive load), and also examined the impact of trait anxiety and task self-efficacy. Second-year medical students were asked to conduct a 12-lead ECG on a simulated patient. Students were randomly assigned to one of four experimental conditions according to clinical urgency (high/low) and cognitive load (high/low), which were manipulated during a handover prior to the ECG. As part of the scenario they were asked to describe the ECG trace to a senior doctor over the phone and to conduct a drug calculation. They then received a performance debrief. Psychological stress and physiological stress were captured (via self-report and heart rate, respectively) and various aspects of performance were observed, including technical competence, quality of communication, work rate and compliance with patient safety checks. Trait anxiety and task self-efficacy were also captured via self-report. Fifty students participated. While there was little impact of experimental condition on stress or performance, there was a significant relationship between stress and performance for the group as a whole. Technical competence was poorer for those reporting higher levels of psychological stress prior to and following the procedure. Neither trait anxiety nor task self-efficacy mediated this relationship. This study has provided evidence for a link between acute stress and impaired technical performance in medical students completing a simulated clinical scenario using real-time measures. The implications for patient safety and medical education are discussed.

Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking-derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6-8) vs. 25 (24-25), P = 0.01] performed in less time [563 (408-600) vs. 246 (214-267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.

Temporal bone surgery requires excellent surgical skills and simulation-based training can aid novices' skills acquisition. However, simulation-based training is challenged by early stagnation of performance after few performances. Structured self-assessment during practice might enhance learning by inducing reflection and engagement in the learning task. In this study, structured self-assessment was introduced during virtual reality (VR) simulation of mastoidectomy to investigate the effects on subsequent performance during cadaveric dissection. A prospective educational study with comparison with historical controls (reference cohort). At a temporal bone dissection course, eighteen participants performed structured self-assessment during 3h of VR simulation mastoidectomy training before proceeding to cadaver dissection (intervention cohort). At a previous course, eighteen participants received identical VR simulation training but without the structured self-assessment (reference cohort). Final products from VR simulation and cadaveric dissection were recorded and assessed by two blinded raters using a 19-point modified Welling Scale. The intervention cohort completed fewer procedures (average 4.2) during VR simulation training than the reference cohort (average 5.7). Nevertheless, the intervention cohort achieved a significantly higher average performance score both in VR simulation (11.1 points, 95% CI [10.6-11.5]) and subsequent cadaveric dissection (11.8 points, 95% CI [10.7-12.8]) compared with the reference cohort, who scored 9.1 points (95% CI [8.7-9.5]) during VR simulation and 5.8 points (95% CI [4.8-6.8]) during cadaveric dissection. Structured self-assessment is a valuable learning support during self-directed VR simulation training of mastoidectomy and the positive effect on performance transfers to subsequent cadaveric dissection performance.

Purpose: To assess the learning curve for the acquisition of colonoscopy skills on a computer-based endoscopy simulator. Methods: A novice group (N = 17) was formed by a cohort of internal medicine residents and medical students, who had never performed an endoscopic procedure. After receiving identical pretest instruction, the novices were asked to undertake 10 trials of colonoscopy within a 1-month period on the GI Mentor II VR simulator. Two experienced gastroenterologists (>1000 colonoscopies each) performed 2 trials each to define benchmark levels. Assessment of skills was based on parameters measured by the simulator. Efficiency, total procedure time, time to cecum and mucosal visualization were felt to be the most relevant outcomes a priori. Data on learning curves was analyzed by the Friedman test. Multiple comparisons were made to identify when plateau of skills had occurred. Comparison of performance between expert and novice groups was undertaken using the Mann-Whitney U-test. A level of P < 0.05 was considered statistically significant. Results: Over the 10 sessions, the novices made significant improvements in their efficiency, total procedure time, time to cecum and percentage in clear view, but not in mucosal visualization, loop formation, or time patient in pain. A plateau in the learning curve was reached after the eighth repetition for efficiency and total procedure time, and after the fifth repetition for time to cecum. By the end of the training program, there were no significant differences between experts and novices for all parameters except for time to cecum (321.24 s vs 155.50 s, P= 0.023). Conclusion: Novices with no endoscopic experience can improve their colonoscopy skills during short phase training on a computer based endoscopy simulator. Simulator-based training may be used early in the learning curve for colonoscopy. Further studies should be done to validate the simulator performance in real procedure.Figure: GI Mentor II VR simulator.

Introduction Electronic media are an integral part of university students’ academic and personal lives; however, their excessive use may interfere with the cognitive functions critical for learning. Intelligence can be assessed through crystallized intelligence (Gc), which reflects accumulated knowledge, and fluid intelligence (Gf), which is associated with problem solving and adaptability. Also, neurophysiological measurements like the event-related potentials (ERPs), particularly P300, provide high temporal resolution measures of cognitive processing, allowing an assessment of attention (neurophysiological measures) and memory functions. This study hypothesizes that excessive screen time negatively impacts attention, fluid and crystallized intelligence, and academic performance in medical students. Materials and methods A total of 305 second-year medical students from a public university participated in the study (mean age: 20 years). Variables assessed included intelligence, attention, academic trajectory, and screen time. Intelligence was measured using the Shipley-2 test, and screen time was measured using a validated Screen Time Survey. For the neurophysiological measures, a subsample (n=30) underwent ERP recording with the P300 oddball paradigm for neurophysiological analysis. Academic performance was determined from standardized physiology test scores. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (2017; IBM Corp., Armonk, New York, United States), GraphPad Prism (Dotmatics, Boston, Massachusetts, United States), and Excel (Microsoft Corporation, Redmond, New York, United States) through descriptive and inferential statistics. Results A significant relationship emerged between screen time, cognitive performance, and academic achievement. Participants reported an average daily screen exposure of 7.1 ± 4.3 hours. A negative correlation was identified between screen time and standardized test scores (r = -0.24, p &lt; 0.001), indicating that increased screen use was associated with lower academic performance. Cognitive intelligence assessments revealed that Gf (R² = 0.848) and general cognition (R² = 0.400) were significantly affected, while Gc remained stable (R² = 0.001). Neurophysiological measures showed average P300 latencies of 358.33 ± 45.6 ms and amplitudes of 259.63 ± 61.6 μV. Shorter N100 latencies (86.7 ± 24.6 ms) correlated with better academic performance (r = -0.45, R² = 0.199). Discussion Students with greater screen time exhibited lower standardized exam scores, suggesting that excessive digital exposure may deplete the cognitive resources essential for academic tasks. The decline in fluid and general cognitive intelligence suggests a diminished capacity for problem-solving and adaptability. Neurophysiological markers indicated prolonged latencies and reduced amplitudes of key ERPs (N100, N200, and P300), reflecting impaired attentional control and working memory in students with higher screen exposure. These findings suggest that prolonged screen use contributes to slower and less efficient cognitive processing. Conclusions Excessive screen time, particularly due to recreational electronic media use, negatively affects cognitive performance and academic outcomes in medical students. The observed decline appears to be mediated by deficits in attention and working memory along with a reduction in Gf, which may impair problem-solving skills and adaptability in complex academic settings.

BackgroundVirtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality.ObjectiveThe aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field.MethodsIn this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale.ResultsOf the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001).ConclusionsOur study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180

Background: Study skills are discrete techniques that can be learned, usually in a short time, and applied to all or most fields of study. The approach students choose appears to be a central factor in determining both the quality and quantity of their learning. Learning styles influence the maintenance of information and the depth of understanding. Methods: A prospective interventional study was conducted among the medical students of phase-II, phase-III part-I and part II studying in government and private medical colleges. The data regarding socio-demographic characteristics like age, sex, religion, total family income, locality, phase of MBBS Course, state in India from which the student came and the learning skills were collected on a self-administered pre tested structured questionnaire, which will also include Study Skills Inventory tool. Paired t test for academic performance before and after intervention, Mann Whitney test for difference in mean ranks in study skill scores between Government and private colleges, spearman correlation for academic skills and study skill scores were applied. Results: The note-taking skills, memory skills and time management skills of private medical college students and their academic performance were correlated significantly. There was a significant improvement in the academic performance of private medical college students by 3.01 and government medical college students by 3.69 after the intervention. Conclusions: There was a significant improvement in the academic performance of both private and government medical college students after the intervention.

This study addresses endovascular training using simulators for uterine artery embolization. A review of endovascular skill training for surgeons using simulators was performed. Surgeons possess varying levels of proficiency in endovascular techniques. A simulator will improve endovascular skills in the following areas: C-arm image intensifier use, catheter selection and manipulation, understanding of the pelvic anatomy, and technique of embolization. Surgeons may gain realistic experience on the simulator prior to entry into the cath lab or procedure room. Using a simulator, surgeons can learn valuable endovascular skills necessary for successful performance of uterine artery embolization.

Background The implementation of a successful international health program comes with a constellation of unique obstacles that require a collaborative approach and careful project design. Over the summer of 2006, a Canadian school-based tooth-brushing and oral health education program, “Brighter Smiles,” was delivered to 600 primary school children in four rural Ugandan communities in Africa. The international program resulted from collaboration between the University of British Columbia (UBC), Vancouver, BC, and Makerere University (MU), Kampala, Uganda, and was implemented in 2006 by medical and dental students from both institutions. Methods Initiation of the Brighter Smiles Program in Uganda was requested by MU faculty members and the third-year dental class. Once collaboration was confirmed, planning began. Initial sessions with the UBC medical students were done in the aboriginal communities to enforce the basic program philosophy and teaching. Fundraising and grant competitions were conducted. An initial contact team composed of two medical students was sent to present the basic program at a local conference and then with faculty on board to begin the adaptation of the program to suit Uganda9s children9s community and write culturally appropriate ethics and protocols. The project then moved into all four communities under the leadership of the Ugandan dental students, who obtained preliminary consents for the project and baseline dental surveys of the children. The main UBC team then arrived for the implementation of the bulk of the project (teaching dental health, brushing techniques, and supply distribution) and while supporting the Ugandan students in this phase of the project saw their collaboration come to life. Results The 2006 pilot year of the program was embraced by target communities and is successfully under way. Six hundred children received baseline dental examinations and enrolled in the oral health tooth-brushing program. In the coming year, the program will be reinforced in Uganda by another cohort of UBC students. Key relationships were established to act as a substrate for future public health initiatives between UBC and MU. Conclusion The implementation of the “Brighter Smiles Program” in Uganda demonstrates the importance of solid preparation in advance and how the potential success of a true collaboration between international universities and local communities depends on this logistic preparation.

The ACIST injection system is an automatic power injection device that allows for online control of injection rate and volume of contrast. Limited data is available whether this technology allows reducing use of contrast and fluoroscopy time. Accordingly, we compared the use of this system to manual injection among 450 consecutive patients who underwent diagnostic coronary angiography and/or angioplasty who were randomly assigned to either manual contrast injection (control; n=198) or to the ACIST system (study group; n=252). The amount of contrast, fluoroscopy and total procedural times were recorded for each patient. In the diagnostic group, the mean total amount of contrast (including wasted) was reduced by 63% when the ACIST was used compared to control (100+/-42 ml versus 163+/-56 ml; P<0.001, respectively). When only the net amount of contrast delivered to the patient was considered, the differences were smaller (20%, P=0.004). During angioplasty, the amount of contrast was also lower in the ACIST group (206+/-65 versus 230+/-69, P=0.008), whereas no difference were noted in net amount of contrast. Fluoroscopy time was significantly shorter in the ACIST group compared to control both during diagnostic catheterization (4.7+/-3.5 min versus 6.3+/-5.5 min, respectively; P=0.014), and angioplasty (16.7+/-9.1 min versus 19.6+/-12.4 min, respectively; P=0.05). Routine utilization of the ACIST system during diagnostic and interventional procedure significantly reduced the total amount of contrast media used and fluoroscopy time.

Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p&lt;0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p&lt;0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p&lt;0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p&lt;0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p&lt;0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p&lt;0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p&lt;0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic

Aim/background: To investigate the effect of a stress and anxiety coping programme on anxiety and objective structured clinical exam (OSCE) performance in medical students. Material and methods: First-year medical students about to sit their first OSCE were randomised into experimental (n = 75) and control (n = 78) groups at the Ondokuz Mayıs University Medical Faculty in 2009–2010. Before the study, the state-trait anxiety inventory (STAI) was applied to both groups (pre-tests). The volunteer medical students in the experimental group received nine sessions (one 30 min session per week for 9 weeks) of an anxiety- and stress-coping programme. At the end of the programme (post-test) and 3 months later, following an overview session with the experimental group, the STAI was readministered to both groups (1st follow-up test). One month later, the experimental group performed deep diaphragmatic breathing and listened to gentle classical music in the test room while waiting to sit the OSCE, while the control group waited in a silent room. Both groups retook the STAI (2nd follow-up) just before sitting the OSCE. The groups’ pre-, post-, 1st and 2nd follow-up STAI scores and the relations with OSCE performance and anxiety were investigated within the groups. Results: Although there was no difference in the pre-test STAI results between the experimental and control groups (state p = .213, trait p = .122), the experimental group had lower post-test, 1st and 2nd follow-up STAI scores (p < .001, respectively). The OSCE results of the experimental group were higher than those of the control group (p < .001). In a linear regression model, post-test, 1st and 2nd follow-up trait anxiety (p = .023, p = .014 and p < .0001, respectively) and state anxiety (p = .032, p = .026 and p < .001, respectively) were identified as independent factors for higher OSCE scores. Conclusion: Our results indicate that the participants in the experimental group achieved lower scores on post-STAI and improved OSCE performance.