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      Practice makes perfect! Patient safety starts in medical school: Do instructional videos improve clinical skills and hygiene procedures in undergraduate medical students? Translated title: Übung macht den Meister – Patientensicherheit beginnt im Studium: Tragen Lehrvideos zu besseren ärztlichen Fertigkeiten und Hygienemaßnahmen bei Medizinstudierenden bei?

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          Abstract

          Introduction: In 2012 safety strategies were defined in five intervention areas to improve patient safety in Austria. Regarding policy development, patient safety should be mandatory part of education of all healthcare sectors, and measures to improve hygiene standards are to be included in organizational development. The aim of this project was to achieve sustained improvement in routine procedures and anchor patient safety in the undergraduate medical curriculum by making online instructional videos on clinical skills and hygiene procedures permanently available as preparation for the first clinical clerkship.

          Method: Short films explaining how to insert urinary catheters in women and men were produced and provided online. These videos were shown to medical students shortly before the practical Objective Structured Clinical Examination (OSCE). After viewing the videos, all of the students were surveyed using an online questionnaire with 15 questions regarding quality and acceptance. The effect of the videos on learning success was determined by the assessment outcome through red cards in the practical exam. A red card for behavior endangering the doctor or others meant zero points and discontinuation of the assessment at that particular OSCE station.

          Results: A total of 647 students viewed one of the two videos on urinary catheters, 623 responded to the online Moodle questionnaire completly. 551 (85.2%) reported being better able to recall individual steps and procedures, 626 students (96.7%) positively rated the fact that instructional videos were available on the Medical University of Vienna’s website. More than half of the respondents (56.6%) were better able to remember critical hygiene practices. The comparison of the assessment outcomes on the OSCE for 2016 and 2013, a year in which the instructional videos were not yet available, shows no significant (chi 2=3.79; p>0.05) but a trend towards improvement. The chance of getting a red card in 2013 was 3.36 times higher than in 2016.

          Conclusion: Even if our study was unable to show significant improvements in the OSCE as a result of viewing the videos, it appears that clearly imparting medical skills and hygiene standards—including in visual form—is still important prior to the first clerkship to ensure the highest level of patient safety possible. The combination of teaching and learning formats, such as videos on online platforms with textbooks or lecture notes, is well suited to increase effectiveness and efficiency in learning. There is a need for further studies to investigate and analyze the effects of instructional videos in more detail.

          Zusammenfassung

          Einleitung: Um im Bereich Patientensicherheit Verbesserungen zu erzielen wurden 2012 in Österreich Sicherheitsstrategien in 5 Interventionsfeldern festgeschrieben. Im Interventionsfeld Politikentwicklung soll die Patientensicherheit in die Ausbildung aller Gesundheitsberufe miteinbezogen werden, in der Organisationsentwicklung sollen Maßnahmen zur Verbesserung von Hygienestandards gesetzt werden. Das Bestreben dieses Projektes war es durch Darstellung klinischer und hygienischer Fertigkeiten in permanent online abrufbaren Lehrvideos, als Vorbereitung auf die erste klinische Famulatur, Handlungsabläufe nachhaltig zu verbessern und damit Patientensicherheit bereits in der medizinisch-studentischen Lehre zu verankern.

          Methode: Kurzfilme mit der Anleitung zum Legen eines Harnkatheters bei der Frau und beim Mann wurden hergestellt und online gestellt. Diese wurden den StudentInnen kurz vor der praktischen OSCE Prüfung vorgeführt. Im Anschluss daran wurden alle StudentInnen mittels eines Online-Fragebogens, der 15 Fragen zur Qualität und Akzeptanz beinhaltete, befragt. Die Auswirkungen der Videos auf den Lernerfolg wurden durch den Prüfungsoutcome beim abschließenden OSCE („Objective Structured Clinical Examination“), indem die Anzahl der vergebenen „Roten Karten“ erhoben wurde, ermittelt. Eine rote Karte bedeutete 0 Punkte und Prüfungsabbruch bei dieser Prüfungsstation bei selbst- oder fremdgefährdendem Verhalten.

          Ergebnisse: Insgesamt sahen 647 Studierende eines der beiden Harnkatheter-Videos, 623 beantworteten online den auf Moodle gestellten Fragebogen vollständig. 551 Studierende (85,2%) gaben an, sich besser an einzelne Handgriffe und Handlungsabläufe erinnern zu können, 626 Studierende (96,7%) bewerteten es positiv, dass Lehrvideos im Online-Tool der MedUni Wien zur Verfügung gestellt werden. Mehr als die Hälfte der Befragten (56,6%), konnten sich besser an notwendige hygienische Handgriffe erinnern. Der Vergleich des Prüfungsoutcome bei der OSCE-Prüfung des Jahrganges 2016 mit dem 2013, bei dem Instruktionsvideos noch nicht zur Verfügung standen, zeigte keine signifikante (Chi 2=3,79; p-Wert>0,05), wohl aber eine tendenzielle Verbesserung der Studierenden. Die Chance eine Rote Karte zu bekommen war 2013 3,36 mal so hoch als im Vergleichsjahr 2016.

          Fazit: Wenngleich in unserer Studie keine signifikanten Ergebnisse durch das Vorführen der Videos in der OSCE Prüfung selbst zu verzeichnen waren, so erscheint uns die regelrechte – auch visuelle – Vermittlung von ärztlichen Fertigkeiten und hygienischen Standards vor der ersten Famulatur wichtig um größtmögliche Patientensicherheit zu gewährleisten. Die Kombination aus Lehr- und Lernformaten, wie Videos auf Online-Plattformen, in Verbindung mit Lehrbüchern oder Skripten, erscheint uns gut geeignet um Effektivität und Effizienz beim Lernen zu erhöhen. Es bedarf weiterer Studien um die Effekte von Lehrfilmen besser belegen zu können.

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          Most cited references 10

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          Effectiveness of a hospital-wide programme to improve compliance with hand hygiene

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            The WHO patient safety curriculum guide for medical schools.

            The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thus, many medical educators are unfamiliar with the literature and unsure how to integrate patient safety learning into existing curriculum. To address this gap and provide a foothold for medical schools all around the world, the WHO's World Alliance for Patient Safety sponsored the development of a patient safety curriculum guide for medical students. The WHO Patient Safety Curriculum Guide for Medical Schools adopts a 'one-stop-shop' approach in that it includes a teacher's manual providing a step-by-step guide for teachers new to patient safety learning as well as a comprehensive curriculum on the main patient safety areas. This paper establishes the need for patient safety education of medical students, describes the development of the WHO Patient Safety Curriculum Guide for Medical Schools and outlines the content of the Guide.
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              Use of online clinical videos for clinical skills training for medical students: benefits and challenges

              Background Multimedia learning has been shown effective in clinical skills training. Yet, use of technology presents both opportunities and challenges to learners. The present study investigated student use and perceptions of online clinical videos for learning clinical skills and in preparing for OSCE (Objective Structured Clinical Examination). This study aims to inform us how to make more effective us of these resources. Methods A mixed-methods study was conducted for this study. A 30-items questionnaire was administered to investigate student use and perceptions of OSCE videos. Year 3 and 4 students from 34 Korean medical schools who had access to OSCE videos participated in the online survey. Additionally, a semi-structured interview of a group of Year 3 medical students was conducted for an in-depth understanding of student experience with OSCE videos. Results 411 students from 31 medical schools returned the questionnaires; a majority of them found OSCE videos effective for their learning of clinical skills and in preparing for OSCE. The number of OSCE videos that the students viewed was moderately associated with their self-efficacy and preparedness for OSCE (p < 0.05). One-thirds of those surveyed accessed the video clips using mobile devices; they agreed more with the statement that it was convenient to access the video clips than their peers who accessed the videos using computers (p < 0.05). Still, students reported lack of integration into the curriculum and lack of interaction as barriers to more effective use of OSCE videos. Conclusions The present study confirms the overall positive impact of OSCE videos on student learning of clinical skills. Having faculty integrate these learning resources into their teaching, integrating interactive tools into this e-learning environment to foster interactions, and using mobile devices for convenient access are recommended to help students make more effective use of these resources.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 March 2019
                2019
                : 36
                : 2 , Patient safety/Patientensicherheit
                Affiliations
                [1 ]Medical University of Vienna, Teaching Center, Assessment and Skills, Vienna, Austria
                [2 ]Medical University of Vienna, Teaching Center, Research Unit for Curriculum-Development, Vienna, Austria
                Author notes
                *To whom correspondence should be addressed: Anita Holzinger, Medical University of Vienna, Teaching Center, Research Unit for Curriculum-Development, Spitalgasse 23/BT87, A-1090 Vienna, Austria, E-mail: anita.holzinger@ 123456meduniwien.ac.at
                Article
                zma001224 Doc16 urn:nbn:de:0183-zma0012245
                10.3205/zma001224
                6446472
                Copyright © 2019 Bäwert et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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