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      Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners

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          Abstract

          Background:

          Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education.

          Objective:

          The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum.

          Settings and Design:

          Learners were first and second year medical students from a single institution.

          Materials and Methods:

          Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired.

          Statistical analysis used:

          To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data.

          Results:

          A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively.

          Conclusions:

          Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.

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          Most cited references16

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          Deliberate practice and acquisition of expert performance: a general overview.

          Traditionally, professional expertise has been judged by length of experience, reputation, and perceived mastery of knowledge and skill. Unfortunately, recent research demonstrates only a weak relationship between these indicators of expertise and actual, observed performance. In fact, observed performance does not necessarily correlate with greater professional experience. Expert performance can, however, be traced to active engagement in deliberate practice (DP), where training (often designed and arranged by their teachers and coaches) is focused on improving particular tasks. DP also involves the provision of immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behavior. In this article, we draw upon the principles of DP established in other domains, such as chess, music, typing, and sports to provide insight into developing expert performance in medicine.
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            The role of deliberate practice in the acquisition of clinical skills

            Background The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training. Methods Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results. Results 875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1. Conclusions The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.
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              Toward a science of exceptional achievement: attaining superior performance through deliberate practice.

              Exceptional performance is frequently attributed to genetic differences in talent. Since Sir Francis Galton's book, Hereditary Genius, many scientists have cited heritable factors that set limits of performance and only allow some individuals to attain exceptional levels. However, thus far these accounts have not explicated the causal processes involved in the activation and expression of unique genes in DNA that lead to the emergence of distinctive physiological attributes and cognitive capacities (innate talent). This article argues on the basis of our current knowledge that it is possible to account for the development of elite performance among healthy children without recourse to innate talent (genetic endowment)--excepting the innate determinants of body size. Our account is based on the expert-performance approach and proposes that the distinctive characteristics of exceptional performers are the result of adaptations to extended and intense practice activities that selectively activate dormant genes that are contained within all healthy individuals' DNA. Furthermore, the theoretical framework of expert performance explains the apparent emergence of early talent by identifying factors that influence starting ages for training and the accumulated engagement in sustained extended deliberate practice, such as motivation, parental support, and access to the best training environments and teachers. In sum, our empirical investigations and extensive reviews show that the development of expert performance will be primarily constrained by individuals' engagement in deliberate practice and the quality of the available training resources.
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                Author and article information

                Journal
                J Med Educ Curric Dev
                J Med Educ Curric Dev
                MDE
                spmde
                Journal of Medical Education and Curricular Development
                SAGE Publications (Sage UK: London, England )
                2382-1205
                8 June 2021
                Jan-Dec 2021
                : 8
                : 23821205211020751
                Affiliations
                [1 ]OhioHealth Simulation, Ohio University Heritage College of Osteopathic Medicine, USA
                [2 ]University of Nebraska Medical Center, USA
                [3 ]University of Nebraska Medical Center, USA
                [4 ]Indiana University 2020-2021, USA
                [5 ]Emergency Medicine Residency, Florida Atlantic University, USA
                [6 ]Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL, USA
                [7 ]Division of Simulation, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
                Author notes
                [*]Brad D Gable, OhioHealth Simulation, 3525 Olentangy River Road, Suite 4300, Columbus, OH 43017, USA. Email: Brad.Gable2@ 123456ohiohealth.com
                Author information
                https://orcid.org/0000-0001-8015-7785
                Article
                10.1177_23821205211020751
                10.1177/23821205211020751
                8191058
                34164580
                a1f080da-47f4-4ac5-b182-9bea979d2829
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 11 March 2021
                : 4 May 2021
                Categories
                Original Research
                Custom metadata
                January-December 2021
                ts1

                simulation,disaster,education,mass casualty
                simulation, disaster, education, mass casualty

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