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The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp's pedagogical effectiveness to that of any other teaching modality. The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60% [SD 9%] vs 68% [SD 11%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further.

Background Physician empathy is an essential attribute of the patient–physician relationship and is associated with better outcomes, greater patient safety and fewer malpractice claims. Objective We tested whether an innovative empathy training protocol grounded in neuroscience could improve physician empathy as rated by patients. Design Randomized controlled trial. Intervention We randomly assigned residents and fellows from surgery, medicine, anesthesiology, psychiatry, ophthalmology, and orthopedics (N = 99, 52% female, mean age 30.6 ± 3.6) to receive standard post-graduate medical education or education augmented with three 60-minute empathy training modules. Main Measure Patient ratings of physician empathy were assessed within one-month pre-training and between 1–2 months post-training with the use of the Consultation and Relational Empathy (CARE) measure. Each physician was rated by multiple patients (pre-mean = 4.6 ± 3.1; post-mean 4.9 ± 2.5), who were blinded to physician randomization. The primary outcome was change score on the patient-rated CARE. Key Results The empathy training group showed greater changes in patient-rated CARE scores than the control (difference 2.2; P = 0.04). Trained physicians also showed greater changes in knowledge of the neurobiology of empathy (difference 1.8; P < 0.001) and in ability to decode facial expressions of emotion (difference 1.9; P < 0.001). Conclusions A brief intervention grounded in the neurobiology of empathy significantly improved physician empathy as rated by patients, suggesting that the quality of care in medicine could be improved by integrating the neuroscience of empathy into medical education.

Video learning prior to surgery is common practice for trainees and surgeons, and immersive virtual reality (IVR) simulators are of increasing interest for surgical training. The training effectiveness of IVR compared with video training in complex skill acquisition should be studied. To evaluate whether IVR improves learning effectiveness for surgical trainees and to validate a VR rating scale through correlation to real-world performance. This block randomized, intervention-controlled clinical trial included senior (ie, postgraduate year 4 and 5) orthopedic surgery residents from multiple institutions in Canada during a single training course. An intention-to-treat analysis was performed. Data were collected from January 30 to February 1, 2020. An IVR training platform providing a case-based module for reverse shoulder arthroplasty (RSA) for advanced rotator cuff tear arthropathy. Participants were permitted to repeat the module indefinitely. The primary outcome measure was a validated performance metric for both the intervention and control groups (Objective Structured Assessment of Technical Skills [OSATS]). Secondary measures included transfer of training (ToT), transfer effectiveness ratio (TER), and cost-effectiveness (CER) ratios of IVR training compared with control. Additional secondary measures included IVR performance metrics measured on a novel rating scale compared with real-world performance. A total of 18 senior surgical residents participated; 9 (50%) were randomized to the IVR group and 9 (50%) to the control group. Participant demographic characteristics were not different for age (mean [SD] age: IVR group, 31.1 [2.8] years; control group, 31.0 [2.7] years), gender (IVR group, 8 [89%] men; control group, 6 [67%] men), surgical experience (mean [SD] experience with RSA: IVR group, 3.3 [0.9]; control group, 3.2 [0.4]), or prior simulator use (had experience: IVR group 6 [67%]; control group, 4 [44%]). The IVR group completed training 387% faster considering a single repetition (mean [SD] time for IVR group: 4.1 [2.5] minutes; mean [SD] time for control group: 16.1 [2.6] minutes; difference, 12.0 minutes; 95% CI, 8.8-14.0 minutes; P < .001). The IVR group had significantly better mean (SD) OSATS scores than the control group (15.9 [2.5] vs 9.4 [3.2]; difference, 6.9; 95% CI, 3.3-9.7; P < .001). The IVR group also demonstrated higher mean (SD) verbal questioning scores (4.1 [1.0] vs 2.2 [1.7]; difference, 1.9; 95% CI, 0.1-3.3; P = .03). The IVR score (ie, Precision Score) had a strong correlation to real-world OSATS scores (r = 0.74) and final implant position (r = 0.73). The ToT was 59.4%, based on the OSATS score. The TER was 0.79, and the system was 34 times more cost-effective than control, based on CER. In this study, surgical training with IVR demonstrated superior learning efficiency, knowledge, and skill transfer. The TER of 0.79 substituted for 47.4 minutes of operating room time when IVR was used for 60 minutes. ClinicalTrials.gov Identifier: NCT04404010.

This study aims to evaluate the efficacy of the Mini Clinical Evaluation Exercise (Mini-CEX) in conjunction with Case-Based Learning (CBL) and mind mapping methodologies in fostering the clinical competencies of ultrasound residents. A cohort of forty-two general practitioners who underwent standardized training at the Department of Ultrasound Medicine at Tianyou Hospital, affiliated with Wuhan University of Science and Technology, from December 1, 2022 to December 1, 2024, were selected for this research. These practitioners were randomly assigned to either an experimental group or a control group using a random number table. The experimental group engaged in training utilizing the Mini-CEX combined with CBL and mind mapping approach, whereas the control group adhered to a traditional training regimen. Subsequently, comparative analyses were conducted on theoretical and practical test scores as well as clinical teaching satisfaction ratings between the two groups. Additionally, variations in Mini-CEX evaluation scores for the experimental group were assessed at admission, after two weeks, and after four weeks of training. The training approach that integrated Mini-CEX with CBL and mind mapping demonstrated significantly superior outcomes compared to the traditional training method regarding theoretical and practical performance, as well as teaching satisfaction, with statistically significant differences noted (p < 0.05). A comparison of Mini-CEX scores among 21 general practitioners at two and four weeks post-training versus admission yielded statistically significant results (p < 0.05). The amalgamation of Mini-CEX with CBL and mind mapping methodologies markedly enhances the instructional effectiveness of standardized resident training.

Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles. This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events. This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters. Interns in all specialties at our institution. Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023. Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good. Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.

Exploring the application of 5E teaching model combined with virtual endoscopic surgical simulation system in surgical teaching. Eighty-six students who received standardized residency training in the Department of General Surgery at the Second Hospital of Shanxi Medical University from September 2022 to June 2023 were selected as the research subjects. They were randomly divided into experimental and control groups, with 43 students in each group. The experimental group adopts the 5E teaching mode combined with a virtual endoscopic surgery simulation system for teaching. In contrast, the control group was taught using traditional teaching and a simple endoscopic simulation training box. A comparison was made between the evaluation results, self-evaluation, and teaching mode evaluation of the two groups. A -test was performed on two sets of measurement data using SPSS 26.0 software. The theoretical test scores (  = 17.240,  = 0.000) and skill test scores (  = 21.335,  = 0.000) of students in the experimental group were higher than those in the control group. Compared to the control group, the experimental group showed significant improvement in operational skills (  = 3.557,  = 0.001), knowledge application (  = 4.936,  = 0.000), and overall performance (  = 2.999,  = 0.003) after training. The attitudes of students in the experimental group toward ability training (  = 3.818,  = 0.000), class order (  = 3.189,  = 0.002), teaching mode (  = 2.955,  = 0.004), and teaching level evaluation (  = 6.238,  = 0.000) were significantly higher than those in the control group. The virtual endoscopic surgery simulation system combined with the 5E teaching mode can significantly improve the theoretical knowledge and clinical practice skills of resident physicians in standardized training. Suggest applying it to clinical teaching.

IntroductionCommunication is fundamental to effective surgical coaching. This can be challenging for training during image-guided procedures where coaches and trainees need to articulate technical details on a monitor. Telestration devices that annotate on monitors remotely could potentially overcome these limitations and enhance the coaching experience. This study aims to evaluate the value of a novel telestration device in surgical coaching.MethodsA randomized-controlled trial was designed. All participants watched a video demonstrating the task followed by a baseline performance assessment and randomization into either control group (conventional verbal coaching without telestration) or telestration group (verbal coaching with telestration). Coaching for a simulated laparoscopic small bowel anastomosis on a dry lab model was done by a faculty surgeon. Following the coaching session, participants underwent a post-coaching performance assessment of the same task. Assessments were recorded and rated by blinded reviewers using a modified Global Rating Scale of the Objective Structured Assessment of Technical Skills (OSATS). Coaching sessions were also recorded and compared in terms of mentoring moments; guidance misinterpretations, questions/clarifications by trainees, and task completion time. A 5-point Likert scale was administered to obtain feedback.ResultsTwenty-four residents participated (control group 13, telestration group 11). Improvements in some elements of the OSATS scale were noted in the Telestration arm but there was no statistical significance in the overall score between the two groups. Mentoring moments were more in the telestration Group. Amongst the telestration Group, 55% felt comfortable that they could perform this task independently, compared to only 8% amongst the control group and 82% would recommend the use of telestration tools here.ConclusionThere is demonstrated educational value of this novel telestration device mainly in the non-technical aspects of the interaction by enhancing the coaching experience with improvement in communication and greater mentoring moments between coach and trainee.

BackgroundSimulation-based mastery training may improve clinical performance. The aim of this study was to determine the effect of simulation-based mastery training on clinical performance in abdominal diagnostic ultrasound for radiology residents.MethodThis study was a multicenter randomized controlled trial registered at clinicaltrials.gov (identifier: NCT02921867) and reported using the Consolidated Standards of Reporting Trials (CONSORT) statement. Twenty radiology residents from 10 different hospitals were included in the study. Participants were randomized into two groups: (1) simulator-based training until passing a validated test scored by a blinded reviewer or (2) no intervention prior to standard clinical ultrasound training on patients. All scans performed during the first 6 weeks of clinical ultrasound training were scored. The primary outcome was performance scores assessed using Objective Structured Assessment of Ultrasound Skills (OSAUS). An exponential learning curve was fitted for the OSAUS score for the two groups using non-linear regression with random variation. Confidence intervals were calculated based on the variation between individual learning curves.ResultsAfter randomization, eleven residents completed the simulation intervention and nine received standard clinical training. The simulation group participants attended two to seven training sessions using between 6 and 17 h of simulation-based training. The performance score for the simulation group was significantly higher for the first 29 scans compared to that for the non-simulation group, such that scores reached approximately the same level after 49 and 77 scans, respectively.ConclusionWe showed improved performance in diagnostic ultrasound scanning on patients after simulation-based mastery learning for radiology residents.Trial registrationNCT02921867Key Points• Improvement in scanning performance on patients is seen after simulation-based mastery learning in diagnostic abdominal ultrasound.• Simulation-based mastery learning can prevent patients from bearing the burden of the initial steep part of trainees’ learning curve.

Introduction Artificial intelligence technology has a wide range of application prospects in the field of medical education. The aim of the study was to measure the effectiveness of ChatGPT-assisted problem-based learning (PBL) teaching for urology medical interns in comparison with traditional teaching. Methods A cohort of urology interns was randomly assigned to two groups; one underwent ChatGPT-assisted PBL teaching, while the other received traditional teaching over a period of two weeks. Performance was assessed using theoretical knowledge exams and Mini-Clinical Evaluation Exercises. Students’ acceptance and satisfaction with the AI-assisted method were evaluated through a survey. Results The scores of the two groups of students who took exams three days after the course ended were significantly higher than their scores before the course. The scores of the PBL-ChatGPT assisted group were significantly higher than those of the traditional teaching group three days after the course ended. The PBL-ChatGPT group showed statistically significant improvements in medical interviewing skills, clinical judgment and overall clinical competence compared to the traditional teaching group. The students gave highly positive feedback on the PBL-ChatGPT teaching method. Conclusion The study suggests that ChatGPT-assisted PBL teaching method can improve the results of theoretical knowledge assessment, and play an important role in improving clinical skills. However, further research is needed to examine the validity and reliability of the information provided by different chat AI systems, and its impact on a larger sample size.

Purpose We tested whether residents would improve in fluoroscopy knowledge and ability after using an inexpensive novel pelvis model and educational website. Methods Twenty-four orthopaedic residents were recruited from three United States residency programs and randomised into two groups with equal numbers of juniors and seniors. The OrthoAcademy group received educational materials from a website ( www.theorthoacademy.com ), whereas the control group did not. Survey scores, radiograph scores, number of fluoroscopic images taken, and overall radiation exposure were compared (1) between control and OrthoAcademy groups and (2) between junior and senior residents. Results Both groups had higher radiograph scores at the second round of testing than at the first ( P  =.004). The OrthoAcademy group had higher post-test than pre-test knowledge survey scores ( P  =.045), whereas the control group did not ( P  =.54). However, the OrthoAcademy group did not have higher radiograph scores between tests ( P  =.15), whereas the control group did ( P  =.01). Junior residents had higher second-round than first-round radiograph scores ( P  =.005) and survey scores ( P  =.006), whereas senior residents did not ( P  =.24 radiograph scores) ( P  =.30 survey scores). Conclusions Testing residents with this novel pelvis model improved the quality of the fluoroscopic images obtained by the residents, especially juniors. This study highlighted the need for more accessible resources for residents to learn about obtaining these images.