| 1. |
- Engberg, Morten, et al.
(författare)
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Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta : An international Delphi consensus study
- 2021
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Ingår i: Journal of Trauma and Acute Care Surgery. - : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 91:2, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure that is potentially lifesaving in major noncompressible torso hemorrhage. It may also improve outcome in nontraumatic cardiac arrest. However, the procedure can be technically challenging and requires the immediate presence of a qualified operator. Thus, evidence-based training and assessment of operator skills are essential for successful implementation and patient safety. A prerequisite for this is a valid and reliable assessment tool specific for the procedure. The aim of this study was to develop a tool for assessing procedural competence in REBOA based on best-available knowledge from international experts in the field.METHODS: We invited international REBOA experts from multiple specialties to participate in an anonymous three-round iterative Delphi study to reach consensus on the design and content of an assessment tool. In round 1, participants suggested items to be included. In rounds 2 and 3, the relevance of each suggested item was evaluated by all participants to reach consensus. Interround data processing was done systematically by a steering group.RESULTS: Forty panelists representing both clinical and educational expertise in REBOA from 16 countries (in Europe, Asia, and North and South America) and seven different specialties participated in the study. After 3 Delphi rounds and 532 initial item suggestions, the panelists reached consensus on a 10-item assessment tool with behaviorally anchored rating scales. It includes assessment of teamwork, procedure time, selection and preparation of equipment, puncture technique, guidewire handling, sheath handling, placement of REBOA catheter, occlusion, and evaluation.CONCLUSION: We present the REBOA-RATE assessment tool developed systematically by international experts in the field to optimize content validity. Following further studies of its validity and reliability, this tool represents an important next step in evidence-based training programs in REBOA, for example, using mastery learning.
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| 2. |
- Engberg, Morten, et al.
(författare)
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Learning insertion of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter : Is clinical experience necessary? A prospective trial
- 2023
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 54:5, s. 1321-1329
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and po-tentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (expe-rienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training.Methods: This was a prospective trial of an educational intervention. Three groups of doctors were en-roled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8-12 weeks after training using a standardised simulated scenario. The endovascular experts, con-stituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff.Results: Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p < 0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p < 0.05).Conclusion: For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequi-site to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency.
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| 3. |
- Engberg, Morten, et al.
(författare)
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Reliable and valid assessment of procedural skills in resuscitative endovascular balloon occlusion of the aorta
- 2021
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Ingår i: Journal of Trauma and Acute Care Surgery. - : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 91:4, s. 663-671
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Valid and reliable assessment of skills is essential for improved and evidence-based training concepts. In a recent study, we presented a novel tool to assess procedural skills in resuscitative endovascular balloon occlusion of the aorta (REBOA), REBOA-RATE, based on international expert consensus. Although expert consensus is a strong foundation, the performance of REBOA-RATE has not been explored. The study aimed to examine the reliability and validity of REBOA-RATE.METHODS: This was an experimental simulation-based study. We enrolled doctors with three levels of expertise to perform two REBOA procedures in a simulated scenario of out-of-hospital cardiac arrest. Procedures were video-recorded, and videos were blinded and randomized. Three clinical experts independently rated all procedures using REBOA-RATE. Data were analyzed using Messick's framework for validity evidence, including generalizability analysis of reliability and determination of a pass/fail standard.RESULTS: Forty-two doctors were enrolled: 16 novices, 13 anesthesiologists, and 13 endovascular experts. They all performed two procedures, yielding 84 procedures and 252 ratings. The REBOA-RATE assessment tool showed high internal consistency (Cronbach's alpha = 0.95) and excellent interrater reliability (intraclass correlation coefficient, 0.97). Assessment using one rater and three procedures could ensure overall reliability suitable for high-stakes testing (G-coefficient >0.80). Mean scores (SD) for the three groups in the second procedure were as follows: novices, 32% (24%); anesthesiologists, 55% (29%); endovascular experts, 93% (4%) (p < 0.001). The pass/fail standard was set at 81%, which all experts but no novices passed.CONCLUSION: Data strongly support the reliability and validity of REBOA-RATE, which successfully discriminated between all experience levels. The REBOA-RATE assessment tool requires minimal instruction, and one rater is sufficient for reliable assessment. Together, these are strong arguments for the use of REBOA-RATE to assess REBOA skills, allowing for competency-based training and certification concepts.
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| 4. |
- Strøm, Michael, et al.
(författare)
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Assessment of EVAR Competence : Validity of a Novel Rating Scale (EVARATE) in a Simulated Setting
- 2018
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 56:1, s. 137-144
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aims of this study were to investigate the validity evidence for a novel procedure specific assessment tool of competence in endovascular aortic repair (EVAR) and to establish a pass/fail level for the assessment. Methods: Computed tomography angiography data of a 55 mm in diameter infrarenal aortic aneurysm was implemented into an endovascular simulator. Twenty-three physicians with varying EVAR experiences were video-recorded when performing a standard EVAR procedure on the simulator. Two experienced EVAR operators assessed the participants using the novel rating scale, “EndoVascular Aortic Repair Assessment of Technical Expertise” (EVARATE). Validity was studied according to the framework endorsed by the American Educational Research Association. Results: The EVARATE scale had a high internal consistency (Cronbach's alpha =.90). The inter-rater reliability was acceptable (Intraclass Correlation Coefficient =.68, p =.005). Specific EVAR experience correlated significantly with the EVARATE score (Spearman's rho =.62, p =.002), but general endovascular experience did not. Consequence analysis showed that the EVARATE assessment could distinguish novices from intermediates (p <.01) and from experts (p <.001). A pass/fail score was determined using the contrasting groups’ method. Conclusion: This paper presents the initial validity evidence for a novel procedure specific assessment tool, EVARATE, for operator competence in endovascular aortic repair investigated in a simulated setting. The assessment tool can be used to provide structured formative feedback to trainees.
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| 5. |
- Kahr Rasmussen, Niklas, et al.
(författare)
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Evaluation of competence in ultrasound-guided procedures—a generic assessment tool developed through the Delphi method
- 2021
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 31:6, s. 4203-4211
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To develop a generic and objective tool for assessing competence in percutaneous ultrasound-guided procedures. Methods: Interventional ultrasound experts from the Nordic countries were invited to participate in a three-round Delphi process. A steering committee was formed to manage the process. In round 1, the experts were asked to suggest all aspects to consider when assessing competence in US-guided procedures. Suggestions were analyzed and condensed into assessment items. In round 2, the expert panel rated these items on a 1–5 scale and suggested new items. Items with a mean rating of ≤ 3.5 were excluded. In round 3, the expert panel rated the list items and suggested changes to the items. Results: Twenty-five experts were invited, and response rates in the three rounds were 68% (17 out of 25), 100% (17 out of 17), and 100% (17 out of 17). The three-round Delphi process resulted in a 12-item assessment tool, using a five-point rating scale. The final assessment tool evaluates pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. Conclusions: Expert consensus was achieved on a generic tool for assessment of competence in percutaneous ultrasound-guided procedures—the Interventional Ultrasound Skills Evaluation (IUSE). This is the initial step in ensuring a valid and reliable method for assessment of interventional US skill. Key Points: • Through a Delphi process, expert consensus was achieved on the content of an assessment tool for percutaneous ultrasound-guided procedures—the Interventional Ultrasound Skills Evaluation (IUSE) tool. • The IUSE tool is comprehensive and covers pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. • This is an important step in ensuring valid and reliable assessment of interventional US skills.
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| 6. |
- Nayahangan, Leizl Joy, et al.
(författare)
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Consensus on technical procedures in radiology to include in simulation-based training for residents : a European-wide needs assessment
- 2021
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Ingår i: European Radiology. - : Springer. - 0938-7994 .- 1432-1084. ; 31, s. 171-180
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To identify and prioritize technical procedures for simulation-based training that should be part of the education of residents in radiology.Methods: This European-wide needs assessment study used a modified Delphi technique to gather consensus from different key education stakeholders in the field. The first round was a brainstorming phase to identify all procedures that a newly specialized radiologist should potentially be able to do. In the second round, each procedure was explored for the need for simulation training; the participants determined frequency, number of radiologists performing the procedure, impact on patient comfort and safety, and feasibility of simulation. The result of this round was sent back to the participants for final evaluation and prioritization.Results: Seventy-one key education stakeholders from 27 European countries agreed to participate and were actively involved in the Delphi process: response rates were 72% and 82% in the second and third round, respectively. From 831 suggested procedures in the first round, these were grouped and categorized into 34 procedures that were pre-prioritized in the second round according to the need for simulation-based training. In the third round, 8 procedures were eliminated resulting in final inclusion of 26 procedures. Ultrasound procedures were highly ranked including basic skills such as probe handling; abdominal ultrasound; and ultrasound of kidneys, retroperitoneum, intestines, and scrotum.Conclusion: The prioritized list of procedures represents a consensus document decided upon by educational stakeholders in radiology across Europe. These procedures are suitable for simulation and should be an integral part of the education of radiologists.
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| 7. |
- Raffing, Rie, et al.
(författare)
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Facilitators and barriers for young medical doctors writing their first manuscript for publication
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:16
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Tidskriftsartikel (refereegranskat)abstract
- Although scientific publication is often mandatory in medical professions, writing the first research article for publication is challenging, especially as medical curricula have only a minor focus on scientific writing. The aim was therefore to identify facilitators and barriers experienced by medical doctors writing their first scientific article for publication. An explorative inductive approach made use of semi-structured interviews for collecting data until saturation. Data were ana-lyzed with systematic text condensation. Several barriers were identified: (a) writing in general; (b) writing in English; (c) dealing with content, structure, and presentation; and (d) navigating in the author group. Good supervision in the initial writing phase was a facilitating factor. Medical doctors requested a course in which they could work on their own articles and give feedback to fellow stu-dents. They valued skilled lecturers and individual supervision, and they wanted to learn about author instructions, how to present text correctly, and how to sell their core message. Their goal was to create a useful end product and to obtain European Credit Transfer System (ECTS) points. The facilitators and barriers that medical doctors experience when writing their first scientific article for publication and their course requests should be reflected in the learning objectives and content of future courses.
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| 8. |
- Raffing, Rie, et al.
(författare)
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From Targeted Needs Assessment to Course Ready for Implementation—A Model for Curriculum Development and the Course Results
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 20:3
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Tidskriftsartikel (refereegranskat)abstract
- This article contributes guidance on how to approach the development of a course curriculum in general and presents a specific example from medical research education. The purpose of this study is to discuss a model for translating needs assessments of targeted learners into a course curriculum. The model employs established methods for data collection, such as different interview approaches and surveys. The authors argue that there is value in going from exploratory in-depth qualitative data collection methods to more conclusive rigorous quantitative methods when developing a course curriculum. In this way, the model is especially sensitive to the needs of targeted learners in the initial phase and at the same time offers a systematic and practical approach to curriculum development. The model is presented step-by-step with the aid of an empirical example of how to assess the needs of medical doctors in the publication process and develop an introductory course in writing an initial manuscript for publication. The article concludes that the proposed model gives curriculum developers a unique opportunity to explore the needs of targeted learners in depth, while systematically aiming towards conclusive decisions on curriculum content ready for implementation.
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| 9. |
- Svane, Jeff Kirk, et al.
(författare)
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Fast and well-reported implementation: Fast-IM and RE-AIM.
- 2020
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Ingår i: Clinical Health Promotion. - : Clinical Health Promotion Centre. - 2226-5864. ; 10:1, s. 10-14
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Tidskriftsartikel (refereegranskat)abstract
- Background Implementation in healthcare is often slow and poorly reported. Results include suboptimal outcomes and ad-verse consequences for patients. However, promising tools to remedy implementation speed and reporting already exist – such as the evidence-based, fast-track implementation model (Fast-IM) and the comprehensive RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) reporting format.Metods In combination, Fast-IM and RE-AIM may constitute a new best practice for fast and well-reported implementation. The aim of this article was to visualize the feasibility of the combination in practice via 3 examples concerning smoking cessa-tion among patients, simulation-based training of healthcare professionals, and mandatory regulation.Results Combining Fast-IM and RE-AIM is feasible and provides a useful overview of both implementation process and results.Conclusion This article describes a new best practice for fast and well-reported implementation by combining Fast-IM and RE-AIM.
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