United States

Background
Virtual Reality (VR) technology is a valuable tool for teaching procedural skills. VR allows students to develop skills in a realistic but controlled setting, and as a self-contained teaching module, could reduce instructor burden. Many researchers have explored the use of VR in educational environments and demonstrated that VR training may be comparable to traditional in-person instruction. The goal of this study was to demonstrate the feasibility of using VR technology to teach central venous catheter (CVC) insertion to medical students.

Methods
Ten fourth-year medical students were randomized into two groups: 1) standard curriculum or 2) standard curriculum plus a VR module. The standard curriculum consisted of instructional literature, a video describing CVC placement, and practice on a mannequin. All subjects completed a pre-study questionnaire which recorded their demographic data, history of VR and video game use, and self-perception of procedural ability. Participants in the VR group were assessed on CVC placement on a mannequin before and after completing the VR module. While the VR group completed the simulation, the control group was allowed to re-review the instructional material before being assessed on CVC placement. Then, all subjects completed a post-study questionnaire. 

Results
There were no differences in any baseline characteristics including years of clinical experience, prior CVC experience, or VR familiarity. Similarly, there were no differences in any procedural metrics, such as completion time, between groups or in the VR group crossover analysis. The VR group rated their system as significantly easier to use than the standard group rated the mannequin. Further, using a system usability scale (SUS), the VR system was found to be superior. Specifically, VR participants thought the system had well-integrated functions and was less cumbersome than the mannequin. Lastly, the VR group matched the standard group regarding improved comfort with placing a central line. Both groups rated their comfort significantly higher on the post-survey compared to the pre-survey. 

Conclusion
In conclusion, an instructional VR module can be a valuable addition for teaching CVC placement at the medical student level. The VR system ranked higher on the SUS compared to the mannequin, in fact, its score was slightly better than that of an inhaler as defined by previous literature. Medical students thought that the VR was easy to use, had streamlined functionality, was less cumbersome than a mannequin and improved their comfort placing a CVC. 


AMA Research Challenge 2024 

Leveraging Virtual Reality in Medical Education: The Feasibility of Using Virtual Reality Simulations for Teaching Medical Students Central Venous Catheter Placement

poster

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Background
Though rare, power outages in the operating room happen, perhaps at increased frequency due to more extreme weather related to climate change. These situations are dangerous and anesthesiologists must be prepared to manage them. However, evidence suggests that anesthesiologists are insufficiently prepared to manage a power outage and 85% desire more training. This problem could be solved during residency, yet many programs overlook power outage training. Thus, the objective of this study was to fill this training gap by designing a power outage simulation for anesthesiology residents and then assess whether the simulation improved confidence in power outage management.

Methods
Our team designed a high-fidelity power outage simulation for PGY-3 and PGY-4 anesthesiology residents. The simulation case involved an intraoperative power loss during an inguinal hernia repair of a patient under general anesthesia. This scenario took place within a simulated operating room at an academic simulation center and included a mannequin as the patient under general anesthesia, a surgeon actor, and a simulation specialist. After the simulation, a debriefing focused on power outage management specifics was led by an anesthesiology faculty member. Once debriefing concluded, the residents completed five-point Likert scale surveys to assess before and after confidence in several aspects of intraoperative power loss management including operating room management, monitoring vital signs, and patient disposition planning. Data were analyzed using a two-tailed paired t-test.

Results
Twenty-two anesthesiology residents completed the simulation over two years. Residents' mean confidence in managing a patient in the operating room during a power outage improved by 1.23 points (p=0.001), confidence in monitoring vital signs during a power outage improved by 1.37 points (p=0.001), and confidence in planning appropriate patient disposition during a power outage improved by 0.88 points (p=0.001). After the simulation, 100% of residents strongly agreed or agreed that they could confidently manage a patient in the operating room during a power outage, compared to just 45.5% before the simulation.

Conclusion
It is essential to address anesthesiologists’ desire for further power outage training and this simulation seems to fill the power outage training gap. After participating, residents felt confident in their power outage management skills. Other residency programs may consider implementing this simulation. A limitation of the study is that it relied solely on self-reported measures to ascertain simulation effectiveness; thus, future research could involve conducting objective performance assessments such as standardized tests or direct observation of clinical practice.

Power Outage: A Simulation Case for Anesthesiology Residents

Background: The decision to undergo labor epidural analgesia (LEA) is a significant aspect of childbirth planning for many pregnant individuals. With the rise of social media, platforms like Instagram, Facebook, and Twitter have become popular sources of information and personal narratives. These platforms provide a space for patients, healthcare professionals, and organizations to share educational content, personal experiences, and professional advice. However, the influence of these social media posts on the decision-making process of expectant mothers regarding LEA remains unclear. In this study, we intend to report the recent trends in online portrayal of LEA and the entities posting this content.

Methods: Public posts on Instagram, Facebook, and Twitter made between 1/1/2022 and 12/31/2022 using the search terms #epidural, #naturalbirth, and #unmedicatedbirth were categorized. Data was collected by three independent reviewers, each focusing on one platform. Posts were categorized by media type, perspective (patient, family/friend, physician, etc.), timing (prepartum, peripartum, postpartum), and tone (persuasive positive, persuasive negative, reflective, neutral). Data analysis was performed using Microsoft Excel to identify patterns in how social media content influences the choice to undergo labor epidural analgesia.

Results: It was found that on Twitter and Facebook, patients were the primary perspective (60% and 59%, respectively), and the tone was mainly reflective (67.7% and 54.9% respectively). For Instagram, doulas yielded the majority perspective (30.4%) while the tone remained neutral (52.9%). Posts on all three forms of social media occurred overwhelmingly in the postpartum period. Reviewers searched for the maximum number of results yielded by each search term, with Instagram generating the most results concerning #unmedicatedbirths. In contrast, Facebook and Twitter results were mainly obtained using the search term #epidural.

Conclusion: This study indicates that social media platforms have distinct user demographics and tones when discussing labor epidural analgesia. Facebook predominantly features postpartum patient perspectives with a reflective tone, suggesting it serves as a platform for sharing personal experiences post-childbirth. Instagram, dominated by doula perspectives, provides neutral and reflective content, highlighting a more balanced view on epidural use. Twitter, similar to Facebook, primarily features patient perspectives with reflective posts in the postpartum period. The variation in content and tone across platforms highlights the need for targeted educational strategies to address the diverse audiences and their preferences on social media. These insights can help healthcare professionals better understand and engage with expectant mothers considering labor epidural analgesia.

The Effect of Educational Social Media on the Choice to Undergo Labor Epidural Analgesia

Introduction: Specialty-specific student interest groups have become stepping stones in medical schools to facilitate student engagement within focused areas of medicine1. However, research on the impact of cardiology interest groups on students’ career interests remains limited. Our study compares the number of students interested in pursuing a career in cardiology with the perceived source of interest across medical students along with student involvement with Cardiology Interest Group (CIG) events and membership. 
Methods: A questionnaire was administered to all Albany Medical College M.D. Program students graduating in 2024, 2025, 2026, and 2027 over two weeks. Participants voluntarily reported their CIG membership, involvement level, and interest in cardiology as a career. Likert scores and percentages were used for comparison among the cohorts (2024-2027) and between preclinical (2026-2027) and clinical students (2024-2025).
Results: A total of 129 participants from the graduating classes of 2024, 2025, 2026 and 2027 voluntarily completed the survey assessing their baseline and degree of involvement in CIG as well as corresponding source of and overall interest in cardiology as a career. 39% percent of students in classes 2026/2027 considered a career in cardiology as compared to 5% of students within classes 2024/2025 (P<0.001). Similar significance was seen in the difference between the class of 2026/2027 and 2024/2025 in attributing interest to CIG, representing 13% and 3%, respectively (P<0.001). The 26/27 cohort was more likely to have attended a CIG event compared to the class of 2024/2025 (P<0.001). An overall influence of CIG on cardiology as a speciality was significantly more predominant within the preclinical classes as compared to the clinical class (P<0.001).
Conclusion: Our study demonstrates CIG’s substantial role in fostering student interest and engagement in cardiology careers. Limitations of our study may be seen in the classes of 2024/2025 being further into clinical years and thus potentially having a narrowed scope of specialty interest at the time of completing the survey. The overall impact of CIG was illustrated most within the classes of 2026/2027 having CIG during preclinical years, as compared to classes of 2024/2025 who did not. These findings highlight the importance of a Cardiology Interest Group in didactic years for fostering interest and potential careers in the field of cardiology.

The Impact of a Cardiology Interest Group (CIG) on Medical Student Interest in a Cardiology Career

It is no secret that social media has taken the world by storm in the past two decades. It have come to the point where people now turn to social media for their health information. TikTok has especially become a popular search engine for young people seeking dermatologic advice. In the study we analyzed the existing content on TikTok regarding vitiligo treatment to determine the source of the videos and the top treatments recommended for vitiligo treatment on the app.

DermTok: Vitiligo Treatment

Background
Out-of-hospital, life-threatening emergencies are increasingly prevalent. In the United States, it is estimated that over 50,000 cardiac arrests occur annually in public settings and that one in 50 individuals are susceptible to anaphylaxis. Last year, 81,083 Americans died from opioid overdose and over 600 mass shootings occurred in the United States. The public expects medical providers, especially physicians, to possess the skills and competencies to effectively intervene in such emergencies. However, undergraduate medical education rarely provides adequate, lifesaving care training to medical students. To address this curriculum gap, we surveyed the need for out-of-hospital, lifesaving care training in undergraduate medical education and implemented a hands-on training curriculum.

Methods
We conducted a needs assessment survey to examine the lifesaving care proficiencies of medical students at a large academic medical center. Surveys consisted of multiple-choice and Likert scale questions regarding student confidence to intervene independently during out-of-hospital emergencies, perform cardiopulmonary resuscitation (CPR) and utilize an automated external defibrillator (AED), pack a penetrating wound, apply a tourniquet, use an epinephrine autoinjector, and administer naloxone. Additional questions assessed medical student opinions on whether the current curriculum had prepared them to perform lifesaving interventions. Descriptive analysis of quantitative survey data was performed to determine the percentage for each response.

Results
Of the 55 medical student respondents, only two (3.6%) felt extremely confident in their abilities to independently respond to an out-of-hospital emergency, while 35 (63.6%) were not at all or minimally confident in such scenarios. Furthermore, 28 students (50.9%) felt confident performing CPR or using an AED, 15 (27.2%) felt prepared to apply a tourniquet, ten (18.2%) to pack a penetrating trauma wound, 41 (74.6%) to use an epinephrine autoinjector, and 27 (49.1%) to administer naloxone. Lastly, 54 students (98.2%) agreed that all physicians should possess the skills to provide lifesaving care during out-of-hospital emergencies, 53 (96.4%) hoped to learn such skills, and five (9.1%) believed the medical school curriculum adequately prepared them for out-of-hospital emergencies.


Is There a Doctor On Board? The Need for Lifesaving Care Training in Medical School
Curricula

Background: Mass casualty incident (MCI) training effectively increases trainees' knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM (Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms.

Methods: Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of <0.01 significant to correct for multiplicity using the Bonferroni method.

Results: Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, and understanding of emergency medical service training/transportation, as well as increased confidence in participating in an MCI (all p < 0.001).

Conclusions: Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models' ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

Triage for Dummies: A Low-Tech Mass Casualty Incident Training for Medical Students

Background: Traditional didactic learning methods often fail to engage students actively, potentially limiting the retention of complex medical knowledge. This study introduces 'Adrenal Disorders Bingo', a game-based learning approach aimed at enhancing the understanding and recall of adrenal disorders among medical students.
Methods: This pilot study used a pre- and post-intervention survey with Likert-scale (1-5) responses to measure changes in students' knowledge, engagement, and application abilities regarding adrenal disorders. The game involved nearly 100 clues related to about 20 adrenal conditions. Students identified and matched these clues with their correct diagnoses on a bingo card. Whenever students achieved five matches in a row, they called "bingo." The game was supplemented by a comprehensive quiz and discussion session, promoting second and third-order thinking.
Results: The results showed significant improvement in students' confidence and ability to describe symptoms, differentiate between adrenal disorders based on clinical presentations and laboratory findings, and apply their knowledge in clinical scenarios. There was also a notable increase in student engagement and positive feedback on the learning experience.
Conclusion: 'Adrenal Disorders Bingo' offers a promising alternative to traditional learning methods, demonstrating potential for improved knowledge retention and engagement among medical students studying adrenal disorders. The interactive nature of the game, which incorporates nearly 100 clues about 20 adrenal conditions, fosters a more engaging and dynamic learning environment. This contrasts with the passive experience of traditional didactic lectures. By incorporating more interactive games into medical education, educators can enhance critical thinking, facilitate deeper understanding, and improve long-term retention of complex medical concepts. This approach not only makes learning more enjoyable but also prepares students to apply their knowledge more effectively in clinical settings. Future curricula should consider integrating similar game-based learning strategies to complement traditional methods, thereby providing a more effective and engaging educational experience.

Evaluating the Educational Impact of Game-Based Learning on Adrenal Disorders Among Medical Students

Background
Rhomboid strain, an increasingly common injury due to chronic digital display use, often goes underdiagnosed or mismanaged in adolescent patients. Enhancing physician knowledge and confidence in diagnosing and treating rhomboid strain can improve patient quality of life. This study aims to measure the impact of an educational lecture on physicians' understanding and confidence in managing rhomboid strain in an adolescent health setting.

Methods
A cohort of 11 physicians at a student health clinic on a college campus was surveyed before and after attending a targeted educational lecture on rhomboid strain. This was accompanied by the addition of a patient educational handout in the electronic medical record. The lecture covered the etiology, diagnosis, treatment options, and natural history of rhomboid strain. The pre-lecture survey assessed baseline knowledge and confidence levels, while the post-lecture survey evaluated changes in these levels. Both surveys utilized a 5-item Likert scale. For statistical analysis, scores of 4 and 5 were assigned a value of 1, while scores less than 4 were assigned a value of 0. Fisher’s Exact Test was performed in R Studio (C) Version 2024.04.1.

Results
Preliminary results indicated that baseline knowledge about rhomboid strain was variable, with a significant proportion of physicians reporting low confidence in their ability to provide patients information and teach home exercises for therapeutic benefit. Following the educational lecture, there was a marked improvement in confidence scores for diagnosis (55% vs 100%, p = 0.04), accessing patient educational materials (36% vs 100%, p = 0.01), and teaching home exercises (45% vs 100%, p = 0.01).

Conclusion
This study shows the value of education in enhancing physicians' knowledge and confidence in diagnosing and managing rhomboid strain in adolescent patients. These findings suggest that targeted educational interventions can effectively address gaps in physician training and improve patient care outcomes for new and evolving chief complaints. Further research is warranted to assess the long-term impact of such educational programs on clinical practice and patient health.

Measuring Physician Confidence Before and After a Lecture on Rhomboid Strain in Adolescent Health

Purpose: This study investigates the feasibility, effectiveness, and patient response to using Mixed Reality (MR) technology, specifically the HoloLens, for preoperative education in patients requiring pancreatoduodenectomy. It aims to determine if MR improves patient understanding, comfort, and comprehension during informed consent compared to traditional methods.

Methods: A single center randomized controlled pilot study was conducted with patients recommended for pancreatoduodenectomy due to pancreatic mass between February and May 2023. Exclusion criteria included age under 18, lack of English fluency, or severe visual/hearing impairments. Participants completed pre- and post-intervention surveys assessing their understanding of their condition and care. The control group received standard education, while the intervention group used the HoloLens.

Results: Nineteen patients participated, with eight in the HoloLens group. Both groups showed improved understanding post-intervention, but only the HoloLens group had a statistically significant increase in overall comprehension (Z= -2.524, p= 0.012). The HoloLens group also had a significant improvement in understanding surgical steps and other aspects compared to controls. High comfort levels with the planned surgery were reported by 75% of participants in both groups.

Conclusions: MR technology, such as the HoloLens, can significantly enhance patient understanding and comfort in preoperative education for complex surgeries. Its integration into clinical practice was feasible and non-disruptive, suggesting broader applicability. The small sample size and single-center design limit generalizability, necessitating larger studies to confirm these findings and assess the full impact of MR on patient surgical education.

Enhanced Preoperative Pancreatoduodenectomy Patient Education Using Mixed Reality Technology: A Randomized Controlled Trial

Background: Meditation and breathing practices have been recognized to have a positive impact on stress reduction and well-being for various healthcare professionals, including physicians. The purpose of this pilot study was to examine the acceptability, feasibility and impact of a brief breathing and meditation workshop on surgeons and surgical residents.   

Methods: Surgeons and surgical residents participated in a meditation and breathwork workshop. Two techniques were taught, Isha Kriya meditation and Nadi Shuddi breathing, over two one-hour sessions. The participants were surveyed for perceived stress and wellbeing before and after the workshop. Participants also engaged in a focus group to examine impact, feasibility and acceptability. 

Results: All participants practiced Nadi Shuddi and Isha Kria 4x/week. Surgical Residents had a slightly higher initial median (IQR) perceived stress scores that Attending Surgeons 17.73 (14.0, 18.75) to 20.82 (17.8, 23.3) (p=0.06). Surgical Residents saw a 30% decrease in perceived stress score 20.82 to 14.0 (p<0.01). Warwick-Edinburgh Mental Well-being scale demonstrated increased wellbeing through the intervention. The cohort demonstranted being 70% more relaxed (1.7 to 2.9; p=.0003) and better able to deal with problemsdeal with problems (2.2 to 2.7; p=.02).   Participants expressed the following benefits: more focus, less irritability, more patience, and more acceptance of difficult issues. Participants offered constructive feedback to help guide adjustments in terms of format and delivery of workshop offering. 

Conclusion: This study shows that both surgical residents and attending physicians can improve perceived stress and wellbeing through mediation and breathwork practices. Leadership should consider offering structured meditation and breathwork opportunities through organizational support to practice enhancing surgical residents and attending physicians' wellness.

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Leveraging Virtual Reality in Medical Education: The Feasibility of Using Virtual Reality Simulations for Teaching Medical Students Central Venous Catheter Placement

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