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The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices. This review used a scoping methodology with a systematic search strategy to identify relevant studies, written in English, and published before January 2021. Four medical education journals (Medical Education, Advances in Health Science Education, Medical Teacher, and Academic Medicine) and four clinical journals (Journal of the American Medical Association, Journal of General Internal Medicine, Annals of Surgery, and British Medical Journal) were purposively selected. Data extraction was charted according to a data collection form. Of 1505 screened studies, 79 studies were included. Three overarching perspectives were identified: ‘understanding errors’) (n = 31), ‘avoiding errors’ (n = 25), ‘learning from errors’ (n = 23). Studies that aimed at’understanding errors’ used qualitative methods (19/31, 61.3%) and took place in the clinical setting (19/31, 61.3%), whereas studies that aimed at ‘avoiding errors’ and ‘learning from errors’ used quantitative methods (‘avoiding errors’: 20/25, 80%, and ‘learning from errors’: 16/23, 69.6%, p = 0.007) and took place in pre-clinical (14/25, 56%) and simulated settings (10/23, 43.5%), respectively (p < 0.001). The three perspectives differed significantly in terms of inclusion of educational theory: ‘Understanding errors’ studies 16.1% (5/31),’avoiding errors’ studies 48% (12/25), and ‘learning from errors’ studies 73.9% (17/23), p < 0.001. Errors in medical education and clinical practice are defined differently, which makes comparisons difficult. A uniform understanding is not necessarily a goal but improving transparency and clarity of how errors are currently conceptualized may improve our understanding of when, why, and how to use and learn from errors in the future.

Context The knowledge of normal variation of reproductive hormones, internal genitalia imaging, and the prevalence of gynecological disorders in adolescent girls is limited. Objective The study aimed to describe reproductive parameters in postmenarchal girls from the general population including the frequency of oligomenorrhea, polycystic ovary syndrome, and use of hormonal contraception. Design The Copenhagen Mother-Child Cohort is a population-based longitudinal birth cohort of 1210 girls born between 1997 and 2002. Setting University hospital. Participants A total of 317 girls were included, with a median age of 16.1 years and time since menarche of 2.9 years. Main Outcome Measure(s) Tanner stage, height, weight, age at menarche, menstrual cycle length and regularity, ovarian/uterine volume, and number of follicles were recorded. Serum concentrations of FSH, LH, anti-Müllerian hormone (AMH), inhibin B, estradiol, testosterone, SHBG, androstenedione, dehydroepiandrosterone sulfate, 17-OH-progesterone, and IGF-1 were measured. Results Twenty girls (6.3%) had oligomenorrhea and differed significantly in serum androgens and AMH, age at and time since menarche from girls with regular cycles. Twenty-seven girls were classified with PCOS (8.5%) and had significantly higher 17-OH-progesterone, estradiol, AMH, LH, and age at menarche than the reference group. Girls on oral contraception had significantly higher serum SHBG concentrations and lower serum concentrations of all hormones except AMH and IGF-1. Ovarian follicles 2 to 29.9 mm correlated positively with serum AMH (P < 0.0001). Conclusions Most 16-year-old girls had regular menstrual cycles, normal reproductive hormones, and uterine and ovarian ultrasound. Serum AMH reflected ovarian follicle count and may be a useful biomarker of ovarian reserve.

The purpose of this systematic review and meta-analysis was to examine the effects of simulation-based ultrasound training (SIM-UT) in obstetrics and gynecology compared to non-SIM-UT on trainee learning, clinical performance, patient-relevant outcomes, and cost of training. A systematic search was performed in June 2019 in PubMed, Embase, and Scopus using search terms for the topic and the intervention as well as certain MESH terms. Inclusion criteria were defined in accordance with the PICO question. Studies published in any language involving SIM-UT in obstetrics and gynecology compared to non-SIM-UT or no training were included. The outcomes included effects on health care provider learning and clinical performance, patient-relevant outcomes, and cost of training. Two authors evaluated the study quality with the MERSQI instrument and the Oxford Quality Scoring System. A meta-analysis was planned for the included randomized controlled trials. 15 studies were included, and 11 studies were eligible for meta-analysis. SIM-UT was significantly superior to clinical training only and theoretical teaching with standard mean differences (SMD) of 0.84 (0.08-1.61) and 1.20 (0.37-2.04), respectively. However, SIM-UT was not superior to live model training; SMD of 0.65 (-3.25-4.55). Of all studies included in the meta-analysis, 91 % favored SIM-UT over clinical training alone, theoretical teaching, or in some cases live model training. In the field of obstetrics and gynecology, SIM-UT in addition to clinical training markedly improves trainee learning, clinical performance, as well as patient-perceived quality of care.ZIEL: Ziel dieser systematischen Übersicht und Metaanalyse war es, die Auswirkungen des simulationsbasierten Ultraschalltrainings (SIM-UT) in der Geburtshilfe und Gynäkologie im Vergleich zu Nicht-SIM-UT auf das Lernen der Auszubildenden, die klinische Leistung, den patientenrelevanten Outcome und die Kosten der Ausbildung zu untersuchen. Im Juni 2019 wurde eine systematische Suche in PubMed, Embase und Scopus mit Suchbegriffen zum Thema und zur Intervention sowie mit bestimmten MESH-Begriffen durchgeführt. Die Einschlusskriterien wurden gemäß des PICO-Schemas definiert. Eingeschlossen wurden Studien jeglicher Sprache, die SIM-UT in der Geburtshilfe und Gynäkologie beinhalten und dieses mit Nicht-SIM-UT oder keiner Schulung verglichen. Die Ergebnisse umfassten Auswirkungen auf das Lernen und die klinische Leistung von Gesundheitsdienstleistern, den patientenrelevanten Outcome und Schulungskosten. Zwei Autoren bewerteten die Studienqualität mit dem MERSQI-Instrument und dem Oxford Quality Scoring System. Für die eingeschlossenen randomisierten kontrollierten Studien war eine Metaanalyse geplant. 15 Studien wurden eingeschlossen, 11 Studien waren für eine Metaanalyse geeignet. SIM-UT war der reinen klinischen Ausbildung und dem theoretischen Unterricht mit mittleren Standarddifferenzen (SMD) von 0,84 (0,08–1,61) bzw. 1,20 (0,37–2,04) signifikant überlegen. Allerdings war SIM-UT der Ausbildung am lebenden Modell nicht überlegen. Die SMD betrug 0,65 (–3,25–4,55). Von allen in die Metaanalyse einbezogenen Studien bevorzugten 91 % SIM-UT gegenüber der reinen klinischen Ausbildung, dem theoretischen Unterricht oder in einigen Fällen gegenüber der Ausbildung am lebenden Modell. Im Bereich der Geburtshilfe und Gynäkologie verbessert SIM-UT zusätzlich zur klinischen Ausbildung das Lernen der Auszubildenden, die klinische Leistung sowie die vom Patienten wahrgenommene Qualität der Versorgung deutlich.

Context: A long-standing myth in medical education research is a divide between two different poles: research aiming to advance theory with little focus on practical applications (‘ivory tower’ research) and practically oriented research aiming to serve educators and decision-makers with little focus on advancing theory (‘in-the-trenches’ practice). We explored this myth in a sample of randomised medical education studies using Stokes’ four-quadrant framework for the classification of research perspective. Methods: We searched MEDLINE, Embase, CINAHL, PsychINFO, ERIC, Web of Science and Scopus for studies in medical education using a randomised design that were published between 1 January 2018 and 31 December 2018. We used Stokes’ four-quadrant framework to categorise the studies according to their use of theory, concepts and their justification for practical use. We compared medical education research published in medical education journals and clinical journals. Results: A total of 150 randomised studies were included in the analysis. The largest segment of studies (46.7%) was categorised as use-inspired basic research (Pasteur's Quadrant), closely followed by pure applied research (40.7%, Edison's Quadrant). Only a few studies were categorised as aiming to advance knowledge with no thought for practical educational application (2.0%, Bohr's Quadrant). The proportion of studies that included educational concepts and theory differed according to publication in clinical journals or medical education journals: 40.5% vs 71.8%, respectively, P

Objectives The aim of this study was to examine the validity of a simulator test designed to evaluate focused assessment with sonography for trauma (FAST) skills. Methods Participants included a group of ultrasound novices (n = 25) and ultrasound experts (n = 10). All participants had their FAST skills assessed using a virtual reality ultrasound simulator. Procedural performance on the 4 FAST windows was assessed by automated simulator metrics, which received a passing or failing score. The validity evidence for these simulator metrics was examined by a stepwise approach according to the Standards for Educational and Psychological Testing. Metrics with validity evidence were included in a simulator test, and the reliability of test scores was determined. Finally, a pass/fail level for procedural performance was established. Results Of the initial 55 metrics, 34 (61.8%) had validity evidence (P

Objective To provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. Methods The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio (ICER) and (iv) estimating cost‐effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to CLM training (midwife‐performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model. Results Intervention‐group participants needed a mean 268.2 (95% confidence interval [CI], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3‒65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician‐performed CLM was the most cost‐effective strategy, whereas midwife‐performed CLM was cost‐effective for WTP values above EUR 0.73 minute−1. Conclusion Cost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable., Discuss ideas arising from the article at http://www.mededuc.com discuss.

INTRODUCTION: There is no international consensus on the orientation of transvaginal ultrasound images and no evidence exists to support the superiority of one image orientation over the other. The aim of this study was to compare learning curves and skills transfer in a group of novices randomized to top-down or bottom-up image orientation, and to determine whether individual preferences for image orientation affect learning and skills transfer.MATERIAL AND METHODS: 60 senior medical students, with no prior ultrasound experience, were randomized to orient the image top-down or bottom-up during training on an ultrasound simulator until attaining expert levels of performance. Participants then completed a transfer test involving a systematic ultrasound examination on a physical mannequin using real ultrasound equipment. Performance was assessed during the transfer test by two independent raters using the objective structured assessment of ultrasound skills (OSAUS) score and a global rating score.RESULTS: The bottom-up group reached the expert level with significantly fewer attempts than did the top-down group [median ± interquartile range: 4 ± 2 vs 5 ± 3] (U = 285.5, P = 0.014). The bottom-up group used less time to achieve the expert level (median ± interquartile range: 3 h 2 m ± 1 h 14 m vs 3 h 28 m ± 2 h 21 m) (U = 301.5, P = 0.029). The two groups performed similarly during the transfer test with respect to their OSAUS scores (top-down 56.7% vs bottom-up 53.2%, P = 0.13). The global rating scores were higher in the top-down group (top-down 57.1% vs bottom-up 50.0%, P = 0.02).CONCLUSIONS: Orientation of the images bottom-up rather than top-down, led to a steeper learning curve, but had little or no impact on the subsequent transfer of skills.

BACKGROUND: Point-of-care ultrasonography plays an increasingly important role in the initial resuscitation of critically ill patients but acquisition of the skill is associated with long learning curves. The skills required to perform ultrasound examinations can be practiced in a simulated setting before being performed on actual patients. The aim of this study was to investigate the learning curves for novices training the FAST protocol on a virtual-reality simulator.METHODS: Ultrasound novices (N = 25) were instructed to complete a FAST training program on a virtual-reality ultrasound simulator. Participants were instructed to continue training until they reached a previously established mastery learning level, which corresponds to the performance level of a group of ultrasound experts. Performance scores and time used during each FAST examination were used to determine participants' learning curves.RESULTS: The participants attained the mastery learning level within a median of three (range two to four) attempts corresponding to a median of 1 h 46 min (range 1 h 2 min to 3 h 37 min) of simulation training. The ultrasound novices' examination speed improved significantly with training, and continued to improve even after they attained the mastery learning level (P = 0.011). Twenty-three participants attained the mastery learning level.CONCLUSION: Novices can attain mastery learning levels using simulation-based ultrasound training with less than, on average, 2 h of practice. However, we found large variations in the amount of training needed, which raises questions about the adequacy of current volume-based models for determining ultrasound competency.

The aim of this study was to examine the validity of a simulator test designed to evaluate focused assessment with sonography for trauma (FAST) skills.Participants included a group of ultrasound novices (n = 25) and ultrasound experts (n = 10). All participants had their FAST skills assessed using a virtual reality ultrasound simulator. Procedural performance on the 4 FAST windows was assessed by automated simulator metrics, which received a passing or failing score. The validity evidence for these simulator metrics was examined by a stepwise approach according to the Standards for Educational and Psychological Testing. Metrics with validity evidence were included in a simulator test, and the reliability of test scores was determined. Finally, a pass/fail level for procedural performance was established.Of the initial 55 metrics, 34 (61.8%) had validity evidence (P .01). A simulator test was constructed based on the 34 metrics with established validity evidence, and test scores were calculated as percentages of the maximum score. The median simulator test scores were 14.7% (range, 0%-47.1%) and 94.1% (range, 94.1%-100%) for novices and experts, respectively (P .001). The pass/fail level was determined to be 79.7%.The performance of FAST examinations can be assessed in a simulated setting using defensible performance standards, which have both good reliability and validity.

PURPOSE: To collect validity evidence for the assessment of mastery learning on a virtual reality transabdominal ultrasound simulator.MATERIALS AND METHODS: We assessed the validity evidence using Messick's framework for validity. The study included 20 novices and 9 ultrasound experts who all completed 10 obstetric training modules on a transabdominal ultrasound simulator that provided automated measures of performance for each completed module (i. e., simulator metrics). Differences in the performance of the two groups were used to identify simulator metrics with validity evidence for the assessment of mastery learning. The novices continued to practice until they had attained mastery learning level.RESULTS: One-third of the simulator metrics discriminated between the two groups. The median simulator scores from a maximum of 40 metrics were 17.5 percent (range 0 - 45.0 percent) for novices and 90.0 percent (range 85.0 - 97.5) for experts, p CONCLUSION: This study found that validity evidence for the assessment of mastery learning in simulation-based ultrasound training can be demonstrated and that ultrasound novices can attain mastery learning levels with less than 5 hours of training. Only one-third of the standard simulator metrics discriminated between different levels of competence.

CONTEXT: Traditionally, trainees are instructed to practise with as few errors as possible during simulation-based training. However, transfer of learning may improve if trainees are encouraged to commit errors. The aim of this study was to assess the effects of error management instructions compared with error avoidance instructions during simulation-based ultrasound training.METHODS: Medical students (n = 60) with no prior ultrasound experience were randomised to error management training (EMT) (n = 32) or error avoidance training (EAT) (n = 28). The EMT group was instructed to deliberately make errors during training. The EAT group was instructed to follow the simulator instructions and to commit as few errors as possible. Training consisted of 3 hours of simulation-based ultrasound training focusing on fetal weight estimation. Simulation-based tests were administered before and after training. Transfer tests were performed on real patients 7-10 days after the completion of training. Primary outcomes were transfer test performance scores and diagnostic accuracy. Secondary outcomes included performance scores and diagnostic accuracy during the simulation-based pre- and post-tests.RESULTS: A total of 56 participants completed the study. On the transfer test, EMT group participants attained higher performance scores (mean score: 67.7%, 95% confidence interval [CI]: 62.4-72.9%) than EAT group members (mean score: 51.7%, 95% CI: 45.8-57.6%) (p < 0.001; Cohen's d = 1.1, 95% CI: 0.5-1.7). There was a moderate improvement in diagnostic accuracy in the EMT group compared with the EAT group (16.7%, 95% CI: 10.2-23.3% weight deviation versus 26.6%, 95% CI: 16.5-36.7% weight deviation [p = 0.082; Cohen's d = 0.46, 95% CI: -0.06 to 1.0]). No significant interaction effects between group and performance improvements between the pre- and post-tests were found in either performance scores (p = 0.25) or diagnostic accuracy (p = 0.09).CONCLUSIONS: The provision of error management instructions during simulation-based training improves the transfer of learning to the clinical setting compared with error avoidance instructions. Rather than teaching to avoid errors, the use of errors for learning should be explored further in medical education theory and practice.