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Background Simulation via Instant Messaging - Birmingham Advance (SIMBA) aimed to improve clinicians’ confidence in managing various clinical scenarios during the COVID-19 pandemic. Methods Five SIMBA sessions were conducted between May and August 2020. Each session included simulation of scenarios and interactive discussion. Participants’ self-reported confidence, acceptance, and relevance of the simulated cases were measured. Results Significant improvement was observed in participants’ self-reported confidence (overall n = 204, pConclusion SIMBA is a novel pedagogical virtual simulation-based learning model that improves clinicians’ confidence in managing conditions across various specialties.

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); pConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

In response to COVID-19, the delivery of medical education has largely transitioned from face-to-face teaching to virtual platforms. Simulation-based learning is a useful teaching modality to develop clinicians' knowledge and skills, while protecting patients from harm.[1][1] While simulation has

BackgroundLeadership and teamwork skills are essential components of medical education. Simulation via Instant Messaging-Birmingham Advance (SIMBA) is an innovative simulation-based learning tool mainly delivered by medical students and junior doctors. This study aimed to investigate the effect of SIMBA on leadership and teamwork skills of medical students and junior doctors during COVID-19.MethodsAll medical students and junior doctors involved in the delivery of SIMBA were invited to complete the Leadership Trait Questionnaire (LTQ) and Teamwork Skills Questionnaire (TSQ) assessing their views pre-SIMBA and post-SIMBA involvement. The changes in scores were analysed using the Wilcoxon signed-rank test. Open-ended questions were reviewed in an inductive thematic analysis.ResultsA total of 33 SIMBA team members completed both questionnaires. There was improvement in all traits measured in the LTQ and TSQ, significant in 9/14 LTQ traits, and all 6 TSQ traits (pConclusionsSIMBA is an effective model to inculcate leadership and teamwork skills among medical students and junior doctors. Prospective studies are underway to assess long-term impact.

Background Simulation via Instant Messaging- Birmingham Advance (SIMBA) delivers simulation-based learning (SBL) through WhatsApp® and Zoom® based on Kolb’s experiential learning theory. This study describes how Kolb’s theory was implemented in practice during SIMBA adrenal session. Methods SIMBA adrenal session was conducted for healthcare professionals and replicated Kolb’s 4-stage cycle: (a) concrete experience—online simulation of real-life clinical scenarios, (b) reflective observation—discussion and Q&A following simulation, (c) abstract conceptualisation—post-session MCQs, and (d) active experimentation—intentions to implement the acquired knowledge in future practice. Participants’ self-reported confidence levels for simulated and non-simulated cases pre- and post-SIMBA were analysed using Wilcoxon Signed-Rank test. Key takeaway and feedback were assessed quantitatively and qualitatively in a thematic analysis. Results Thirty-three participants were included in the analysis. A Wilcoxon signed-rank test showed that the SIMBA session elicited a statistically significant change in participants’ self-reported confidence in their approach to Cushing’s syndrome (Z = 3.873, p = 0.0001) and adrenocortical carcinoma (Z = 3.970, p n = 31/33) and 84.8% (n = 28/33) strongly agreed/agreed the topics were applicable to their clinical practice and accommodated their personal learning style, respectively. 81.8% (n = 27/33) reported increase in knowledge on patient management, and 75.8% (n = 25/33) anticipated implementing learning points in their practice. Conclusions SIMBA effectively adopts Kolb’s theory to provide best possible experience to learners, highlighting the advantages of utilising social media platforms for SBL in medical education. The ability to conduct SIMBA sessions at modest cost internationally paves way to engage more healthcare professionals worldwide.

The COVID-19 pandemic has disrupted medical education internationally. As a result, medical students and doctors in training have missed out on months of essential training and career progression. Thus, the use of media has evolved and expanded exponentially to deliver medical education remotely.1 Hargis and Wilcox discussed the potential use of media in medical education to enhance the learning environment.2 Different types of media possess unique characteristics and are feasible educational tools to promote learning. These include text documents, infographics, podcasts, videos, webinars and social media platforms. In this letter, we share our experience of designing a teaching intervention incorporating different media. We also highlight the potential uses of other media based on our non-systematic review of the use of media in medical education. ### Simulation via Instant Messaging—Birmingham Advance (SIMBA) SIMBA is an innovative simulation-based learning intervention initially conceptualised for postgraduate medical education. SIMBA uses WhatsApp to facilitate real-time interaction between learners and moderators. Real-life clinical cases are selected and approved by specialist consultants. Anonymised patient data are used to create transcripts (online supplemental material 1), used by moderators to provide standardised responses and progress participants through case simulation. Moderators adopt the roles of a patient, senior clinician and individuals in the multidisciplinary team at different points during the simulation, which is initiated by prompting learners with the presenting issues of patients. Participants then elicit the patient history, physical examinations, investigations, propose diagnoses and appropriate management/follow-up plans. This is followed by a debrief session chaired by an expert in the specialty who highlights the key clinical aspects …

Background Simulation-based learning (SBL) has been increasingly used in both undergraduate and postgraduate medical training curricula. The aim of Simulation via Instant Messaging-Birmingham Advance (SIMBA) is to create a simple virtual learning environment to improve trainees’ self-reported confidence in diabetes and Endocrinology. Methods This study was done as part of the continuous professional development for Health Education England West Midlands speciality trainees in diabetes and Endocrinology. Standardized transcripts of anonymized real-life endocrinology (endocrine session) and diabetes cases (diabetes session) were used in the simulation model. Trainees interacted with moderators through WhatsApp® in this model. All cases were then discussed in detail by a consultant endocrinologist with reference to local, national and international guidelines. Trainee acceptance rate and improvement in their self-reported confidence levels post-simulation were assessed. Results 70.8% (n = 17/24) and 75% (n = 18/24) strongly agreed the simulation session accommodated their personal learning style and the session was engaging. 66.7% (n = 16/24) strongly felt that the simulation was worth their time. In the endocrine session, there was a significant improvement in trainees’ confidence in the management of craniopharyngioma (p = 0.0179) and acromegaly (p = 0.0025). There was a trend towards improved confidence levels to manage Cushing’s disease and macroprolactinoma. In diabetes session, there was a significant improvement in trainees’ confidence to interpret continuous glucose monitor readings (p = 0.01). There was a trend towards improvement for managing monogenic diabetes, hypoglycaemic unawareness and interpreting Libre readings. Overall, there was a significant improvement in trainees’ confidence in managing cases that were discussed post-simulation. Conclusion SIMBA is an effective learning model to improve trainees’ confidence to manage various diabetes and endocrine case scenarios. More sessions with a variety of other speciality case scenarios are needed to further assess SIMBA’s effectiveness and application in other areas of medical training.

Emergency general surgery (EGS) is a high-risk process and is associated with poor outcomes and high mortality. This study aimed to evaluate the service delivery factors in a tertiary referral centre which may influence patient outcomes in emergency general surgery.Data on consecutive patients undergoing emergency laparotomy in a tertiary referral centre were prospectively collected from July 2017-July 2018. An extensive review of patient charts and IT systems was performed to extract demographic, clinical and care pathway data. Transfers for surgery from within the institution or within the centralised hospital network were recorded.The unadjusted 30-day mortality rate in 163 patients undergoing emergency laparotomy was 13%. On multivariate analysis, 30-day mortality was significantly associated with p-POSSUM predicted mortality (p = 0.003), p-POSSUM predicted morbidity (p = 0.01), SORT mortality (p = 0.004), ICU admission (p = 0.02), ASA grade (p 0.001) and transfer from non-surgical services (p 0.001). 19.2% of patients were transferred from a referring hospital for emergency laparotomy. There was no association between inter-hospital transfer and 30-day mortality while increased mortality was observed in patients admitted to non-surgical services who required laparotomy (p 0.001).Inter-hospital transfer for emergency laparotomy was not associated with increased mortality. Increased mortality was observed in patients admitted to non-surgical services who subsequently required emergency laparotomy. Configuration of emergency general surgery services must accommodate safe and effective transfer of patients, both between and within hospitals.

Simulation is defined as a process that substitutes or amplifies real patient encounters with artificial models, live actors, or virtual reality patients.[1][1] The goal of simulation is to replicate patient care scenarios with guided experiences in a realistic environment.[2][2] This is usually

Proteins play a crucial role in the biomineralization of hard tissues such as eggshells. We report here the purification, characterization, and in vitro mineralization studies of a peptide, pelovaterin, extracted from eggshells of a soft-shelled turtle. It is a glycine-rich peptide with 42 amino acid residues and three disulfide bonds. When tested in vitro, the peptide induced the formation of a metastable vaterite phase. The floret-shaped morphology formed at a lower concentration ( approximately 1 microM) was transformed into spherical particles at higher concentrations (>500 microM). The solution properties of the peptide are investigated by circular dichroism (CD), fluorescence emission spectroscopy, and dynamic light scattering (DLS) experiments. The conformation of pelovaterin changed from an unordered state at a low concentration to a beta-sheet structure at high concentrations. Fluorescence emission studies indicated that the quantum yield is significantly decreased at higher concentrations, accompanied by a blue shift in the emission maximum. At higher concentrations a red-edge excitation shift was observed, indicating the restricted mobility of the peptide. On the basis of these observations, we discuss the presence of a peptide concentration-dependent monomer-multimer equilibrium in solution and its role in controlling the nucleation, growth, and morphology of CaCO(3) crystals. This is the first peptide known to induce the nucleation and stabilization of the vaterite phase in solution.

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