YouTube-based critical care educational videosgo viral

William G Carlos, Kara Goss & Mohamed Morad

What problem was addressed? The intensive careunit (ICU) is a daunting place in which to beginclinical training. Trainees often find the plethora ofinformation, coupled with the severity and complex-ity of disease, overwhelming. They struggle to adaptbecause no formal textbook can fully prepare themfor the nuances of caring for critically ill patients.The ICU is unique in that learners receive little for-mal training specifically for this environment. Webelieve this environment presents distinct educa-tional challenges suited to online teaching methodstailored to the new generation of learner.What was tried? The new learner is technologicallysavvy regarding access to information and media viasmartphones and tablets. We aimed to capitalise onthis by developing visual media presentations on aYouTube channel (www.youtube.com/iucriticalcare)to allow learners to engage with humorous, pithy,visually stimulating videos that introduce keyelements of caring for critically ill patients. Wecalled this the ‘Critical Care Survival Guide’ anddeveloped it for our local medical students andinterns. The videos were created by a team ofphysicians (the authors), and were choreographedand edited utilising Chroma keying techniques, andthen linked to PowerPoint slides via video-editingsoftware. This enabled video and graphic interfacesthat highlighted key teaching points, such asventilator waveforms and ICU monitors.What lessons were learned? The response to oureducational content surprised us. It has truly ‘goneviral’. In one year of online publication, our videoshave been viewed over 77 000 times by learnersfrom all over the world. YouTube allows us to trackthe duration of view (280 000 minutes in total),country of viewership (53% is USA-based), andreceive feedback through comments posted. Inter-estingly, we now have 1550 current ‘subscribers’ toour channel on YouTube. Comments have included:‘Great production and better than just still slidesand voiceover’ and ‘Thank you so much for thesevideos, they are helping me as a nursing student!’By tracking how long learners watch each video, welearn which videos are engaging and which videosneed adjustment. Locally, our experience has beenthat students and interns who view the videos inadvance of their ICU rotation feel more preparedthan those who do not. Specifically, learners appre-ciate the videos that equip them in the psychomotor

(central lines, intubation, running codes) andknowledge (X-ray interpretation, sepsis manage-ment, ventilator alarms) domains of learning.Our perspective on medical education has been

changed by this project. The popularity of these vid-eos attests to their demand and usefulness. Themedical profession has not defined metrics to ‘mea-sure’ the significance of scholarship in the YouTuberealm; however, we believe that over 77 000 views isan impressive impact. Our success is likely to haveresulted from the format, delivery and accessibilityof the videos. They can be viewed anywhere, at anytime and in any environment. Learners are usingsmartphones, tablets and personal computers totune in. The content of the videos helps to equiplearners from the medical, nursing and respiratorymedicine fields. Finally, they showcase our teachingphilosophy that learning can be fun! We encourageothers to embrace YouTube as an educational tooland look forward to impacting more learners in theyears to come.

Correspondence: William G Carlos, Department of InternalMedicine, Indiana University School of Medicine, 541 ClinicalDrive CL 260, Indianapolis, Indiana 46202, USA.Tel: 00 1 317 691 8107; E-mail: wcarlos@iu.edu

doi: 10.1111/medu.12457

Understanding chronic disease: student exposureto support groups

Benjamin Bensadon & Germaine Odenheimer

What problems were addressed? Steady increasesin life expectancy across the developed world areresulting in a dramatic shift from acute to chronicdisease and a growing need for effective patient self-management.1 Historically, however, medical train-ing has emphasised biomedical diagnosis and cure,and has placed limited focus on supporting andmanaging the behavioural and psychosocial impactsof incurable illness, or the adequate considerationof the roles and health of informal caregivers. Toaddress this gap, future physicians require appropri-ate training.What was tried? All graduating medical students(n = 128) were exposed to dementia support groupsin order to sensitise them to the psychosocial needsof chronic disease patients and their caregivers, pre-pare them to meet those needs, and familiarise themwith support groups as an adjunct to traditionalmedical therapy. Each month during the 2012–2013academic year, the authors and students attended

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two community-based groups – one for persons diag-nosed with young-onset dementia and one for theircaregivers – as part of a required month-long geriat-ric medicine rotation. Groups were run by trainedfacilitators, lasted 1.5 hours, and took place everyother week in a local hospital. The impact on stu-dents was captured via anonymous 24-item surveysadministered immediately following the sessions(example items: ‘To what degree can support groupsbe therapeutic?’ ‘How relevant is preserving dignityto treatment?’ ‘How well are participants coping?’)and semi-structured reflective essays collected1–2 days later (example questions: ‘What themeswere discussed?’ ‘What did you learn?’).What lessons were learned? The study confirmedour hypothesis that support group exposure can filla long standing gap in training by sensitising futurephysicians to the psychosocial needs of chronic dis-ease patients and their caregivers. However, we werequite surprised by students’ willingness to recogniseand challenge their own stereotypes because thiswas not required. For many learners, this was theirfirst-ever support group exposure. They oftendescribed it as ‘eye opening’. Overall, 99% recogni-sed the therapeutic value of support groups, 86%reported that the experience taught them about liv-ing with dementia, and 83% recommended that itshould become a required component in future cur-ricula. Many ranked it as the best experience of therotation and some extended this to their entiremedical training. Students differentiated betweendidactic and experiential learning and appreciatedthe capacity of support groups to facilitate under-standing of the interaction between biomedical and‘human’ elements of illness. By reaching studentson both cognitive and affective levels, this formatenabled discussion of dignity, a somewhat abstractconcept, to occur in a compelling manner difficultto simulate in the classroom. Students acknowl-edged the unique value of learning directly frompatients and caregivers about chronic disease-relatedneeds, the medical community’s ability to meetthese needs, and related strategies they can imple-ment in their practice. Most discussions targetedcommunication. Students reported being ‘shocked’,‘surprised’ and ‘saddened’ when hearing ofinstances in which a diagnosis was disclosed bytelephone or letter rather than in person, but theyempathised and felt empowered to do better. Takentogether, results suggest medical students want tolearn more about non-biomedical aspects of care,their attitudes are modifiable, and the erosion ofempathy is not inevitable, even among Year 4trainees.

REFERENCE

1 Lorig KR, Holman HR. Self-management education:history, definition, outcomes, and mechanisms. AnnBehav Med 2003;26 (1):1–7.

Correspondence: Benjamin Bensadon, Department of IntegratedMedical Science, Charles E. Schmidt College of Medicine, FloridaAtlantic University, 777 Glades Rd, Boca Raton, FL 33431, USA.Tel: 00 1 561 297 2578; E-mail: bbensadon@fau.edu

doi: 10.1111/medu.12464

Undergraduate interprofessional paediatricsimulation in a district general hospital

Ahmed Osman

What problems were addressed? Undergraduateinterprofessional simulation-based education(IPSE) is relatively new, but its use is growingworldwide.1 The literature shows an almost univer-sally positive response, and IPSE has been usedfor teaching teamwork, leadership and communi-cation skills, as well as practical clinical skills.However, although a large proportion of under-graduate education takes place in district generalhospitals (DGHs), most reported undergraduateIPSE interventions have occurred in teaching hos-pitals or university-based simulation laboratories.This means that a potentially valuable educationaltool is not being utilised for a significant part ofthe undergraduate course. In order to address thiseducational gap, an interprofessional simulation-based teaching half-day was piloted in our DGH,based around the assessment and initial manage-ment of a sick child.What was tried? Four final-year nursing (NS) andtwo final-year medical students (MS) took part inthe pilot programme, which comprised three small-group sessions. The first session was an interactivetutorial on assessment and initial management ofsick children, followed by an interprofessional com-munication tutorial, including videos of good andbad communication.A real-time, high-fidelity simulation session fol-

lowed, in which groups of medical and nursing stu-dents managed a simulated patient as a team, usingthe assessment and communication skills developedin the previous sessions. Students played the rolesof newly qualified professionals, with a junior doctorpresent to allow them to contact a senior forsupport. Each scenario lasted 15 minutes and wasfollowed by up to 15 minutes of feedback.

ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548 527

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