STAT PEARLS- CHSOS Exam 2023 with complete
solution
What are the 6 hierarchical levels of Bloom Taxonomy?
The revised Bloom taxonomy has six hierarchical levels: remember, understand, apply,
analyze, evaluate, and create
Remember- Recall and understanding show basic knowledge of a topic. When a learner
moves to the evaluation phase, he/she has the ability to diagnose and treat but move
beyond that towards critically appraising other methods.
Understand
Apply- When a learner applies information, he/she can show how they understand the
knowledge and use it in clinical practice.
Analyze
Evaluate
Create
What type of simulation is stopped repeatedly during the scenario? When is this type of
simulation used?
RAPID CYCLE DELIBERATIVE: Feedback in rapid cycle deliberative practice comes
during multiple pauses, and micro debriefs within the scenario. Microdebriefing and the
subsequent repetition of some or all of the scenarios allow for the incorporation of this
feedback during iterative cycles of the simulation. Rapid cycle deliberative practice
allows for multiple learning points to be addressed during different micro debriefs.
Highly scripted, algorithmic cases, such as those in a resuscitation, have been studied
for use in rapid cycle deliberative practice.
A medical simulation program has been started at a facility. While participants seem to
enjoy their simulation scenarios, the post-course surveys suggest that they would like
better-quality feedback on how they have done. Before the next simulation course, a
literature review of recent trends in simulation debriefing is done, and a new debriefing
technique is considered to improve the learning experience. Which of the following
innovations is most likely to improve the quality of debriefing for the participants?
Giving observers specific tasks to complete while they observe their peers during a
scenario and using these during the feedback session. There is some evidence for the
use of "collaboration scripts," which are instructional tools with content-specific roles
and activities for non-active participants to complete while they watch others. These
may result in better quality feedback for the participants at the end of each scenario.
High-fidelity simulation is appropriate at all four levels of Miller's pyramid of clinical
competence. What are all four levels of Miller's pyramid of clinical competence? And
examples of how each level is tested.
,An understanding of educational principles such as Miller's pyramid of clinical
competence and Benner's novice-to-expert model, guide the determination of the
appropriate level of fidelity.
"Shows how" refers to the demonstration of clinical skills, which can be tested by
OSCE, standardized patients, clinical exams, etc. (competency).
"Does" refers to the top of the pyramid and correlates to daily patient care, which can be
assessed by direct observation in clinical settings (performance).
"Knows how" refers to the application of knowledge and can be tested by clinical
problem-solving.
"Knows" refers to the bottom of the pyramid and correlates with knowledge, which can
be tested by written exams.
Miller's pyramid and how it is tested (simplified)
Knows- written exams
Knows how- clinical problem solving
Shows how- OSCE, clinical exams
Does- direct observation in clinical setting
In Miller's pyramidal model, a learner progresses from knowledge (having knowledge
about a procedure) to competence (having knowledge about how to do a procedure) to
performance (being able to demonstrate the procedure) to action (actually performing
the procedure in the field).
What are latent organizational weaknesses?
unknown human errors in a system from the past that do not surface until triggered by
another event.
"If you pit a good performer against a bad system, the system will win every time."
what is deliberate practice?
Deliberate practice is an educational framework that encompasses defined and
achievable learning objectives, focussed and repetitive practice, and informative and
personalized feedback in the form of a debrief. These factors ensure that set tasks and
skills can be practiced, and feedback can be delivered in a consistent and highly
educational format.
Simulation with deliberate practice has been shown to be more effective than traditional
methods of teaching in multiple studies. However, simulation cannot replace the
benefits of actual clinical experience.
Deliberate practice is an insight into the skills we are learning. This insight allows for
further development, and if performed several times, the learner becomes a teacher and
can modify the technique based on experience.
, Deliberate practice is a higher level of understanding and learning where the
mechanical part of a skill has already being dominated as well as the functionality of the
procedure.
Deliberate practice is not just a mechanical achievement. It is also having an insight into
the procedures we are performing as well as understanding the steps.
Crowd-Sourced Assessment of Technical Skills (C-SATS)
Crowdsourcing refers to a model used by an organization in which unbiased observers
or "the crowd" perform a service. In procedural skills assessment, a video recording of
the performance is shared with the crowd, and then they are asked to evaluate the
performance using an assessment instrument.
The crowd is usually comprised of a big number of observers that are trained to
examine the videos using the same instructions.
Increasing evidence is showing that the crowd assessment correlates with surgical
experts demonstrating that crowd-sourcing can be used as an objective evaluation
method.
What is a global rating scale?
Global rating scales (GRS) uses a rating scale to evaluate the quality of the skill
developed during the training. GRS can be developed to evaluate both objective and
subjective criteria for evaluation. GRS can be used for evaluating non-technical skills
like coordination and communication skills, which are essential for enhancing the
outcomes in disaster medicine.
EP vs SP
The ideal use of EPs (embedded Simulation Personnel) includes scripting and training
all roles and teaching them the timing of the scenario as well as its learning objectives.
EPs should also be included in rehearsal simulation scenarios and offered feedback on
their role.
Vs Standardized Patient
Direct Cost vs Opportunity Cost vs Material Cost vs Indirect Cost
This is a prime example of an opportunity cost (Physician volunteers 10 hrs each week
doing sim). The physician is presumably giving up some clinical time in order to teach.
This clinical time given up, unless compensated in otherways represents lost income.
This is an opportunity cost to the physician that is not realized by the simulation center;
however, it should be considered.
A material cost would supply such as central line kits, mannequin, endotracheal tubes
and etc.
An indirect cost can be thought of as a cost that is realized but not directly spent on
simulation such as building maintenance, upkeep, utilities, etc.
Do SPs (standardized patients) rate physicians higher than real patients?
Simulated patients (SPs) have excellent interrater reliability but tend to rate physicians
lower than true patients would rate them. Thus it is important to validate SPs and
ensure that they are assessing appropriately internally.
solution
What are the 6 hierarchical levels of Bloom Taxonomy?
The revised Bloom taxonomy has six hierarchical levels: remember, understand, apply,
analyze, evaluate, and create
Remember- Recall and understanding show basic knowledge of a topic. When a learner
moves to the evaluation phase, he/she has the ability to diagnose and treat but move
beyond that towards critically appraising other methods.
Understand
Apply- When a learner applies information, he/she can show how they understand the
knowledge and use it in clinical practice.
Analyze
Evaluate
Create
What type of simulation is stopped repeatedly during the scenario? When is this type of
simulation used?
RAPID CYCLE DELIBERATIVE: Feedback in rapid cycle deliberative practice comes
during multiple pauses, and micro debriefs within the scenario. Microdebriefing and the
subsequent repetition of some or all of the scenarios allow for the incorporation of this
feedback during iterative cycles of the simulation. Rapid cycle deliberative practice
allows for multiple learning points to be addressed during different micro debriefs.
Highly scripted, algorithmic cases, such as those in a resuscitation, have been studied
for use in rapid cycle deliberative practice.
A medical simulation program has been started at a facility. While participants seem to
enjoy their simulation scenarios, the post-course surveys suggest that they would like
better-quality feedback on how they have done. Before the next simulation course, a
literature review of recent trends in simulation debriefing is done, and a new debriefing
technique is considered to improve the learning experience. Which of the following
innovations is most likely to improve the quality of debriefing for the participants?
Giving observers specific tasks to complete while they observe their peers during a
scenario and using these during the feedback session. There is some evidence for the
use of "collaboration scripts," which are instructional tools with content-specific roles
and activities for non-active participants to complete while they watch others. These
may result in better quality feedback for the participants at the end of each scenario.
High-fidelity simulation is appropriate at all four levels of Miller's pyramid of clinical
competence. What are all four levels of Miller's pyramid of clinical competence? And
examples of how each level is tested.
,An understanding of educational principles such as Miller's pyramid of clinical
competence and Benner's novice-to-expert model, guide the determination of the
appropriate level of fidelity.
"Shows how" refers to the demonstration of clinical skills, which can be tested by
OSCE, standardized patients, clinical exams, etc. (competency).
"Does" refers to the top of the pyramid and correlates to daily patient care, which can be
assessed by direct observation in clinical settings (performance).
"Knows how" refers to the application of knowledge and can be tested by clinical
problem-solving.
"Knows" refers to the bottom of the pyramid and correlates with knowledge, which can
be tested by written exams.
Miller's pyramid and how it is tested (simplified)
Knows- written exams
Knows how- clinical problem solving
Shows how- OSCE, clinical exams
Does- direct observation in clinical setting
In Miller's pyramidal model, a learner progresses from knowledge (having knowledge
about a procedure) to competence (having knowledge about how to do a procedure) to
performance (being able to demonstrate the procedure) to action (actually performing
the procedure in the field).
What are latent organizational weaknesses?
unknown human errors in a system from the past that do not surface until triggered by
another event.
"If you pit a good performer against a bad system, the system will win every time."
what is deliberate practice?
Deliberate practice is an educational framework that encompasses defined and
achievable learning objectives, focussed and repetitive practice, and informative and
personalized feedback in the form of a debrief. These factors ensure that set tasks and
skills can be practiced, and feedback can be delivered in a consistent and highly
educational format.
Simulation with deliberate practice has been shown to be more effective than traditional
methods of teaching in multiple studies. However, simulation cannot replace the
benefits of actual clinical experience.
Deliberate practice is an insight into the skills we are learning. This insight allows for
further development, and if performed several times, the learner becomes a teacher and
can modify the technique based on experience.
, Deliberate practice is a higher level of understanding and learning where the
mechanical part of a skill has already being dominated as well as the functionality of the
procedure.
Deliberate practice is not just a mechanical achievement. It is also having an insight into
the procedures we are performing as well as understanding the steps.
Crowd-Sourced Assessment of Technical Skills (C-SATS)
Crowdsourcing refers to a model used by an organization in which unbiased observers
or "the crowd" perform a service. In procedural skills assessment, a video recording of
the performance is shared with the crowd, and then they are asked to evaluate the
performance using an assessment instrument.
The crowd is usually comprised of a big number of observers that are trained to
examine the videos using the same instructions.
Increasing evidence is showing that the crowd assessment correlates with surgical
experts demonstrating that crowd-sourcing can be used as an objective evaluation
method.
What is a global rating scale?
Global rating scales (GRS) uses a rating scale to evaluate the quality of the skill
developed during the training. GRS can be developed to evaluate both objective and
subjective criteria for evaluation. GRS can be used for evaluating non-technical skills
like coordination and communication skills, which are essential for enhancing the
outcomes in disaster medicine.
EP vs SP
The ideal use of EPs (embedded Simulation Personnel) includes scripting and training
all roles and teaching them the timing of the scenario as well as its learning objectives.
EPs should also be included in rehearsal simulation scenarios and offered feedback on
their role.
Vs Standardized Patient
Direct Cost vs Opportunity Cost vs Material Cost vs Indirect Cost
This is a prime example of an opportunity cost (Physician volunteers 10 hrs each week
doing sim). The physician is presumably giving up some clinical time in order to teach.
This clinical time given up, unless compensated in otherways represents lost income.
This is an opportunity cost to the physician that is not realized by the simulation center;
however, it should be considered.
A material cost would supply such as central line kits, mannequin, endotracheal tubes
and etc.
An indirect cost can be thought of as a cost that is realized but not directly spent on
simulation such as building maintenance, upkeep, utilities, etc.
Do SPs (standardized patients) rate physicians higher than real patients?
Simulated patients (SPs) have excellent interrater reliability but tend to rate physicians
lower than true patients would rate them. Thus it is important to validate SPs and
ensure that they are assessing appropriately internally.
