Universidad de Especialidades Espiritu Santo

To evaluate the effectiveness of Rapid Cycle Deliberate Practice (RCDP) compared to traditional simulation and Peyton's Four-Step Approach in improving technical and non-technical skills, during chest tube insertion and fixation in medical students.

Pilot quasi-experimental study conducted in 3 instructional cohorts. Each cohort received training through a different educational methodology: traditional simulation (control), RCDP, or Peyton's Four-Step Approach. All participants completed 2 standardized training sessions, followed by an individual simulation-based assessment. Technical performance was evaluated using the Objective Structured Assessment of Technical Skills (OSATS), patient communication skills were assessed with the CoMeD-OSCE scale, and non-technical skills such as leadership and teamwork were measured using the Non-Technical Skills for Surgeons (NOTSS) framework.

The study was conducted between August 2024 and May 2025 at a teaching simulation center in Ecuador.

A total of 55 third-year medical students completed the study. The RCDP group achieved significantly higher scores in technical performance (OSATS mean 41.11, SD 8.32, p < 0.001), patient communication (CoMeD-OSCE mean 15.27, SD 3.93, p < 0.001), and non-technical skills (NOTSS mean 39.05, SD 4.97, p < 0.001) compared to the control and Peyton groups. Strong positive correlations were observed between technical and non-technical performance (OSATS and NOTSS r = 0.84; OSATS and CoMeD r = 0.61; both p < 0.001). Female students scored significantly higher in communication (p = 0.008) but not in leadership (p = 0.254).

RCDP is an effective educational method for enhancing both technical and non-technical competencies in chest tube insertion and fixation among medical students. The integration of RCDP into simulation-based curricula may foster comprehensive clinical skill development. Future studies with randomized designs and larger sample sizes are recommended to assess long-term retention and generalizability across diverse clinical scenarios.

To compare the effectiveness of a traditional weekly simulation-based training model versus a program combining Rapid Cycle Deliberate Practice (RCDP) with spaced learning for the acquisition of intracorporeal simple suture skills in medical students.

Prospective quasi-experimental pilot study with block randomization. Students were grouped in blocks of 4 based on scheduling availability. Within each block, participants were randomly assigned to the intervention (RCDP with spaced learning) or control (traditional weekly training group). All participants received 4 sessions of laparoscopic simulation training and were assessed using blinded video evaluation. OSATS (Objective Structured Assessment of Technical Skills) and GRC (Global Rating Checklist) scores were compared using t-test or Mann-Whitney U test, pass/fail outcomes with chi-square or Fisher's exact test, and procedure time-OSATS associations with Spearman's correlation.

The study was conducted at a tertiary teaching hospital in Ecuador, between October and December 2024.

Thirty-eight students completed the study. No statistically significant differences were found between the intervention and control groups in OSATS scores: intervention: median 13, IQR 9-15; control: median 12.5, IQR 10-15.5; p = 0.889) or in Global Rating Checklist (GRC) scores; intervention: median 12, IQR 8.75-16; control: median 11.5, IQR 8-15; p = 0.890). Time metrics for individual tasks and overall procedure time were also comparable between groups (p > 0.3). Significant negative correlations were observed between total procedure time and OSATS performance scores in both groups, indicating that faster completion was associated with higher technical performance.

The combination of Rapid Cycle Deliberate Practice and spaced learning yielded comparable performance to a traditional weekly training model, despite a significant reduction in tutor-guided time and hands-on intracorporeal suture training. These findings support the potential of this approach as a viable and resource-efficient teaching alternative for basic laparoscopic skills, particularly under conditions of increased retention demand. Further studies are needed to evaluate its applicability to more complex procedures and its impact on long-term skill retention.

Inhalation of methanol vapor is a rare but potentially life-threatening occupational hazard, particularly in environments with inadequate ventilation and safety controls. We report the case of an 18-year-old male shrimp processing worker who developed acute respiratory failure following accidental inhalation of methanol vapors mislabeled as kerosene. The patient presented with severe dyspnea, hypoxemia, metabolic acidosis, and radiographic findings of diffuse pulmonary infiltrates. He required mechanical ventilation, corticosteroids, antibiotics, and intensive supportive care. Bronchoscopy revealed erythematous bronchial mucosa with hemorrhagic stippling and was followed by bronchoalveolar lavage (BAL). Based on imaging findings, therapeutic segmental pulmonary lavage (TSPL) was performed, targeting the most affected lower lobe segments. The procedure involved instillation and aspiration of small saline aliquots to remove inflammatory debris. Following TSPL, the patient exhibited marked clinical improvement, with normalization of inflammatory markers and successful extubation within 48 hours. This case illustrates the potential value of TSPL as an adjunctive therapy in methanol-induced chemical pneumonitis. Unlike standard BAL, TSPL enables targeted clearance of toxic exudates from specific lung segments, potentially accelerating recovery in patients with localized airway injury. Given the rarity of inhalational methanol poisoning and the absence of established respiratory interventions beyond supportive care, TSPL may offer a novel approach to managing severe pulmonary complications. This experience highlights the need for heightened clinical awareness of inhalational toxic exposures and further research into therapeutic lavage techniques. Our findings suggest that TSPL could be considered in selected cases of toxic inhalation injury when conventional measures fail to produce timely improvement.