Juan Cendan is a surgeon and medical educator. His background in biomedical engineering prepared him for a career in medicine and, in particular, as a researcher in the field of learning through the use of simulation. He led the department of Medical Education at UCF COM from 2014-2020 and is now Senior VP of Health Affairs and Dean of the Herbert Wertheim College of Medicine at Florida International University.
Objectives:Active learning techniques result in greater knowledge acquisition compared to passive... more Objectives:Active learning techniques result in greater knowledge acquisition compared to passive methods. For medical students with limited hands-on operative experiences, virtual reality (VR) platforms represent active learning and may enhance procedural training. We hypothesize that VR simulators like TIPS (Toolkit for Illustration of Procedures in Surgery) are a more effective modality in teaching laparoscopic surgical techniques to medical students when compared to passive learning tools like videos.Design:In this crossover study participants were randomly assigned to perform either a TIPS laparoscopic appendectomy followed by video of a laparoscopic cholecystectomy, or video of a laparoscopic appendectomy followed by TIPS laparoscopic cholecystectomy. A knowledge assessment followed each intervention. A post-survey was used to gather feedback and subjective impressions of the learning experience.Setting:University of Central Florida College of Medicine (UCF COM).Participants:Second, third, and fourth-year medical students (n=37).Results:Validation of the content assessments revealed strong internal consistency (Cronbach’s α = 0.73 ). A two-tailed Fisher’s exact test revealed that the video had greater ease of use ( p = 0.032 ), but TIPS had greater utility as a learning tool ( p < 0.001 ) and instilled greater confidence in the ability to reproduce procedural steps ( p < 0.001 ). A two-tailed T-test of the average content quiz scores revealed no significant difference in percentage correct between groups on the laparoscopic appendectomy quiz ( p = 0.772 ), but a difference favoring video learning on the laparoscopic cholecystectomy quiz ( p = 0.042 )Conclusion:Video and TIPS both enhanced different aspects of student learning; however, the active TIPS platform produced greater confidence in the ability to reproduce the steps of the procedure and had greater utility as a learning strategy. Videos are simple to use and can serve a complementary role in curriculum design.
OBJECTIVE To develop an anatomy clinical correlations module utilizing modern instructional desig... more OBJECTIVE To develop an anatomy clinical correlations module utilizing modern instructional design techniques and theoretically structured student feedback for course improvements. DESIGN A pre-experimental, single group post-test study. Eleven module sessions were structured using the 5-E instructional strategy (engage, explore, explain, elaborate, and evaluate). Learning impact was measured using Keller's ARCS framework (attention, relevance, confidence, and satisfaction) and narrative student feedback was collected to inform case alterations. The course was repeated the following year with the integrated feedback and year-on-year comparisons were drawn. SETTING Single-institution study at the University of Central Florida College of Medicine. PARTICIPANTS Medical students currently enrolled in the first-year anatomy course. RESULTS Year-on-year comparisons for AY18-19 (n = 78) and AY19-20 (n = 118) yielded statistically significant improvements in attention (4.69-4.76, p = 0.01) and relevance (4.54 to 4.75, p ≤ 0.001) with high total combined survey response rates (n = 196/238, 82.4%). Internal consistency was good for attention and strong for the following scales: total scale, relevance, confidence, and satisfaction. Narrative feedback referenced the importance of applied anatomy, clinical context and decision-making, the format of the sessions. CONCLUSIONS We structured a series of anatomic clinical correlations using an evidence-based instructional strategy, assessed its impact, and improved on the course to optimize the motivation to learn anatomy. Systematic use of structured student feedback is important to ensure case difficulty is within the zone of proximal development.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2020
Supplemental digital content is available in the text. Introduction We introduce a new type of pa... more Supplemental digital content is available in the text. Introduction We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse). Methods We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board–approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed. Results Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories. Conclusions We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.
Educational Technology Research and Development, 2016
In Part I of this two-part series, we examined the design and development of NERVE: A virtual pat... more In Part I of this two-part series, we examined the design and development of NERVE: A virtual patient simulation created to give medical students standardized experiences in interviewing, examining, and diagnosing virtual patients with cranial nerve disorders. We illustrated key design features and discussed how design-based research studies improved the total learning experience, including the virtual patient (VP) simulations and the instructional features incorporated with the simulations. In Part II, we examine the efficacy of NERVE and the strategy used to integrate the system into the medical school curriculum by field-testing it with 119 s-year medical students, and measuring students’ use, reactions, learning, and transfer. We report findings and reflect on lessons learned from the field-test to posit recommendations for improvement and guide the future research and development of virtual patient simulations.
BRIEF DESCRIPTION This SURGICAL PERSPECTIVE paper brings to our readers the general topic of &quo... more BRIEF DESCRIPTION This SURGICAL PERSPECTIVE paper brings to our readers the general topic of "followership." Leadership has received a lot of attention in the administrative education domain; however, there is a history of academic research on the role and importance of the effective follower. We review some of the critical articles in this field, and present a possible approach for incorporating the notion of effective followership in a surgical context.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily r... more Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy of the U.S. Department of Defense. References and Online Resources 1. Tekian A, Harris I. Preparing health professions education leaders worldwide: A description of masters-level programs. Med Teach. 2012;34:52–58. 2. For a list of master’s degree in HPE programs in the United States, along with their associated Web site addresses, please see Supplemental Digital Table 1, available at http://links.lww.com/ACADMED/A146. 3. For additional information on master’s degree in HPE programs worldwide, please see the Foundation for Advancement of International Medical Education and Research (www.faimer.org) and MedEdWorld (www.mededworld.org). Author contact: tekian@uic.edu Just 15 years ago, the number of master’s degree in health professions education (HPE) programs worldwide was in the single digits.1 Today, there are 121 such programs, with new HPE programs created annually.1–3 The purpose of this AM Last Page is to provide information about the existing master’s degree in HPE programs, with a focus on location, core content, and program characteristics.
BACKGROUND: Communication breakdowns during handovers contribute to adverse medical events. Hando... more BACKGROUND: Communication breakdowns during handovers contribute to adverse medical events. Handover errors have resulted in miscommunication of active medical problems, clinical conditions, medications, treatments, tests, and pending consults. The risk of miscommunications in handoffs have been suggested to be most common for novice clinicians, and 59% of residents report at least one incident of patient harm related to handoff errors. Problem patient care situations could have been anticipated during sign-out in as many as 33 of 49 cases, if potentially useful information had been communicated to allow the oncoming staff to prepare for such circumstances. Only 8% of medical schools formally teach patient handovers; however, early studiesinvestigating the effectiveness of handover interventions in medical education are promising. A didactic course and practicum on patient handovers has been shown to increase medical students’ confidence in performing handovers. Similar programs hav...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Gastroparesis following lung transplantation can complicate medical management leading to malnutr... more Gastroparesis following lung transplantation can complicate medical management leading to malnutrition, weight loss, and erratic absorption of immunosuppressive medications, which are all important factors in the success of grafts. Gastric electrical stimulation has been shown to reduce the frequency of nausea and vomiting and lead to weight gain in patients with gastroparesis refractory to standard medical treatment; however, it has not yet been reported as being used for the treatment of gastroparesis in lung transplant recipients. We report the case of a female bilateral lung transplant recipient suffering from severe gastric reflux and severe gastroparesis, who was successfully treated with simultaneous creation of a laparoscopic Nissen fundoplication and placement of a gastric stimulator. The patient noted an immediate and sustained decrease in her symptoms of nausea and vomiting, and an increased appetite, and less variability in the serum levels of her immunosuppressive medic...
Abstract Introduction The clinical breast examination is part of the female comprehensive physica... more Abstract Introduction The clinical breast examination is part of the female comprehensive physical exam and a component that can be difficult to teach to first- and second-year medical students due...
Objectives:Active learning techniques result in greater knowledge acquisition compared to passive... more Objectives:Active learning techniques result in greater knowledge acquisition compared to passive methods. For medical students with limited hands-on operative experiences, virtual reality (VR) platforms represent active learning and may enhance procedural training. We hypothesize that VR simulators like TIPS (Toolkit for Illustration of Procedures in Surgery) are a more effective modality in teaching laparoscopic surgical techniques to medical students when compared to passive learning tools like videos.Design:In this crossover study participants were randomly assigned to perform either a TIPS laparoscopic appendectomy followed by video of a laparoscopic cholecystectomy, or video of a laparoscopic appendectomy followed by TIPS laparoscopic cholecystectomy. A knowledge assessment followed each intervention. A post-survey was used to gather feedback and subjective impressions of the learning experience.Setting:University of Central Florida College of Medicine (UCF COM).Participants:Second, third, and fourth-year medical students (n=37).Results:Validation of the content assessments revealed strong internal consistency (Cronbach’s α = 0.73 ). A two-tailed Fisher’s exact test revealed that the video had greater ease of use ( p = 0.032 ), but TIPS had greater utility as a learning tool ( p < 0.001 ) and instilled greater confidence in the ability to reproduce procedural steps ( p < 0.001 ). A two-tailed T-test of the average content quiz scores revealed no significant difference in percentage correct between groups on the laparoscopic appendectomy quiz ( p = 0.772 ), but a difference favoring video learning on the laparoscopic cholecystectomy quiz ( p = 0.042 )Conclusion:Video and TIPS both enhanced different aspects of student learning; however, the active TIPS platform produced greater confidence in the ability to reproduce the steps of the procedure and had greater utility as a learning strategy. Videos are simple to use and can serve a complementary role in curriculum design.
OBJECTIVE To develop an anatomy clinical correlations module utilizing modern instructional desig... more OBJECTIVE To develop an anatomy clinical correlations module utilizing modern instructional design techniques and theoretically structured student feedback for course improvements. DESIGN A pre-experimental, single group post-test study. Eleven module sessions were structured using the 5-E instructional strategy (engage, explore, explain, elaborate, and evaluate). Learning impact was measured using Keller's ARCS framework (attention, relevance, confidence, and satisfaction) and narrative student feedback was collected to inform case alterations. The course was repeated the following year with the integrated feedback and year-on-year comparisons were drawn. SETTING Single-institution study at the University of Central Florida College of Medicine. PARTICIPANTS Medical students currently enrolled in the first-year anatomy course. RESULTS Year-on-year comparisons for AY18-19 (n = 78) and AY19-20 (n = 118) yielded statistically significant improvements in attention (4.69-4.76, p = 0.01) and relevance (4.54 to 4.75, p ≤ 0.001) with high total combined survey response rates (n = 196/238, 82.4%). Internal consistency was good for attention and strong for the following scales: total scale, relevance, confidence, and satisfaction. Narrative feedback referenced the importance of applied anatomy, clinical context and decision-making, the format of the sessions. CONCLUSIONS We structured a series of anatomic clinical correlations using an evidence-based instructional strategy, assessed its impact, and improved on the course to optimize the motivation to learn anatomy. Systematic use of structured student feedback is important to ensure case difficulty is within the zone of proximal development.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2020
Supplemental digital content is available in the text. Introduction We introduce a new type of pa... more Supplemental digital content is available in the text. Introduction We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse). Methods We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board–approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed. Results Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories. Conclusions We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.
Educational Technology Research and Development, 2016
In Part I of this two-part series, we examined the design and development of NERVE: A virtual pat... more In Part I of this two-part series, we examined the design and development of NERVE: A virtual patient simulation created to give medical students standardized experiences in interviewing, examining, and diagnosing virtual patients with cranial nerve disorders. We illustrated key design features and discussed how design-based research studies improved the total learning experience, including the virtual patient (VP) simulations and the instructional features incorporated with the simulations. In Part II, we examine the efficacy of NERVE and the strategy used to integrate the system into the medical school curriculum by field-testing it with 119 s-year medical students, and measuring students’ use, reactions, learning, and transfer. We report findings and reflect on lessons learned from the field-test to posit recommendations for improvement and guide the future research and development of virtual patient simulations.
BRIEF DESCRIPTION This SURGICAL PERSPECTIVE paper brings to our readers the general topic of &quo... more BRIEF DESCRIPTION This SURGICAL PERSPECTIVE paper brings to our readers the general topic of "followership." Leadership has received a lot of attention in the administrative education domain; however, there is a history of academic research on the role and importance of the effective follower. We review some of the critical articles in this field, and present a possible approach for incorporating the notion of effective followership in a surgical context.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily r... more Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy of the U.S. Department of Defense. References and Online Resources 1. Tekian A, Harris I. Preparing health professions education leaders worldwide: A description of masters-level programs. Med Teach. 2012;34:52–58. 2. For a list of master’s degree in HPE programs in the United States, along with their associated Web site addresses, please see Supplemental Digital Table 1, available at http://links.lww.com/ACADMED/A146. 3. For additional information on master’s degree in HPE programs worldwide, please see the Foundation for Advancement of International Medical Education and Research (www.faimer.org) and MedEdWorld (www.mededworld.org). Author contact: tekian@uic.edu Just 15 years ago, the number of master’s degree in health professions education (HPE) programs worldwide was in the single digits.1 Today, there are 121 such programs, with new HPE programs created annually.1–3 The purpose of this AM Last Page is to provide information about the existing master’s degree in HPE programs, with a focus on location, core content, and program characteristics.
BACKGROUND: Communication breakdowns during handovers contribute to adverse medical events. Hando... more BACKGROUND: Communication breakdowns during handovers contribute to adverse medical events. Handover errors have resulted in miscommunication of active medical problems, clinical conditions, medications, treatments, tests, and pending consults. The risk of miscommunications in handoffs have been suggested to be most common for novice clinicians, and 59% of residents report at least one incident of patient harm related to handoff errors. Problem patient care situations could have been anticipated during sign-out in as many as 33 of 49 cases, if potentially useful information had been communicated to allow the oncoming staff to prepare for such circumstances. Only 8% of medical schools formally teach patient handovers; however, early studiesinvestigating the effectiveness of handover interventions in medical education are promising. A didactic course and practicum on patient handovers has been shown to increase medical students’ confidence in performing handovers. Similar programs hav...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Gastroparesis following lung transplantation can complicate medical management leading to malnutr... more Gastroparesis following lung transplantation can complicate medical management leading to malnutrition, weight loss, and erratic absorption of immunosuppressive medications, which are all important factors in the success of grafts. Gastric electrical stimulation has been shown to reduce the frequency of nausea and vomiting and lead to weight gain in patients with gastroparesis refractory to standard medical treatment; however, it has not yet been reported as being used for the treatment of gastroparesis in lung transplant recipients. We report the case of a female bilateral lung transplant recipient suffering from severe gastric reflux and severe gastroparesis, who was successfully treated with simultaneous creation of a laparoscopic Nissen fundoplication and placement of a gastric stimulator. The patient noted an immediate and sustained decrease in her symptoms of nausea and vomiting, and an increased appetite, and less variability in the serum levels of her immunosuppressive medic...
Abstract Introduction The clinical breast examination is part of the female comprehensive physica... more Abstract Introduction The clinical breast examination is part of the female comprehensive physical exam and a component that can be difficult to teach to first- and second-year medical students due...
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Papers by Juan Cendan