Evaluation of multidisciplinary and pharmacy-only student-run clinics on student's perceptions of interprofessional roles

BACKGROUND AND PURPOSE

To determine how participation in multidisciplinary training workshops and student-run clinics impacts students' perceptions of the role of other health professions. Student perceptions from pharmacy-only versus multidisciplinary smoking cessation clinics were also compared.

EDUCATION ACTIVITY AND SETTING

Students from pharmacy, osteopathic medicine, physician assistant, and clinical psychology programs participated in two multidisciplinary smoking cessation training sessions, then provided smoking cessation services to the underserved population in either a multidisciplinary or pharmacy-only student-run smoking cessation clinic. Students completed a survey regarding the roles of other healthcare professionals prior to the workshops, after the workshops, and after the smoking cessation clinic.

FINDINGS

Fifty-six students attended both smoking cessation training sessions and showed statistically significant increases in familiarity and confidence related to smoking cessation after the training workshops. Forty-two students participated in the ten smoking cessations clinics, which included six multidisciplinary clinics and four pharmacy-only clinics. A statistically significant improvement was seen between the pre-workshop survey and post-clinic survey regarding the students' perception of the roles of other healthcare providers in a smoking cessation clinic. Students who participated within the multidisciplinary smoking cessation clinics experienced a significantly greater impact on their perceptions of other healthcare providers than students who participated in the pharmacy-only clinics.

SUMMARY

Student participation in a student-run free clinic is an effective method to increase role awareness of other health professional students in an underserved setting.

Accurate pain reporting training diminishes the placebo response: Results from a randomised, double-blind, crossover trial

Analgesic trials frequently fail to demonstrate efficacy of drugs known to be efficacious. Poor pain reporting accuracy is a possible source for this low essay-sensitivity. We report the effects of Accurate-Pain-Reporting-Training (APRT) on the placebo response in a trial of Pregabalin for painful-diabetic-neuropathy. The study was a two-stage randomized, double-blind trial: In Stage-1 (Training) subjects were randomized to APRT or No-Training. The APRT participants received feedback on the accuracy of their pain reports in response to mechanical stimuli, measured by R-square score. In Stage-2 (Evaluation) all subjects entered a placebo-controlled, cross-over trial. Primary (24-h average pain intensity) and secondary (current, 24-h worst, and 24-h walking pain intensity) outcome measures were reported. Fifty-one participants completed the study. APRT patients (n = 28) demonstrated significant (p = 0.036) increases in R-square scores. The APRT group demonstrated significantly (p = 0.018) lower placebo response (0.29 ± 1.21 vs. 1.48 ± 2.21, mean difference ± SD = -1.19±1.73). No relationships were found between the R-square scores and changes in pain intensity in the treatment arm. In summary, our training successfully increased pain reporting accuracy and resulted in a diminished placebo response. Theoretical and practical implications are discussed.

Theory-Informed Research Training and Mentoring of Underrepresented Early-Career Faculty at Teaching-Intensive Institutions: The Obesity Health Disparities PRIDE Program

Mentoring has been consistently identified as an important element for career advancement in many biomedical and health professional disciplines and has been found to be critical for success and promotion in academic settings. Early-career faculty from groups underrepresented in biomedical research, however, are less likely to have mentors, and in general, receive less mentoring than their majority-group peers, particularly among those employed in teaching-intensive institutions. This article describes Obesity Health Disparities (OHD) PRIDE, a theoretically and conceptually based research training and mentoring program designed for early-career faculty who trained or are employed at Historically Black Colleges and Universities (HBCUs).

Addressing sexual health in geriatrics education

Adults remain sexually active well into later life, but few report discussing sexual health with a physician after age 50. The authors explored how geriatrics education might better address sexual health in the context of a psychosocial conference for geriatrics fellows, program directors, and faculty comprising an informational plenary, which included a skills-building presentation on taking sexual histories, and a program director/faculty roundtable. Although informed about older adult sexual health, knowledge scores of geriatrics fellows increased following the plenary. Fellows reported inconsistent sexual history taking with older adults and noted patient differences in age and gender as barriers. The roundtable discussion highlighted several barriers to inclusion of sexual health content in geriatrics curricula including competing competencies, lack of educational materials, and discomfort with this topic on the part of faculty. Implications of these findings for geriatrics training and education programs and suggestions for improving this domain of geriatrics education are discussed.

Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study

OBJECTIVES

The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants' perception of usefulness of PROMPT in their clinical practice.

STUDY DESIGN

Mixed methods approach with a pre-test/post-test design.

SETTING

Healthcare network providing obstetric care in Victoria, Australia.

PARTICIPANTS

Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011-2012 (n=15 361 births) and 2014-2015 (n=12 388 births).

INTERVENTION

Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills.

MAIN OUTCOME MEASURE

Clinical outcomes compared before and after embedding PROMPT in educational practice.

SECONDARY OUTCOME MEASURE

Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice.

RESULTS

There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies.

CONCLUSION

Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes.

The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries

Background

Contextual factors play an important role in health and related behaviours. This study aims to examine the association of co-occurrence of five health-risk behaviours with healthcare and education contextual factors using nationally representative samples from 27 European countries.

Methods

Data were from Eurobarometer 72.3, 2009. The outcome was a count variable ranging from 0 to 5 indicating co-occurrence of five health-risk behaviours, namely smoking, excessive alcohol consumption, non-frequent fresh fruit consumption, physical inactivity and non-dental check-ups. Public expenditures on healthcare and education as a percentage of GDP and quality of healthcare and education at a country-level were used as contextual factors. A set of multilevel Poisson regression models were conducted to examine the associations between co-occurrence of health-risk behaviours and each of the contextual factors considering age, gender, marital status, urbanisation, individual socioeconomic positions (education, subjective social status or difficulty in paying bills) and GDP per capita.

Results

The total population was 23 842. Greater expenditures on healthcare and education, and better quality of healthcare systems had negative associations with co-occurrence of health-risk behaviours in the model adjusted for all individual demographic indicators. However, statistical significance disappeared after adjusting for socioeconomic indicators and GDP per capita.

Conclusion

While the study highlights the importance of developing high-quality healthcare and education systems generously supported by public fund in relation to co-occurrence of health-risk behaviours, the influence of contextual factors in adopting health-related behaviours is probably attenuated by individual socioeconomic factors.

Impacts of Educating for Equity Workshop on Addressing Social Barriers of Type 2 Diabetes With Indigenous Patients

INTRODUCTION

Health education about Indigenous populations in Canada (First Nations, Inuit, and Métis people) is one approach to enable health services to mitigate health disparities faced by Indigenous peoples related to a history of colonization and ongoing social inequities. This evaluation of a continuing medical education workshop, to enhance family physicians' clinical approach by including social and cultural dimensions within diabetes management, was conducted to determine whether participation in the workshop improved self-reported knowledge, skills, and confidence in working with Indigenous patients with type 2 diabetes.

METHODS

The workshop, developed from rigorous national research with Indigenous patients, diabetes care physicians, and Indigenous health medical educators, was attended by 32 family physicians serving Indigenous populations on three sites in Northern Ontario. A same-day evaluation survey assessed participants' satisfaction with workshop content and delivery. Preworkshop and postworkshop surveys consisting of 5-point Likert and open-ended questions were administered 1 week before and 3 month after the workshop. Descriptive statistics and t test were performed to analyze Likert scale questions; thematic analysis was used to elicit and cluster themes from open-ended responses.

RESULTS

Participants reported high satisfaction with all aspects of the workshop. Reporting improved understanding of socioeconomic (P = .002), psychosocial, and cultural factors (P = .001), participants also described adapting their clinical approach to more actively incorporating social and cultural factors and focusing on patient-centered care.

DISCUSSION

The workshop was effective in shifting physician's self-reported knowledge, attitudes, and skills resulting in clinical approach modifications within social, psychosocial, and cultural domains for their Indigenous patients with diabetes.

Shared decision-making for psychiatric medication: A mixed-methods evaluation of a UK training programme for service users and clinicians

BACKGROUND

Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health.

AIMS

Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators.

METHODS

The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews.

RESULTS

Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users' decisional conflict and perceptions of practitioners' interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users' and care co-ordinators confidence to explore medication experience, and group-based training was valued.

CONCLUSIONS

The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions.

Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review

INTRODUCTION

Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.

METHODS

A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project's Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.

RESULTS

The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before-after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.

CONCLUSION

The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.

Simulation Clinical Scenario Design Workshop for Practicing Clinicians

INTRODUCTION

Faculty development is important to developing skilled faculty members who are able to effectively design and deliver educational content. There has been an increase in courses designed to help faculty better teach at the bedside, but fewer options for those interested in developing their skills as simulation-based educators. Our goal was to create a workshop to train prospective simulation educators on the skills and knowledge necessary to design a clinical scenario.

METHODS

Learners participate in a 90-minute workshop utilizing short, didactic teaching and practical hands-on practice. Faculty guide learners through the process of developing targeted goals and learning outcomes, setting the scene for a clinical scenario, and storyboarding the main action. Learners work individually, but engage in peer-to-peer feedback, as well as instructor feedback, throughout the session.

RESULTS

We have run four iterations of this workshop at our institution in the past year, and developed a modified version for an international meeting. A total of 51 learners from our hospital have completed the workshop. Overall, learners agree that the workshop is informative and increases their knowledge. For each educational objective, more than 70% of participants indicated the workshop increased their competence in the area either "extremely" or "quite a bit."

DISCUSSION

This workshop provides learners hand-on practice in developing a scenario for simulation-based education. Learners leave with the tools and knowledge necessary to take the work developed in the session and create a complete scenario that can be used at our simulation center or at another facility.

Negotiating Work-Life Integration

Introduction

Integrating work and home domains is a constant challenge for medical professionals. Only half of physicians report positive work-life satisfaction, implying that negotiating the inherent conflicts between work and home may not be intuitive. Early teaching of skills focused on professional sustainability may best prepare physicians to navigate conflicts between work and home domains.

Methods

This interactive workshop targets trainees and junior faculty. It aims to highlight the current state of physician career satisfaction, to bring awareness to the risk of physician burnout, and to apply strategies that promote work-life integration as a lifelong practice for sustained career satisfaction. It includes a detailed presentation with structured resources to reinforce skill development.

Results

This workshop was delivered five times to trainees and junior faculty. Workshop evaluations (n = 50) revealed that all participants believed the information presented was useful, addressed competencies relevant to their training, and increased their knowledge about how to create better work-life integration; all anticipated improvement in their professional work. They all recommended this program to a colleague.

Discussion

This workshop offers an effective way to teach a skill set that enhances physicians' abilities to negotiate conflicting work and life domain boundaries. Our results indicate that learners intend to apply newly acquired strategies for work-life integration so as to improve career satisfaction and wellness. Such skill sets may mitigate physician burnout and promote career sustainability, both critical issues with far-reaching implications for the delivery of safe, high-quality health care at the provider and system levels.

Using whiteboards to support college students' learning of complex physiological concepts

Research underscores the importance of retrieval-based practice and application of knowledge for meaningful learning. However, the didactic lecture format continues to persist in traditional university physiology courses. A strategy called whiteboarding, where students use handheld dry erase boards and work in small groups to actively retrieve, discuss, and apply concepts presented in the lecture, has the potential to address challenges associated with actively engaging students in science courses for greater learning. The purpose of this study was to empirically examine the potential benefits of whiteboarding for increasing students' understanding of animal physiology concepts. Student performance on physiology questions assessing concepts taught using lecture only vs. concepts taught using lecture and whiteboarding were compared within the term that whiteboarding was used, as well as across whiteboard and lecture-only terms taught by the same instructor. Results showed that when whiteboarding was incorporated in the course, student performance on items that assessed concepts corresponding to the whiteboarding activities were significantly higher compared with performance on items that assessed concepts taught through lecture only. These patterns in student performance were found within and across terms. Taken together, findings point to whiteboarding as an effective tool that can be integrated in traditional lecture courses to promote students' understanding of physiology.

Approaches to education provision for mobile pastoralists

Experiences of mobile pastoralists often attest to a wide range of contradictions about the presumed advantages of formal education. While effort to 'reach' pastoralists has intensified under the global Education for All movement, there remain considerable difficulties in finding ways to make formal education relate to pastoralist livelihoods and complement endogenous knowledge. This paper examines how these dynamics play out across models of formal and non-formal education service provision, and identifies innovations that offer promising ways forward: Alternative Basic Education, Open and Distance Learning, and Pastoralist Field Schools.

Designing blended learning interventions for the 21st century student

The learning requirements of diverse groups of students in higher education challenge educators to design learning interventions that meet the need of 21st century students. A model was developed to assist lecturers, especially those that are new to the profession, to use a blended approach to design meaningful learning interventions for physiology. The aim of the model is to encourage methodical development of learning interventions, while the purpose is to provide conceptual and communication tools that can be used to develop appropriate operational learning interventions. A whole brain approach that encourages challenging the four quadrants is encouraged. The main arguments of the model are to first determine the learning task requirements, as these will inform the design and development of learning interventions to facilitate learning and the assessment thereof. Delivery of the content is based on a blended approach.

Caring for children who self-harm

Aim [Figure: see text] To co-produce, with children and young people (CYP) and registered children's nurses, a digital education programme to improve nurses' knowledge and confidence in the care of CYP injured through self-harm.

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills

BACKGROUND

Undergraduate training in core urology skills is lacking in many Irish training programmes.

AIMS

Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies.

METHODS

A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course.

RESULTS

Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2.

CONCLUSION

This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

An investigation of perceptions of programme quality support of adult basic education programmes

This study was designed to identify the degree to which the directors of adult basic education programs perceive they have program quality support, as evidenced by a well-defined mission and role in the community, a management system, human resources management, and a suitable learning environment. NSCALL's Evidence-based program self-assessment (2006) was modified and administered electronically to administrators of adult education programs in a mid-southern state. Findings indicated that most directors perceive they are implementing the indicators of program quality support in all of the areas surveyed. A research-based annual self-study that considers the quality indicators is recommended, leaving a need for an update to the NCSALL assessment for use as a program assessment instrument.

Evaluating investment in quality improvement capacity building: a systematic review

PURPOSE

Leading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building.

METHODS

We searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components.

RESULTS

48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning-stakeholder perspective; (2) planning-temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis.

CONCLUSIONS

The literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building, can be used to start closing this knowledge gap.

Child-Staff Ratios in Early Childhood Education and Care Settings and Child Outcomes: A Systematic Review and Meta-Analysis

Child-staff ratios are a key quality indicator in early childhood education and care (ECEC) programs. Better ratios are believed to improve child outcomes by increasing opportunities for individual interactions and educational instruction from staff. The purpose of this systematic review, and where possible, meta-analysis, was to evaluate the association between child-staff ratios in preschool ECEC programs and children’s outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Cross-sectional or longitudinal studies that evaluated the relationship between child-staff ratios in ECEC classrooms serving preschool aged children and child outcomes were independently identified by two reviewers. Data were independently extracted from included studies by two raters and differences between raters were resolved by consensus. Searches revealed 29 eligible studies (31 samples). Child-staff ratios ranged from 5 to 14.5 preschool-aged children per adult with a mean of 8.65. All 29 studies were included in the systematic review. However, the only meta-analysis that could be conducted was based on three studies that explored associations between ratios and children’s receptive language. Results of this meta-analysis were not significant. Results of the qualitative systematic review revealed few significant relationships between child-staff ratios and child outcomes construed broadly. Thus, the available literature reveal few, if any, relationships between child-staff ratios in preschool ECEC programs and children’s developmental outcomes. Substantial heterogeneity in the assessment of ratios, outcomes measured, and statistics used to capture associations limited quantitative synthesis. Other methodological limitations of the research integrated in this synthesis are discussed.

Parents' and Teachers' Attitudes regarding School Involvement in Education That Extends beyond the Traditional Academic Core

In a survey conducted with 1,107 parents (590 mothers, M age = 38.8 yr., SD = 5.8; 517 fathers, M age = 41.3 yr., SD = 6.0) and 123 teachers (82 women, M age = 41.1 yr., SD = 9.2; 41 men, M age = 41.3 yr., SD = 9.1) in coastal rural Southern Ostrobothnia, Finland, an assessment of the relative responsibility of the family in comparison with that of school in the teaching of various skills to children was made. Parents and teachers agreed that the school carries 30–40% of the responsibility for the teaching of socio-emotional skills, such as conflict resolution, norms and values, self-esteem, sense of justice and responsibility, and close human relations. They also agreed that school carries 50% of the responsibility for providing information about sexuality and drugs. Fathers opined that school carried a greater responsibility in teaching skills than mothers did.

Causal inferences on the effectiveness of complex social programs: Navigating assumptions, sources of complexity and evaluation design challenges

This paper explores avenues for navigating evaluation design challenges posed by complex social programs (CSPs) and their environments when conducting studies that call for generalizable, causal inferences on the intervention's effectiveness. A definition is provided of a CSP drawing on examples from different fields, and an evaluation case is analyzed in depth to derive seven (7) major sources of complexity that typify CSPs, threatening assumptions of textbook-recommended experimental designs for performing impact evaluations. Theoretically-supported, alternative methodological strategies are discussed to navigate assumptions and counter the design challenges posed by the complex configurations and ecology of CSPs. Specific recommendations include: sequential refinement of the evaluation design through systems thinking, systems-informed logic modeling; and use of extended term, mixed methods (ETMM) approaches with exploratory and confirmatory phases of the evaluation. In the proposed approach, logic models are refined through direct induction and interactions with stakeholders. To better guide assumption evaluation, question-framing, and selection of appropriate methodological strategies, a multiphase evaluation design is recommended.

Grace Under Fire: The Army Nurses of Pearl Harbor, 1941

OBJECTIVE

Much has been written about the military events of December 7, 1941; however, little has been documented about the nurses' work and experience at Pearl Harbor, Hawaii. The aerial assault on Pearl Harbor was the first time in US history that Army nurses had been on the front line of battle. Nurses quickly triaged and stabilized those who could be saved, and provided compassion and comfort to those who were dying, in an environment where the nurses were unsure of their own survival.

METHODS

Traditional historical methods and a social history framework were used in this investigation. Primary sources included oral histories from the US Army Medical Department Center of History and Heritage and the State of Hawaii's website, Hawaii Aviation. Secondary sources included published books, newspaper articles, military websites, and history texts.

RESULTS

Due to the limited bed capacity, Hickam Field Hospital converted to an evacuation hospital. Nurses, physicians, and medical corpsman triaged, stabilized, and transported those likely to survive, while staging the dead behind the building. The emergency room at Tripler Hospital was quickly flooded with patients from the battlefield, but the staff was able to sort patients appropriately to the wards, to the operating room, or provide comfort care as they died. At Schofield Hospital, collaboration between tireless doctors, nurses, and corpsmen was key to providing life-saving surgery and care.