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George B, Hampton K, Elliott M. Effectiveness of an educational intervention on first-year nursing students' knowledge and confidence to perform basic life support: a quasi-experimental study. Contemp Nurse 2023; 59:478-490. [PMID: 38019880 DOI: 10.1080/10376178.2023.2287075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Knowing how to respond effectively to an acutely deteriorating patient is a National Safety and Quality Health Service Standard and a requirement for nurse registration with the Australian Health Practitioner Regulatory Authority. Literature has highlighted that a lack of knowledge, skills and confidence in healthcare professionals to perform basic life support may be a contributing factor to the high mortality and morbidity rates associated with cardiac arrest in the hospital setting. AIM To explore first-year nursing students' knowledge and confidence to perform basic life support according to the Australian Resuscitation Council guidelines before and after watching an online video lecture. METHOD A quantitative quasi-experimental pre- and post-test design to measure changes, if any, in first-year nursing students' knowledge and confidence to perform basic life support at an Australian university in 2021. FINDINGS The collected data were analysed using Stata, a statistical software for data sciences. Participants' mean knowledge score increased from 9.3 (SD: 2.5) in the pre-test to 13.9 (SD: 3) (p < 0.001) in the post-test (maximum possible score: 19). Participants' mean confidence score increased from 17.0 (SD: 6.3) in the pre-test to 24.5 (SD: 4.4) (p < 0.001) in the post-test (maximum possible score: 30; p < 0.001). DISCUSSION The most significant improvement in knowledge was observed in chest compression rate, breathing/ ventilation and checking patient response. The study found that the video lecture is an effective teaching method to increase students' confidence to perform basic life support. CONCLUSION An online video-recorded lecture can increase undergraduate student nurses' knowledge and confidence to perform basic life support. This is one educational strategy that universities can use to improve students' knowledge and confidence to perform this essential skill for practice.
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Affiliation(s)
- Basil George
- School of Nursing & Midwifery, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Kerry Hampton
- School of Nursing & Midwifery, Monash University, Wellington Road, Clayton, VIC 3800, Australia
- Nursing and Midwifery, Monash University, Clayton, Australia
| | - Malcolm Elliott
- School of Nursing & Midwifery, Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Knudsen MH, Breindahl N, Dalsgaard TS, Isbye D, Mølbak AG, Tiwald G, Svendsen MBS, Konge L, Bergström J, Todsen T. Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study. J Med Internet Res 2023; 25:e45210. [PMID: 37279049 DOI: 10.2196/45210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. OBJECTIVE This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. METHODS Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). RESULTS We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). CONCLUSIONS This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.
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Affiliation(s)
- Marie Høxbro Knudsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Breindahl
- Prehospital Center Region Zealand, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
| | - Tor-Salve Dalsgaard
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Dan Isbye
- Department of Anesthesia, Section 6011, Centre of Head and Orthopeadics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Gerhard Tiwald
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanna Bergström
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Church HR, Murdoch-Eaton D, Sandars J. Under- and post-graduate training to manage the acutely unwell patient: a scoping review. BMC MEDICAL EDUCATION 2023; 23:146. [PMID: 36869334 PMCID: PMC9983517 DOI: 10.1186/s12909-023-04119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Junior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach. METHODS The review, informed by the Arksey and O'Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022. RESULTS Seventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study. CONCLUSIONS The results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.
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Affiliation(s)
- Helen R Church
- Faculty of Medicine and Health Sciences, University of Nottingham, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK.
| | - Deborah Murdoch-Eaton
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, England, UK
| | - John Sandars
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, England, UK
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Ashokka B, Ching Lee DW, Dong C. Twelve tips for developing a systematic acute care curriculum for medical students. MEDICAL TEACHER 2023; 45:17-24. [PMID: 34663178 DOI: 10.1080/0142159x.2021.1987405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students' reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals.
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Affiliation(s)
- Balakrishnan Ashokka
- Department of Anaesthesia, National University Health System, Singapore, Singapore
- Centre for Medical Education, CenMED, National University of Singapore, Singapore, Singapore
| | | | - Chaoyan Dong
- Education Office, Sengkang General Hospital, Singapore, Singapore
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Orsi A, Watson A, Wijegoonewardene N, Botan V, Lloyd D, Dunbar N, Asghar Z, Siriwardena AN. Perceptions and experiences of medical student first responders: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:721. [PMID: 36242030 PMCID: PMC9561313 DOI: 10.1186/s12909-022-03791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective. METHODS We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12. RESULTS We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD - index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills. CONCLUSION MSFRs' attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.
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Affiliation(s)
- Andrew Orsi
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
- East Midlands School of Anaesthesia, Health Education England, Leeds, UK
| | - Adam Watson
- Medical Science Division, University of Oxford, Oxford, UK
| | | | - Vanessa Botan
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Dylan Lloyd
- Medical School, University of Buckingham, Buckingham, UK
| | - Nic Dunbar
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Zahid Asghar
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
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Selvan K, Clark A, Walters R, Jain S, Kaul V, Richards JB, Caverzagie KJ, Dallaghan GB, Stewart NH. Subinternships in the Medical Intensive Care Unit: A Needs Assessment. ATS Sch 2022; 3:352-357. [PMID: 36312812 PMCID: PMC9585702 DOI: 10.34197/ats-scholar.2022-0019br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kavitha Selvan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ashley Clark
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ryan Walters
- Department of Medicine, Creighton University, Omaha, Nebraska
| | - Snigdha Jain
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Viren Kaul
- Crouse Medical Practice, Syracuse, New York
| | - Jeremy B. Richards
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Kelly J. Caverzagie
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - Gary Beck Dallaghan
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Nancy H. Stewart
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Dairi MS, Aljabri MK, Bahakim AK, Aljabri AA, Alharbi TA, Alsehli AH, Alotaibi AT, Alsufyani AA, Alsairafi RA. Knowledge and Competence Towards Critical Care Concepts Among Final Year Medical Students and Interns: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1091-1101. [PMID: 36157377 PMCID: PMC9507286 DOI: 10.2147/amep.s372119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Critical care knowledge constitutes an essential component in medicine. Unfortunately, ICU knowledge acquisition is limited in many medical schools. This study is intended to measure the knowledge background, gaps, and the confidence toward critical care concepts among final year medical students and interns at Umm Al-Qura University, Saudi Arabia. METHODS This was a cross-sectional study using a self-administered online questionnaire completed by final-year medical students and interns during January and February 2022. We collected data on demographics, academic year, critical care knowledge, competency, and satisfaction. RESULTS Two-hundred-twenty-one (221) responses were analyzed. The male gender was 54.3%. A small proportion (15.8%) identified the lowest acceptable oxygen saturation in a normal person. Around three-quarters of the participants did not feel competent about nasal airway suctioning and endotracheal tube suctioning (65.6% and 75.6%, respectively). Only 7.2% of the responder correctly identified the three most useful physiological observations pertinent to quick SOFA criteria. Regarding the training adequacy for identifying critically ill patients, 59.3% answered that they are inadequately trained. Regarding the satisfaction level of exposure to critical care, 54% of the sample responded that they need further improvement. CONCLUSION Undergraduate students and interns have limited knowledge and confidence in critical care medicine. Thus, we highly recommend an early institution of a dedicated critical care training module in the medical school curriculum.
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Affiliation(s)
- Mohammad S Dairi
- Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Moayad K Aljabri
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah K Bahakim
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulkarim A Aljabri
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Tayil A Alharbi
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Anas H Alsehli
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alwaleed T Alotaibi
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Rani A Alsairafi
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
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8
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Nijhawan A, Kam J, Martin J, Forrester L, Thenabadu S, Aziz S. Medical students in the pre-hospital environment - An untapped resource for undergraduate acute care and interprofessional education. MEDICAL TEACHER 2022; 44:372-379. [PMID: 34723749 DOI: 10.1080/0142159x.2021.1994536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The King's College London Pre-hospital Care Programme (KCL PCP) is a student-run programme that provides undergraduate medical students with the opportunity to attend observer shifts with the local ambulance service. This study evaluates the contribution of pre-hospital exposure to medical students' clinical and professional development. METHODS Students were asked to complete a Likert-scale based survey on self-reported exposure and confidence in various aspects of acute patient assessment, communication and interprofessional education, both before and after the programme; additional qualitative questions querying their experience were asked post-programme. Pre and post-programme Likert-scale responses were matched and statistically analysed, alongside a thematic analysis of qualitative responses. RESULTS Exposure to ambulance service clinicians, confidence assessing acutely unwell patients, and confidence making clinical handovers all increased with statistical significance. Key areas of learning identified from the thematic analysis include increased confidence communicating with patients and families, and an enriched understanding of the work done by pre-hospital clinicians. CONCLUSIONS Time spent in the pre-hospital environment shadowing ambulance service clinicians positively contributes to acute care knowledge, inter-personal skills and interprofessional understanding. Rotating medical students through the pre-hospital environment could bridge education gaps in these areas in a manner that complements traditional pre-clinical and clinical teaching.
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Affiliation(s)
- Aditi Nijhawan
- GKT School of Medical Education, King's College London, London, UK
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Joyce Kam
- GKT School of Medical Education, King's College London, London, UK
| | - Jonathan Martin
- GKT School of Medical Education, King's College London, London, UK
| | - Lewis Forrester
- GKT School of Medical Education, King's College London, London, UK
| | - Sam Thenabadu
- GKT School of Medical Education, King's College London, London, UK
| | - Shadman Aziz
- GKT School of Medical Education, King's College London, London, UK
- Newham University Hospital, Barts Health NHS Trust, London, UK
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Ahmed N, Davids R. COVID 19: are South African junior doctors prepared for critical care management outside the intensive care unit? Pan Afr Med J 2021; 40:41. [PMID: 34795822 PMCID: PMC8571942 DOI: 10.11604/pamj.2021.40.41.30134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION the coronavirus disease 2019 (COVID-19) pandemic has negatively impacted countries across the globe. Infected individuals will seek aid at various health care facilities. Many patients will recover without requiring specialised treatment. A significant percentage of infected individuals will need critical care management, which will begin in the emergency department, generally staffed by junior doctors. Junior doctors will need to stabilize, triage and manage these patients prior to referral to specialized units. Above and beyond the usual occupational demands that accompany junior doctors in state facilities, this pandemic will thrust further responsibility on them. The objectives were to describe crisis preparedness of junior doctors in the areas of triage decision-making and critical care management, outside the intensive care unit. METHODS this is a descriptive, cross-sectional study, utilizing a web-based survey. Junior doctors in South Africa, being doctors in year one or year two of internship and community service, were invited to participate anonymously via various social media platforms. Results: a total of 210 junior doctors across South Africa answered the survey. Junior doctors expressed confidence with knowledge of intubation drugs, to perform intubation and cardiopulmonary arrest resuscitation without supervision. Only 13.3% of respondents expressed comfort with setting and adjusting ventilator settings independently. 57% of participants expressed discomfort with making critical care triage decisions. Ninety-three percent (93%) of participants expressed benefit from a telemedicine intervention. CONCLUSION junior doctors in South Africa indicate that they are prepared to initiate management of the critically ill patient outside the intensive care unit but remain uncertain in their ability to provide ongoing critical care management. The COVID-19 pandemic has highlighted the need to prepare junior doctors with the ability to manage critical care triage and management in emergency rooms. Leveraging of the workforce in South Africa may be potentiated by telemedicine interventions.
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Affiliation(s)
- Nadiya Ahmed
- Department of Surgical Sciences, Department Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa
| | - Ryan Davids
- Department of Surgical Sciences, Department Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa
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Hayden C, Raidan J, Rees J, Oswal A. Understanding junior doctors' experiences of teaching on the acute take: a qualitative study. BMC MEDICAL EDUCATION 2021; 21:383. [PMID: 34256755 PMCID: PMC8278645 DOI: 10.1186/s12909-021-02815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND New medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Supporting undergraduate learning in the acute setting can be challenging for junior doctors when balancing teaching and clinical responsibilities. Our aim was to explore junior doctors' first-hand experiences of supporting undergraduate education in the acute admissions environment(take). METHODS Fourteen junior doctors in one teaching hospital in South West England took part in semi-structured focus groups (4-6 participants in each) which were audio-recorded, transcribed, and thematically analysed. RESULTS Junior doctors described their educational role as comprising: teaching, demonstrating, coaching, and supervising. They perceived the acute take as a highly variable, unpredictable setting that offered a broad scope for learning. Tensions between doctors' clinical and educational roles were described, influenced by internal and external factors. Clinical work was prioritised over teaching and participants lacked confidence in supervisory and clinical skills. Doctors felt pressured to meet students' expectations and lacked understanding of their educational needs. Senior colleagues were highly influential in establishing an educational culture and were often a source of pressure to deliver timely clinical care. Organisations were perceived not to value teaching due to the lack of provision of dedicated teaching time and prioritisation of limited resources towards patient care. Participants managed tensions by attempting to formally separate roles, demoting students to passive observers, and they sought greater continuity in placements to better understand students' abilities and expectations. CONCLUSIONS Educational opportunities for undergraduate students on the acute take are varied and highly valuable. This study provides insight into the provision of workplace education and its challenges from junior doctors' perspectives. We highlight areas for improvement of relevance to educational providers.
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Affiliation(s)
- Charlotte Hayden
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK.
| | - Jedd Raidan
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
- University of Bristol Medical School, 5 Tyndall Avenue, BS8 1UD, Bristol, UK
| | - Jonathan Rees
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Abhishek Oswal
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
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Al Ansari M, Al Bshabshe A, Al Otair H, Layqah L, Al-Roqi A, Masuadi E, Alkharashi N, Baharoon S. Knowledge and Confidence of Final-Year Medical Students Regarding Critical Care Core-Concepts, a Comparison between Problem-Based Learning and a Traditional Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120521999669. [PMID: 35187261 PMCID: PMC8855474 DOI: 10.1177/2382120521999669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 02/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical undergraduates should be prepared to recognize life threating critical conditions. Undergraduate medical curriculum development to incorporate more critical care education is an essential requirement. Problem Based Learning curriculum has a potential advantage in providing more focused critical care education to medical undergraduate. OBJECTIVES We aimed to evaluate the final year medical students' knowledge and confidence in key critical care concepts in Problem Based Learning (PBL) curriculum compared to those in Traditional (Lecture) Based Learning curriculum. We also aimed to evaluate undergraduate's level of satisfaction with the exposure to critical care education during medical education and training. MATERIALS AND METHODS This is a cross-sectional anonymous self-administered survey questionnaire completed by two groups of final-year medical students (PBL and TBL) from three Saudi medical schools to assess the degree of undergraduate exposure to critical care and their knowledge of key critical care assessment parameters. RESULTS The responses of 279 final year medical students was analyzed (70% response rate). The majority (53%) was male and the mean age 23.9 ± 1.4 years. Only 13% of students felt confident to manage hypovolemic shock and 15% could recognize the signs of a threatened airway. One third of the students (29%) correctly identified the critical level of lactic acid in shock and less than 2% of the sample responded correctly to all the questions related to the formal assessment of critically ill patients. Lectures were the main source of information in acute care. More than two-thirds (46%) of the sample indicated that they received tuition in critical care, however the total duration spent in a critical care rotation or teaching was 1 day or less. The medical students, who completed their training with a Problem-Based Learning curriculum, had a higher knowledge base and were more confident in many critical care concepts. Only 6.5% choose critical care as their likely future career. CONCLUSION Medical undergraduates in PBL have an overall better knowledge on key concepts and assessment tools applicable to evaluating and managing critically ill patients compared to students in TBL. However the gap in knowledge and confidence in assessing ill patients in both groups is evident. Critical care was not chosen as a preferred future career in all surveyed students. There is a need for institutional support and endorsement of undergraduate critical care exposure and education in Saudi Universities both to better prepare medical students for their imminent post-graduates exposure to ill patients and to help in closing the gap in critical care physicians through promoting the specialty.
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Affiliation(s)
- Mariam Al Ansari
- Department of Adult Critical Care Medicine, King Hamad University Hospital, Bahrain
| | - Ali Al Bshabshe
- Critical Care Division, Department of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Hadil Al Otair
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Layla Layqah
- Research Office, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Al-Roqi
- Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Emad Masuadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawaf Alkharashi
- Emergency Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salim Baharoon
- Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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Major ME, Ramaekers SPJ, Engelbert RHH, Van der Schaaf M. Preparing undergraduate students for clinical work in a complex environment: evaluation of an e-learning module on physiotherapy in the intensive care unit. BMC MEDICAL EDUCATION 2020; 20:130. [PMID: 32345330 PMCID: PMC7189528 DOI: 10.1186/s12909-020-02035-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intensive Care Units (ICUs) are daunting environments for physiotherapy (PT) students performing clinical rotations. To prepare students for this environment, a newly developed, evidence-based e-learning module was designed and implemented in the undergraduate curriculum. The aim of this study was to investigate whether e-learning is a feasible method in preparing PT students for clinical work in complex ICU environments, as perceived by students and experts. METHODS A mixed methods proof of concept study was undertaken. Participants were final-year students of an international curriculum, and experts from didactic and clinical fields. An e-learning module consisting of 7 separate chapters based on the latest scientific evidence and clinical expertise was developed, piloted and incorporated into the undergraduate curriculum as a compulsory course to be completed prior to clinical ICU rotations. Data were collected through 3 focus group meetings and 5 semi-structured interviews; these meetings and interviews were audio recorded, transcribed verbatim and analyzed. RESULTS The study sample comprised of 14 students and 5 experts. Thematic analysis revealed three themes: expected competencies of PT students in ICU, feeling prepared for ICU clinical work and dealing with local variety. The e-learning module enabled students to anticipate clinical situations and PT tasks in the ICU. Higher level clinical reasoning skills, handling of lines and wires and dealing with out-of-textbook situations could not be achieved with the e-learning module alone. CONCLUSIONS An e-learning module can sufficiently prepare PT students for their clinical tasks in the ICU, as long as it is integrated with, or closely connected to, the students' clinical placement.
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Affiliation(s)
- Mel E. Major
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stephan P. J. Ramaekers
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Raoul H. H. Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marike Van der Schaaf
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Berg H, Steinsbekk A. Is individual practice in an immersive and interactive virtual reality application non-inferior to practicing with traditional equipment in learning systematic clinical observation? A randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:123. [PMID: 32326948 PMCID: PMC7181571 DOI: 10.1186/s12909-020-02030-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/01/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND The aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students. METHODS A non-inferior parallel group randomized controlled trial. The study was linked to a regular teaching program conducted in August and September 2019. All students participated in a 15-min ABCDE introduction session, before they self-practiced the ABCDE approach for 20 min in either a fully immersive and interactive VR application using hand controllers with some haptic feedback (Individual VR) or with blood pressure gauge, ear-thermometer and oximeter (Individual TP). The primary outcome was the number of students who documented all the eight predefined observations in the ABCDE approach in the correct order in a practical test on an advanced simulator manikin with a time limit of 5 min, done immediately after the self-practice. The predefined one-sided non-inferiority limit was 13% points. RESULTS Of all eligible students, 84% participated in the study and randomly allocated to VR (n = 149) or TP (n = 140). The primary outcome showed non-inferiority of the VR application with 24.8% in individual VR doing all observations in correct order compared to 27.1% TP (absolute difference 2.3% points, one sided 95% CI 2.3 to 10.8). The secondary outcomes were similar between the groups, but more students in VR reported liking the way they practiced (absolute difference 46% points, 95% CI 36.5 to 56.6) and that it was a good way to learn (36.9% points, 95% CI 26.8 to 47). VR also scored high on the System Usability Scale (mean difference 6.4% points, 95% CI 2.8-10.1). CONCLUSIONS Individual self-practicing the ABCDE approach in VR was non-inferior to individual self-practicing with traditional equipment.
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Affiliation(s)
- Helen Berg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway
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Morris NA, Czeisler BM, Sarwal A. Simulation in Neurocritical Care: Past, Present, and Future. Neurocrit Care 2020; 30:522-533. [PMID: 30361865 DOI: 10.1007/s12028-018-0629-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA. .,Division of Neurocritical Care and Emergency Neurology, University of Maryland Medical Center, 22 S. Greene St, G7K18, Baltimore, MD, 21201, USA.
| | - Barry M Czeisler
- Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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A Cognitive Load Theory Simulation Design to Assess and Manage Deteriorating Patients. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2019-0009. [DOI: 10.1515/ijnes-2019-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/05/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Cognitive load theory (CLT) uses an understanding of brain architecture for educational design, with implications for simulation. Since working memory is limited, minimising extraneous cognitive load improves learning of new tasks (intrinsic load) and use of existing knowledge (germane load). This study evaluates the effectiveness of low-fidelity simulation (LFS) utilising CLT principles in the assessment and management of the deteriorating patient (AMDP).
Method
CLT design principles informed the choice of LFS and simulation design. The self-rated ability of 13 undergraduate nurses across seven aspects of AMDP was measured in a pre-post design.
Results
Self-rated ability increased from 2.98 (SD = 0.19) to 4.47 (SD = 0.12) (p < 0.001), with improvements across all AMDP aspects.
Conclusion
This study indicates that CLT informed design has benefits for simulation. LFS may be preferred to high fidelity simulation for AMDP teaching and medical simulation for novice learners.
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Graham B, Elbeltagi H, Nelmes P, Jenkin A, Smith JE. What difference can a year make? Findings from a survey exploring student, alumni and supervisor experiences of an intercalated degree in emergency care. BMC MEDICAL EDUCATION 2019; 19:188. [PMID: 31170966 PMCID: PMC6554867 DOI: 10.1186/s12909-019-1579-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/26/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND One third of UK medical students undertake an intercalated degree, typically in traditional academic disciplines. It is less usual for students to undertake intercalated degrees that are directly aligned to a clinical speciality with longitudinal placements. This cross sectional survey aims to explore the self-reported experiences of students, alumni and supervisors associated with a clinically oriented intercalated degree in emergency care featuring a longitudinal placement in a hospital emergency department over a 9-month academic year. Themes for exploration include student clinical and academic development, effect on career choice, supervisor experience and the effect on host institutions. METHODS Current students, previous alumni, and clinical placement supervisors associated with a single intercalated degree programme in urgent and emergency care since 2005 were identified from records and using social media. Separate online surveys were then developed and distributed to current students/ previous alumni and consultant physician supervisors, between May and August 2016. Results are presented using basic descriptive statistics and selected free text comments. RESULTS Responses were obtained from 37 out of 46 contactable students, and 14 out of 24 supervisors (80 and 63%, respectively). Students self-reported increased confidence in across a range of clinical and procedural competencies. Supervisors rated student competence in clinical, inter-professional and academic writing skills to be commensurate with, or in many cases exceeding, the level expected of a final year medical student. Supervisors reported a range of benefits to their own professional and personal development from supervising students, which included improved teaching and mentoring skills, providing intellectual challenge, and helping with the completion of audits and service improvement projects. CONCLUSIONS Students report the acquisition of a range of clinical, academic, and inter-professional skills following their intercalated BSc year. A positive experience was reported by supervisors, extending to host institutions. Students reported feeling more enthusiastic about emergency medicine careers on completion. However, as students embarking on this degree naturally bring pre-existing interest in the area, it is not possible to attribute causation to these associations. Further investigation is also required to determine the longer term effect of clinically oriented intercalated degrees on career choice.
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Affiliation(s)
- Blair Graham
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Hadir Elbeltagi
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Pam Nelmes
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Annie Jenkin
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
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Almarhabi Y, Subki A, Alsallum M, Albeshri M, Mukhtar AM. Effect of the Trauma Evaluation and Management module on the knowledge of senior medical students: a prospective cohort study. Can J Surg 2019; 62:1-5. [PMID: 30900434 PMCID: PMC6738512 DOI: 10.1503/cjs.018517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 11/01/2022] Open
Abstract
Background Despite the high incidence of motor vehicle collisions and associated mortality rates in Saudi Arabia, formal trauma training and management for undergraduate medical students is not optimal. The aim of our study was to assess the effect of the Trauma Evaluation and Management (TEAM) module on trauma knowledge among senior medical students. Methods Final-year medical students were recruited between September 2016 and May 2017 at King Abdulaziz University, Jeddah. They were allocated to 1 of 2 groups: 1 group was exposed to the TEAM module, and the other was not (control group). We employed a widely used 20-item multiple-choice standardized questionnaire to assess trauma-related knowledge of both groups. Results Our study included 136 participants, 68 in the TEAM module group and 68 in the control group. The mean scores for trauma-related knowledge were 68.4% (standard deviation [SD] 15.63%) and 45.4% (SD 19.52%), respectively. Linear regression analysis showed that the TEAM module participants scored 23% higher on the test than the control participants (β = 22.94%, 95% confidence interval 16.94%–28.94%). Conclusion Mean test scores were significantly higher for those who completed the TEAM module than for those who did not. We highly recommend incorporating the TEAM module into the formal medical curriculum at all Saudi universities.
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Affiliation(s)
- Yahya Almarhabi
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Medical Students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ahmed, Mohammed, Marwan); and the Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Moniem)
| | - Ahmed Subki
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Medical Students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ahmed, Mohammed, Marwan); and the Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Moniem)
| | - Mohammed Alsallum
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Medical Students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ahmed, Mohammed, Marwan); and the Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Moniem)
| | - Marwan Albeshri
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Medical Students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ahmed, Mohammed, Marwan); and the Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Moniem)
| | - Abdel Moniem Mukhtar
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia (Yahya); the Medical Students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ahmed, Mohammed, Marwan); and the Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Moniem)
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Cecilio-Fernandes D, Brandão CFS, de Oliveira DLC, Fernandes GCVR, Tio RA. Additional simulation training: does it affect students' knowledge acquisition and retention? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:140-143. [PMID: 35514946 DOI: 10.1136/bmjstel-2018-000312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/04/2022]
Abstract
Introduction Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students' acquisition and retention of knowledge. Methods Two subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students' scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test. Results Group B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge. Conclusions Adding a simulation training, before students entered their clinical rotation, improves students' knowledge acquisition and retention compared with those who did not receive the additional simulation training.
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Affiliation(s)
- Dario Cecilio-Fernandes
- Center for Education Development and Research in Health Professions (CEDAR), research group LEARN, University of Groningen and University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | | | | | | | - René A Tio
- Department of Cardiology, Catharina Hospital, and Department of Educational Development and Research, and Faculty of Health, Medicine and Life Sciences, Maastricht University, Eindhoven, North Brabant, The Netherlands
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The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine: A Systematic Review and Meta-Analysis. Simul Healthc 2018; 12:104-116. [PMID: 28704288 DOI: 10.1097/sih.0000000000000189] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).
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George PP, Ooi CK, Leong E, Jarbrink K, Car J, Lockwood C. Return on investment in blended advanced cardiac life support training compared to face-to-face training in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818760045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Internet adoption during the past decade has provided opportunities for innovation in advanced cardiac life support (ACLS) training. With pressure on budgets across health care systems, there is a need for more cost-effective solutions. Recently, traditional ACLS training has evolved from passive to active learning technologies. The objective of this study is to compare the cost, cost-savings and return on investment (ROI) of blended ACLS (B-ACLS) and face-to-face ACLS (F-ACLS) in Singapore. Methods: B-ACLS and F-ACLS courses are offered in two training institutes in Singapore. Direct and indirect costs of training were obtained from one of the training providers. ROI was computed using cost-savings over total cost if B-ACLS was used instead of F-ACLS. Results: The estimated annual cost to conduct B-ACLS and F-ACLS were S$43,467 and S$72,793, respectively. Discounted total cost of training over the life of the course (five years) was S$107,960 for B-ACLS and S$280,162 for F-ACLS. Annual productivity loss cost account for 52% and 23% of the costs among the F-ACLS and B-ACLS, respectively. B-ACLS yielded a 160% return on the money invested. There would be 61% savings over the life of the course if B-ACLS were to be used instead of F-ACLS. Conclusion: The B-ACLS course provides significant cost-savings to the provider and a positive ROI. B-ACLS should be more widely adopted as the preferred mode of ACLS training. As a start, physicians looking for reaccreditation of the ACLS training should be encouraged to take B-ACLS instead of F-ACLS.
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Affiliation(s)
- Pradeep Paul George
- Health Services & Outcomes Research (HSOR), National Healthcare Group, Singapore
| | - Chee Kheong Ooi
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Edwin Leong
- Singapore First Aid Training Centre Pte Ltd, Singapore
| | - Krister Jarbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Craig Lockwood
- Implementation Science, The University of Adelaide, Australia
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Kukulski P, Ward M, Carter K. Ultrasound for Volume Assessment in Patients with Shock: Effectiveness of an Educational Intervention for Fourth-year Medical Students. Cureus 2018; 10:e2129. [PMID: 29610713 PMCID: PMC5878096 DOI: 10.7759/cureus.2129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective Shock is a common emergency condition with high morbidity and mortality, and judicious fluid resuscitation can significantly affect outcomes. The use of a bedside echocardiogram and evaluation of the inferior vena cava (IVC) via ultrasound (US) for collapsibility can predict volume status. Additionally, the Association of American Medical Colleges (AAMC) Entrustable Professional Activities (EPA) 10 states that residents need to be able to address a patient with a critical illness, including hypotension, on Day 1 of residency. Existing literature revealed no published curriculum to teach medical students these skills. We aimed to determine the effectiveness of an educational intervention to teach fourth-year medical students how to utilize IVC US measurement and echocardiography to assist in volume assessment of patients presenting with shock. Methods Students participated in an hour session on the first day of the emergency medicine (EM) clerkship. Didactic effectiveness was evaluated by comparing results on a pre-test and post-test. The test was administered to residents and attendings during the first week of the academic year to gain evidence for content validity. Students also responded to a survey to evaluate learner satisfaction. Results The average score on the validation test was 68.4% (standard deviation (SD): 21.6%, number (n) = 38) for residents and attendings, and 47.4% (SD: 19.4, n = 13) for interns. Students scored an average of 45.6% (SD: 23.6, n = 83) on the pre-test and 66.4% (SD: 22.1 n = 72) on the post-test, p < 0.01 (degrees of freedom (df) = 153, t = 5.7), Cohen's d = 0.92. The satisfaction survey showed 97.6% of students felt the session was worthwhile, 96.4% would recommend it to other students, and 83.1% felt it taught new information. Conclusion These results show that the educational intervention provides a significant increase in knowledge regarding volume assessment and the use of echocardiogram and IVC US. Additionally, students rated the course highly and felt that it provided information not otherwise taught in medical school. This curriculum addresses the AAMC EPA 10, as it increases students’ readiness to address hypotension and could add significant value to the medical school curriculum.
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Affiliation(s)
- Paul Kukulski
- Emergency Medicine, The University of Chicago Medicine
| | | | - Keme Carter
- Emergency Medicine, The University of Chicago Medicine
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Khan N, Jovestani K, Spencer C, Man R, Pugh M, Woywodt A. Twelve tips on how to establish a new undergraduate firm on a critical care unit. MEDICAL TEACHER 2017; 39:244-249. [PMID: 28024427 DOI: 10.1080/0142159x.2017.1266314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU. AIMS To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students. METHODS Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized. RESULTS Our new firm has exceeded all expectations and, based on student feedback, received the "Firm of the Year" award for several years in succession. It now serves as a model of undergraduate teaching in our hospital. CONCLUSIONS Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate medical education.
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Affiliation(s)
- Nasser Khan
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Keiarash Jovestani
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Craig Spencer
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Raymond Man
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Mark Pugh
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Alexander Woywodt
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
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Hogg G, Miller D. The effects of an enhanced simulation programme on medical students' confidence responding to clinical deterioration. BMC MEDICAL EDUCATION 2016; 16:161. [PMID: 27287426 PMCID: PMC4902916 DOI: 10.1186/s12909-016-0685-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/07/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND Clinical deterioration in adult hospital patients is an identified issue in healthcare practice globally. Teaching medical students to recognise and respond to the deteriorating patient is crucial if we are to address the issue in an effective way. The aim of this study was to evaluate the effects of an enhanced simulation exercise known as RADAR (Recognising Acute Deterioration: Active Response), on medical students' confidence. METHODS A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students' perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to a cohort of third-year medical students (n = 158) in the North East of Scotland 130 (82 %) were returned for analysis, employing IBM SPSS v18 and ANOVA techniques. RESULTS Students' responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students' confidence to recognise deterioration increased significantly (p. < .001) as a result of the sessions. Effect sizes (Eta(2)) were high, (0.68-0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios. CONCLUSIONS The use of this enhanced form of simulation with simulated patients and the judicious use of moulage is an effective method of increasing realism for medical students. Importantly, it gives them greater confidence in recognising and responding to clinical deterioration in adult patients. We recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups.
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Affiliation(s)
- George Hogg
- School of Medicine, University of Dundee, Dundee, Scotland, UK.
- School of Education and Social Work, University of Dundee, Dundee, Scotland, UK.
- Clinical Skills Centre, University of Dundee School of Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - David Miller
- School of Medicine, University of Dundee, Dundee, Scotland, UK
- School of Education and Social Work, University of Dundee, Dundee, Scotland, UK
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Robak O, Leonardelli M, Zedtwitz-Liebenstein K, Rützler K, Schuster E, Vaida S, Salem R, Frass M. Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions. CAN J EMERG MED 2015; 14:330-4. [PMID: 23131479 DOI: 10.2310/8000.2012.120658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions. METHODS Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs. RESULTS Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs. CONCLUSION The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.
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Affiliation(s)
- Oliver Robak
- Department of Medicine I, Intensive Care Unit, Medical University Vienna, Vienna, Austria.
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Ellington M, Chilvers N. Undergraduate medical education; a new role for Army Reserve Medical Units? J ROY ARMY MED CORPS 2015; 161:156. [DOI: 10.1136/jramc-2014-000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 01/20/2015] [Indexed: 11/03/2022]
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Tallentire VR, Smith SE, Skinner J, Cameron HS. Exploring patterns of error in acute care using framework analysis. BMC MEDICAL EDUCATION 2015; 15:3. [PMID: 25592440 PMCID: PMC4352279 DOI: 10.1186/s12909-015-0285-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Junior doctors are often the first responders to deteriorating patients in hospital. In the high-stakes and time-pressured context of acute care, the propensity for error is high. This study aimed to identify the main subject areas in which junior doctors' acute care errors occur, and cross-reference the errors with Reason's Generic Error Modelling System (GEMS). GEMS categorises errors according to the underlying cognitive processes, and thus provides insight into the causative factors. The overall aim of this study was to identify patterns in junior doctors' acute care errors in order to enhance understanding and guide the development of educational strategies. METHODS This observational study utilised simulated acute care scenarios involving junior doctors dealing with a range of emergencies. Scenarios and the subsequent debriefs were video-recorded. Framework analysis was used to categorise the errors according to eight inductively-developed key subject areas. Subsequently, a multi-dimensional analysis was performed which cross-referenced the key subject areas with an earlier categorisation of the same errors using GEMS. The numbers of errors in each category were used to identify patterns of error. RESULTS Eight key subject areas were identified; hospital systems, prioritisation, treatment, ethical principles, procedural skills, communication, situation awareness and infection control. There was a predominance of rule-based mistakes in relation to the key subject areas of hospital systems, prioritisation, treatment and ethical principles. In contrast, procedural skills, communication and situation awareness were more closely associated with skill-based slips and lapses. Knowledge-based mistakes were less frequent but occurred in relation to hospital systems and procedural skills. CONCLUSIONS In order to improve the management of acutely unwell patients by junior doctors, medical educators must understand the causes of common errors. Adequate knowledge alone does not ensure prompt and appropriate management and referral. The teaching of acute care skills may be enhanced by encouraging medical educators to consider the range of potential error types, and their relationships to particular tasks and subjects. Rule-based mistakes may be amenable to simulation-based training, whereas skill-based slips and lapses may be reduced using strategies designed to raise awareness of the interplay between emotion, cognition and behaviour.
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Affiliation(s)
- Victoria R Tallentire
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Samantha E Smith
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Janet Skinner
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Helen S Cameron
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Carpenter A, Khodabocus R. Do we teach medical students acute care skills? CLINICAL TEACHER 2014; 11:148-9. [PMID: 24629255 DOI: 10.1111/tct.12096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Burden C, Fox R, Lenguerrand E, Hinshaw K, Draycott TJ, James M. Curriculum development for basic gynaecological laparoscopy with comparison of expert trainee opinions; prospective cross-sectional observational study. Eur J Obstet Gynecol Reprod Biol 2014; 180:1-7. [PMID: 24973478 DOI: 10.1016/j.ejogrb.2014.05.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 03/27/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop content for a basic laparoscopic curriculum in gynaecology. STUDY DESIGN Prospective cross-sectional observational study. Modified Delphi method with three iterations undertaken by an invited group of national experts across the United Kingdom (UK). Two anonymous online surveys and a final physical group meeting were undertaken. Junior trainees in gynaecology undertook a parallel iteration of the Delphi process for external validation. Population included: expert panel - certified specialists in minimal-access gynaecological surgery, RCOG national senior trainee representatives, and medical educationalists, junior trainees group - regional trainees in gynaecology in first and second year of speciality training. RESULTS Experts (n=37) reached fair to almost complete significant agreement (κ=0.100-0.8159; p<0.05) on eight out of nine questions by the second iteration. Trainees (n=19) agreed with the experts on 89% (51/57) of categories to be included in the curriculum. Findings indicated that 39 categories should be included in the curriculum. Port placement, laparoscopic equipment and patient selection were ranked the most important theoretical categories. Hand-eye co-ordination, camera navigation and entry techniques were deemed the most valuable skills. Diagnostic laparoscopy, laparoscopic sterilisation, and laparoscopic salpingectomy were the operations agreed to be most important for inclusion. Simulation training was agreed as the method of skill development. The expert panel favoured box trainers, whereas the junior trainee group preferred virtual reality simulators. A basic simulation laparoscopic hand-eye co-ordination test was proposed as a final assessment of competence in the curriculum. CONCLUSION Consensus was achieved on the content of a basic laparoscopic curriculum in gynaecology, in a cost- and time-effective, scientific process. The Delphi method provided a simple, structured consumer approach to curriculum development that combined views of trainers and trainees that could be used to develop curricula in other areas of post-graduate education.
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Affiliation(s)
- Christy Burden
- University of Bristol, School of Social and CommunityMedicine, Clinical Research Registrar, Obstetrics and Gynaecology, Gloucester Royal Hospital, Great Western Road, Gloucester, Gloucestershire GL1 3NN, UK; Research into Safety and Quality (RiSQ), Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK.
| | - Robert Fox
- Research into Safety and Quality (RiSQ), Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK; RiSQ Group, Taunton & Somerset Hospital, Taunton TA1 5DA, UK
| | - Erik Lenguerrand
- University of Bristol, School of Clinical Science, RiSQ, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK
| | - Kim Hinshaw
- Sunderland Royal Hospital, Sunderland SR4 7TP, UK
| | - Timothy J Draycott
- Research into Safety and Quality (RiSQ), Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK
| | - Mark James
- Research into Safety and Quality (RiSQ), Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK
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Effect of engaging trainees by assessing peer performance: a randomised controlled trial using simulated patient scenarios. BIOMED RESEARCH INTERNATIONAL 2014; 2014:610591. [PMID: 24967383 PMCID: PMC4054978 DOI: 10.1155/2014/610591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022]
Abstract
Introduction. The aim of this study was to explore the learning effect of engaging trainees by assessing peer performance during simulation-based training. Methods. Eighty-four final year medical students participated in the study. The intervention involved trainees assessing peer performance during training. Outcome measures were in-training performance and performance, both of which were measured two weeks after the course. Trainees' performances were videotaped and assessed by two expert raters using a checklist that included a global rating. Trainees' satisfaction with the training was also evaluated.
Results. The intervention group obtained a significantly higher overall in-training performance score than the control group: mean checklist score 20.87 (SD 2.51) versus 19.14 (SD 2.65) P = 0.003 and mean global rating 3.25 SD (0.99) versus 2.95 (SD 1.09) P = 0.014. Postcourse performance did not show any significant difference between the two groups. Trainees who assessed peer performance were more satisfied with the training than those who did not: mean 6.36 (SD 1.00) versus 5.74 (SD 1.33) P = 0.025. Conclusion. Engaging trainees in the assessment of peer performance had an immediate effect on in-training performance, but not on the learning outcome measured two weeks later. Trainees had a positive attitude towards the training format.
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Tume LN, Sefton G, Arrowsmith P. Teaching paediatric ward teams to recognise and manage the deteriorating child. Nurs Crit Care 2013; 19:196-203. [PMID: 24147837 DOI: 10.1111/nicc.12050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/02/2013] [Accepted: 08/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Issues around the deterioration of hospitalised children are known: the failure to observe and monitor patients adequately, a failure to recognise the deteriorating patient, a failure to communicative effectively within the healthcare team and a failure to respond appropriately or in a timely manner (Pearson, 2008; NPSA, 2009). In response to this, a new 1-day course called RESPOND (Recognising Signs of Paediatric hOspital iNpatients Deterioration) was developed. OBJECTIVES To describe the development of the RESPOND course and present a preliminary evaluation of the first four courses. METHODS A written postcourse survey was completed by participants (junior doctors, medical students, nurses and health care assistants) immediately after the course and an electronic survey completed three months later in a large children's hospital in the North West of England. Data were analysed descriptively and by simple thematic analysis of free text responses. RESULTS Sixty-five participants undertook the RESPOND course over four separate days. Overwhelmingly participants found the course positive, with the most frequently cited benefit being improved multidisciplinary communication. Despite a poor response to the second survey, 18% (12 of 65) of respondents remained positive about the impact of the course. CONCLUSIONS AND RELEVANCE TO PRACTICE This preliminary evaluation combined with a reduction in hospital cardiac arrest rates suggest that the multiprofessional RESPOND course (in conjunction with an early warning tool and response system) is successful as part of a targeted strategy to promote patient safety within a children's hospital.
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Affiliation(s)
- Lyvonne N Tume
- L N Tume, RN RSCN RNT Dip App Sci (Nurs), B Nurs, M Clin Nurs (Crit Care), PGDE, PhD, Senior Nursing Research Fellow PICU, Alder Hey Children's NHS Foundation Trust and University of Central Lancashire, Liverpool, UK
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State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med 2013; 6:23. [PMID: 23842482 PMCID: PMC3727950 DOI: 10.1186/1865-1380-6-23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. Methods In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. Results In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. Conclusions Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.
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Deiorio NM, Fitch MT, Jung J, Promes SB, Thibodeau LG, Woolley WL, Gisondi MA, Gruppen LD. Evaluating educational interventions in emergency medicine. Acad Emerg Med 2013; 19:1442-53. [PMID: 23279250 DOI: 10.1111/acem.12022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
Abstract
This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine (EM) knowledge, skills, and attitudes outside of the clinical setting. The objective was to summarize both medical and nonmedical education literature and report the consensus formation methods and results. The authors present final statements to guide future research aimed at evaluating the best methods for understanding and developing successful EM curricula using all types of educational interventions.
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Affiliation(s)
- Nicole M. Deiorio
- Department of Emergency Medicine; Oregon Health and Science University; Portland; OR
| | - Michael T. Fitch
- Department of Emergency Medicine; Wake Forest University; Salem; NC
| | - Julianna Jung
- Department of Emergency Medicine; Johns Hopkins University; Baltimore; MD
| | - Susan B. Promes
- Department of Emergency Medicine; University of California San Francisco; San Francisco; CA
| | | | - Wendy L. Woolley
- Department of Emergency Medicine; Albany Medical College; Albany; NY
| | | | - Larry D. Gruppen
- Department of Medical Education; University of Michigan; Ann Arbor; MI
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Couper K, Salman B, Soar J, Finn J, Perkins GD. Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis. Intensive Care Med 2013; 39:1513-23. [DOI: 10.1007/s00134-013-2951-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/03/2013] [Indexed: 02/06/2023]
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Manikam L, Blackwell N, Banerjee J, Nightingale P, Lakhanpaul M. Improving assessment of paediatric acute breathing difficulties in medical education: a cluster randomized controlled trial. Acta Paediatr 2013; 102:e205-9. [PMID: 23398452 DOI: 10.1111/apa.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 12/01/2022]
Abstract
AIM Impact assessment of an adjunct to standard teaching on knowledge gain and self-assessed confidence for students undertaking their paediatric attachment and evaluation of an acute breathing difficulties (ABDs) learning package. METHODS Pragmatic cluster randomized controlled trial involving 248 UK medical undergraduates within six paediatric clinical rotations. Intervention groups received an online ABD learning package consisting of symptom-based decision-making pathways underpinned by a ratified ABD evidence-based guideline. Control groups received an online dummy package. Outcome measures were a pre- and post-intervention multiple choice question assessment and confidence questionnaire utilising 5-point Likert scales. RESULTS Significant knowledge gain in the intervention group (mean 6.84, 95% CI 5.56-8.12) versus no such difference in the control group, significant improvement in self-assessed confidence in intervention group versus no such difference in control group and significant confidence differences in ABD-specific statements were noted. In the satisfaction questionnaire, the learning content was noted to be new to only 16% participants. CONCLUSION Supplementation of standard teaching with an interactive delivery method resulted in cognitive gain and self-assessed confidence improvement in interaction with children with ABDs. This indicates that a well-designed tool can help prepare students for direct interaction with sick children as a junior clinician. TRIAL REGISTRATION ISRCTN27499282.
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Affiliation(s)
- Logan Manikam
- Medical and Social Care Education; University of Leicester; Leicester; UK
| | - Nicholas Blackwell
- Medical and Social Care Education; University of Leicester; Leicester; UK
| | | | - Peter Nightingale
- University Hospitals of Birmingham NHS FoundationTrust; Birmingham; UK
| | - Monica Lakhanpaul
- Medical and Social Care Education; University of Leicester; Leicester; UK
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Cresswell K, Ghinai I, Singer E, Lodhi W, Nauta M, Yoong W. Bully for you: Workplace harassment of obstetrics and gynaecology trainees. J OBSTET GYNAECOL 2013; 33:329-30. [DOI: 10.3109/01443615.2013.765394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Voigt I, Naber C, Sabin G. Ärztliche Ausbildung an deutschen internistischen Intensivstationen. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s00390-011-0311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2011; 81:1305-52. [PMID: 20956049 DOI: 10.1016/j.resuscitation.2010.08.017] [Citation(s) in RCA: 751] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kelly D. The Knowledge of Medical Students and Newly Qualified Doctors concerning the Specialty of Intensive Care Medicine. J Intensive Care Soc 2011. [DOI: 10.1177/175114371101200205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Current evidence suggests that around the transition from undergraduate to postgraduate training, deficiencies exist in doctors' knowledge of acute care. This study assessed Foundation Year 1 (FY1) doctors and medical students in intensive care/acute medicine with respect to their understanding of ICU practice and identifying critically ill patients. A qualitative questionnaire was formulated focusing on several targeted areas including training experience, broader ICU knowledge, formal assessment of ICU medicine and critically ill patients encountered outside the ICU. After successfully piloting the study, ethics approval was granted. In February 2010, the questionnaires were distributed to 50 final-year medical students at Brighton and Sussex Medical School and 50 FY1 doctors working at Worthing Hospital or the Royal Sussex County Hospital. One hundred percent of participants completed the questionnaires; 12.5% of medical students knew about the Surviving Sepsis Campaign compared to 62% FY1s (p<0.05). Non-significant trends were evident when choosing three most useful observations for identifying sick patients. The study concluded medical students lack knowledge regarding assessment and monitoring of critically ill patients. Undergraduate training and ICU exposure did not differ between groups, however differences existed in understanding of ICU practice. There was a relative paucity in understanding from final year students regarding the Surviving Sepsis Campaign compared to FY1 doctors, which highlights the need for further improvement.
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Smyth M, Perkins GD. Self-directed learning: Does it affect team performance? Resuscitation 2011; 82:241-2. [DOI: 10.1016/j.resuscitation.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wise MP, Frost PJ. Hospital mortality and junior doctors' handover: the role of medical schools and consultants. QJM 2010; 103:895-6. [PMID: 20534653 DOI: 10.1093/qjmed/hcq091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
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Neves LMT, Silva MSVD, Carneiro SR, Aquino VDS, Reis HJL. Conhecimento de fisioterapeutas sobre a atuação em suporte básico de vida. FISIOTERAPIA E PESQUISA 2010. [DOI: 10.1590/s1809-29502010000100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O estudo visou avaliar o conhecimento de fisioterapeutas e graduandos em Fisioterapia sobre diagnóstico e atendimento de urgência à parada cardiorrespiratória. A amostra foi composta de 72 estudantes e 108 fisioterapeutas, dos quais 64 atuam no ambiente extra-hospitalar e 44 no ambiente hospitalar. Foi aplicado aos participantes um questionário sobre ressuscitação cardiopulmonar (RCP) baseado nas diretrizes da American Heart Association de 2005. As respostas foram analisadas estatisticamente. Quanto ao diagnóstico da parada cardíaca, os grupos comportaram-se de maneira semelhante, optando pela avaliação da"presença de pulso e respiração". Quanto à seqüência de atendimento da RCP, a seqüência preconizada foi corretamente indicada por 52,8% do grupo estudante, 65,9% do subgrupo hospitalar e 40,6% do subgrupo extra-hospitalar. Quanto à relação compressão/ventilação, apenas 4,1% do grupo estudante, ninguém do extra-hospitalar e 25% do subgrupo hospitalar indicaram a relação preconizada atualmente. Quase todos (94%) os participantes reconheceram a importância do conhecimento em RCP para o fisioterapeuta. Assim, a maioria dos atuais e futuros fisioterapeutas reconhecem a importância da RCP para sua atuação profissional, mas têm conhecimento insuficiente sobre o tema e apenas uma pequena parcela busca atualizar-se.
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McFarlane HJ, van der Horst N, Kerr L, McPhillips G, Burton H. The Scottish Audit of Surgical Mortality: a review of areas of concern related to anaesthesia over 10 years. Anaesthesia 2009; 64:1324-31. [PMID: 19849676 DOI: 10.1111/j.1365-2044.2009.06125.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Scottish Audit of Surgical Mortality is a voluntary, peer reviewed, critical event analysis of patients who die under the care of consultant surgeons in acute hospitals in Scotland. The anaesthetic contribution to surgical mortality over a 10-year period from 1996 was reviewed. The total number of deaths was 44 230 or 1.5% of all admissions. Forty thousand, eight hundred and ninety-six deaths (92%) were audited. Deaths after elective surgery declined over 10 years. Over 80% of deaths followed emergency admission. The number of deaths where an anaesthetist was present was 16 981 or 0.6% of all admissions. Anaesthetic areas of concern were identified in 8% of deaths. Of these, 43% were related to pre-operative assessment. Anaesthesia also played a part in a further 18% of deaths where decision making was shared with the surgical team. Of these, 41% were related to access to critical care. A further 24% related to communication failures, principally when the operation should not have been done or was unnecessary.
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Hüter L, Schwarzkopf K, Rödiger J, Preussler NP, Schreiber T. Students insert the laryngeal tube quicker and more often successful than the esophageal–tracheal combitube in a manikin. Resuscitation 2009; 80:930-4. [DOI: 10.1016/j.resuscitation.2009.04.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 04/11/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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46
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The educational environment for training in intensive care medicine: structures, processes, outcomes and challenges in the European region. Intensive Care Med 2009; 35:1575-83. [DOI: 10.1007/s00134-009-1514-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/30/2009] [Indexed: 11/24/2022]
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Tait M, Tait D, Thornton F, Edwards M. Development and evaluation of a critical care e-learning scenario. NURSE EDUCATION TODAY 2008; 28:970-980. [PMID: 18603339 DOI: 10.1016/j.nedt.2008.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 03/22/2008] [Accepted: 05/17/2008] [Indexed: 05/26/2023]
Abstract
This paper describes the development and evaluation of a critical care e-learning scenario for student nurses. At present, there are insufficient opportunities in the United Kingdom (UK) for student nurses to experience clinical placements where their skills in care of the critically-ill can be developed. There is therefore a need for new learning materials that help learners recognise the signs of clinical deterioration and rehearse the management of critically-ill patients. One way of meeting this need is by using electronic care scenarios. Several electronic care scenarios have been developed at Swansea University as part of the eWARD project. This article describes the design and evaluation of a critical care scenario that follows the care of a road casualty (John Macadam) after admission to an intensive care unit. The scenario was designed by an advisory team comprising a clinical lecturer and e-learning specialists. After using the scenario, 144 nursing students completed a Web-based questionnaire that collected demographic and attitudinal data for analysis using SPSS. Nursing students had a strongly positive attitude to the scenario with median scores in excess of 20 compared to maxima of 25 for scales measuring ease-of-use, interactivity, realism and confidence. None of the demographic data collected had a significant effect on these attitudes. The positive attitude of student nurses to this scenario strongly supports its use to help learners to (1) acquire knowledge and awareness when real life placements in these settings are not available and (2) extend their knowledge after coming across similar situations in practice.
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Affiliation(s)
- Michael Tait
- School of Health Science, Swansea University, Singleton Park, Swansea SA2 8PP, Wales, UK.
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Wiseman J, Snell L. The Deteriorating Patient: a realistic but ‘low-tech’ simulation of emergency decision-making. CLINICAL TEACHER 2008. [DOI: 10.1111/j.1743-498x.2008.00213.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Ellison S, Sullivan C, Quaintance J, Arnold L, Godfrey P. Critical care recognition, management and communication skills during an emergency medicine clerkship. MEDICAL TEACHER 2008; 30:e228-e238. [PMID: 19117219 DOI: 10.1080/01421590802334259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Medical students need to learn how to recognize and manage critically ill patients; to communicate in critical situations with patients, families, and the healthcare team; and finally, to integrate technical knowledge with communication skills in caring for these patients. Meeting their needs will help prepare them to demonstrate, as physicians, the ability to synthesize information while simultaneously caring for patients, that the American Medical Association recently characterized as vital. AIMS Responding to these needs, we developed and implemented a curriculum to enable students in a required emergency medicine clerkship to recognize, manage, and simultaneously communicate with critically ill patients. METHODS The curriculum consisted of lectures and exercises on caring for the critically ill including: an introduction to the systematic approach; an interactive lecture on comprehensive communication; observation and discussion of real patients in the emergency department; participation in a single standardized patient encounter while peers and a faculty member observed them; assessment of students' own videotaped performance of the examination by using critical care and communication/interpersonal skills checklists; and receipt of private feedback based on the checklists from the faculty and the standardized patient. Students evaluated the curriculum at the end of the clerkship. RESULTS Complete performance data for 46 students and curriculum evaluation data from 42 students were available. According to faculty assessment, students as a group performed 79.6% (SD 0.15) of the critical care and 70.9% (SD 11.5%) of the communication skills. Students most often demonstrated Basic Interpersonal Skills (97.9%, SD 0.056) and least often demonstrated Empathy skills (41.7%, SD 0.235). Students rated the curriculum positively. CONCLUSIONS It is feasible to integrate the teaching of communication skills with the recognition and management of critically ill patients. The next step will be to revise the curriculum to address student deficiencies and to evaluate its effectiveness more rigorously.
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Frost P, Wise MP. Recognition and early management of the critically ill ward patient. Br J Hosp Med (Lond) 2007; 68:M180-3. [DOI: 10.12968/hmed.2007.68.sup10.27338] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Paul Frost
- University Hospital of Wales, Cardiff CF14 4XW
| | - Matt P Wise
- University Hospital of Wales, Cardiff CF14 4XW
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