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Alnabulsi M, Abo Ali EA, Alsharif MH, Filfilan NF, Fadda SH. Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study. Ann Med 2024; 56:2337725. [PMID: 38590157 PMCID: PMC11005869 DOI: 10.1080/07853890.2024.2337725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND In-flight medical emergencies (IMEs) are expected to increase as air travel normalized in the post-COVID-19 era. However, few studies have examined health professions students' preparedness to respond to such emergencies. Therefore, this study aimed to investigate medical students' knowledge, confidence, and willingness to assist during an IME in their internship program. METHODS This cross-sectional survey utilized an online, self-administered questionnaire-based survey targeted at medical students at two medical colleges in Saudi Arabia. The questionnaire comprised three parts: sociodemographic characteristics, knowledge about aviation medicine (10 items), and confidence (7 items)/willingness (4 items) to assist during an IME. Odds Ratios (OR) and 95% Confidence Intervals (95%CI) were computed to detect potential associations between the knowledge levels and the other independent variables. Responses to confidence and willingness questions were scored on a 5-point Likert scale. RESULTS Overall, 61.4% of participants had inadequate knowledge scores for providing care during an IME, and the proportion of participants did not differ between those who had or had not attended life support courses (60.4% vs. 66.7%, p > 0.99). Only frequency of air travel ≥ two times per year was associated with higher odds of adequate knowledge score [OR = 1.89 (95%CI 1.14-3.17), p = 0.02]. In addition, 93.3% of the participants had low, 6.3% had moderate, and 0.8% had high willingness scores, while 86.3% had low, 12.2% had moderate, and 1.5% had high confidence scores. There were no differences in the proportion of participants with low, moderate, and high willingness or confidence scores by attendance in life support courses. CONCLUSION Even though over 8 in 10 students in our study had previously attended life support courses, the overwhelming majority lacked the knowledge, confidence, and willingness to assist. Our study underscores the importance of teaching medical students about IMEs and their unique challenges before entering their 7th-year mandatory general internship.
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Affiliation(s)
- Majed Alnabulsi
- Department of Internal Medicine, Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Ehab Abdelhalim Abo Ali
- Department of Community Medicine, Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
- Public Health and Community Medicine Department, Faculty of Medicine, University of Tanta, Tanta, Egypt
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Scholte JBJ, Strehler JC, Dill T, van Mook WNKA. Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees. BMC MEDICAL EDUCATION 2024; 24:120. [PMID: 38321516 PMCID: PMC10848472 DOI: 10.1186/s12909-023-04980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. METHODS We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. RESULTS Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees' ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees' progress visualisation, which is caused by unsatisfactory familiarisation with the trainees' development. The lack of an overview of a trainee's previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym "ICU-STAR" representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. CONCLUSIONS According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee's development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees' assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym "ICU-STAR" as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Johannes B J Scholte
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
- Master of Medical Education Student, University of Bern, Bern, Switzerland.
| | - Johannes C Strehler
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Tatjana Dill
- Master of Medical Education Student, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Swiss Air-Ambulance Ltd, Rega, Zurich, Switzerland
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Zante B. Impact of number of critical care procedural skill repetitions on supervision level and teaching style. PLoS One 2023; 18:e0280207. [PMID: 36689411 PMCID: PMC9870148 DOI: 10.1371/journal.pone.0280207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND During critical care procedural skills training (e.g., in intubation and pericardiocentesis) the appropriate supervision level is important to ensure correct use of techniques and guarantee patient safety. The appropriate teaching style should be selected to address residents' learning behavior and foster their competence. The aim of this study was to explore the number of repetitions for given skills needed to achieve a specified supervision level and a specific teaching style. METHODS This cross-sectional multicenter survey obtained data from residents and faculty of three multidisciplinary intensive care units (ICU) in Switzerland. Using a 4-point Likert scale, participants were asked to indicate the number of repetitions required to achieve the specified supervision level and teaching style. RESULTS Among 91 physicians, the response rate was 64% (n = 59). Their median estimations of the numbers of skill repetitions needed to achieve the final fourth level of supervision and final fourth stage of teaching style were as follows: arterial catheter insertion: supervision level 32, teaching style 17.5; peritoneal paracentesis: supervision level 27, teaching style 17; central venous catheter insertion: supervision level 38, teaching style 28; lumbar puncture: supervision level 38, teaching style 21; endotracheal intubation: supervision level 100, teaching style 45; chest drain insertion: supervision level 27, teaching style 21.5; temporary pacemaker placement: supervision level 50, teaching style 19.5; percutaneous tracheostomy: supervision level 50, teaching style 29; pericardiocentesis: supervision level 50, teaching style 35. Comparison of repetitions between supervision level and teaching style revealed no difference at the first and second levels, except for endotracheal intubation at level 2 (p = 0.03). Differences were observed at the third and fourth levels of supervision level and teaching style (p≤0.04). CONCLUSIONS It appears that the supervision level and teaching style applied by faculty should change according to both the number of repetitions and the difficulty of critical care procedural skills.
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Affiliation(s)
- Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Liu Z, Chen Q, Wu J, Li X, He Y, Yu Q. Simulation-based training in asthma exacerbation for medical students: effect of prior exposure to simulation training on performance. BMC MEDICAL EDUCATION 2022; 22:223. [PMID: 35361196 PMCID: PMC8973632 DOI: 10.1186/s12909-022-03300-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the effect of prior exposure to simulation-based training on medical students' performance in simulation-based training in asthma exacerbation. METHODS Third-year novice medical students, who had no prior experience in simulation education and completed diagnostics and internal medicine courses, were recruited in this prospective observational study and divided into the pre-exposure and unexposed groups. Each group received a four-hour asthma exacerbation simulation-based training. The pre-exposure group was exposed to a myocardial infarction simulation training two weeks prior to the asthma simulation training. The main outcome was the performance scores in clinical skills and abilities. Performance and task checklist completion were recorded during the training. In addition, the knowledge level was tested before and after the simulation training. Students' satisfaction was evaluated using a feedback questionnaire. RESULTS In a class of 203 third-year novice medical students, 101 (49.8%) and 102 (50.2%) were assigned to the unexposed and pre-exposure groups, respectively. Scores were higher in the post-simulation test compared with the pre-simulation test. Checklist completion was greater in the pre-exposure group compared with the unexposed group (p < 0.001). Performances in communication and medical humanistic care were better in the pre-exposure group than in the unexposed group (p < 0.001). There were no differences in medical history taking, physical examination, auxiliary examination interpretation and treatment formulation between the two groups (p > 0.001). Totally 73.21% and 26.13% of students strongly agreed and agreed, respectively, that asthma exacerbation simulation-based training was necessary and valuable. CONCLUSIONS Prior exposure to simulation training can improve performance in medical students, including communication skills, medical humanistic care and checklist completion in subsequent asthma exacerbation simulation-based training.
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Affiliation(s)
- Zhenhua Liu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
| | - Qiong Chen
- Department of Gerontology and Respirology, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
| | - Jing Wu
- Clinical Skills Training Center, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- Department of Internal Medicine, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- Medical Virtual Reality Research Center of Central South University, Changsha, 410008 Hunan China
| | - Xinhua Li
- Clinical Skills Training Center, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- Department of Internal Medicine, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- Medical Virtual Reality Research Center of Central South University, Changsha, 410008 Hunan China
| | - Yuchen He
- Clinical Skills Training Center, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
| | - Qiao Yu
- Department of Gerontology and Respirology, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008 Hunan China
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Personal protective equipment training for non-healthcare workers in the Covid-19 pandemic: Effectiveness of an evidence-based skills training framework. Infect Dis Health 2021; 27:38-48. [PMID: 34688581 PMCID: PMC8495050 DOI: 10.1016/j.idh.2021.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/25/2023]
Abstract
Background Large-scale quarantine facilities staffed with non-healthcare workers (NHCW) were instrumental in preventing community spread of COVID-19 (coronavirus disease of 2019). The objective of this study was to determine the effectiveness of a newly developed procedural skills training framework in ensuring personal protective equipment (PPE) compliance of PPE-naïve NHCWs. Methods We developed a PPE procedural skills training framework for NHCWs using the Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) framework and international guidelines on PPE for healthcare workers. The NHCWs underwent PPE training using this framework, conducted by a team of Infection Prevention nurses, prior to being stationed within the CCF. Effectiveness of the LSPPDM PPE training framework was assessed using: 1) competency assessment scores for NHCWs, 2) PPE compliance rates from daily audit findings, and, 3) healthcare-associated COVID-19 infection rates of NHCWs. Results A total of 883 NHCWs had completed the PPE training and demonstrated competency in PPE compliance, fulfilling 100% of the checklist requirements. Mean PPE compliance of all NHCWs during the 11-week study period was noted to be >96%. The post-implementation improvement was statistically significant when the compliance was expressed in 3-days blocks) and in bed management staff (P = < 0.05). None of the 883 NHCWs who underwent PPE training via the LSPPDM framework were diagnosed with healthcare-associated COVID-19 infection. Conclusion An evidence-based skills training framework is effective in PPE training of large numbers of NHCWs, resulting in high compliance of appropriate PPE use and prevention of healthcare-associated COVID-19 infection.
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Zante B, Klasen JM. Learner-centered education: ICU residents' expectations of teaching style and supervision level. BMC MEDICAL EDUCATION 2021; 21:411. [PMID: 34330260 PMCID: PMC8325219 DOI: 10.1186/s12909-021-02844-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND If the education of intensive care unit (ICU) residents focuses on individual learning behavior, the faculty's style of teaching and level of supervision need to be adapted accordingly. The aim of this study was to delineate the associations between residents' perceived learning behavior, experience, and demographics and their expectations with regard to teaching style and supervision levels. METHODS This multicenter survey obtained data on ICU residents' base specialty, duration of ICU training, individual postgraduate year, gender, and number of repetitions of ICU skills. Using 4-point Likert scales, residents assessed perceived learning behavior, expected teaching style, and supervision level for respective skills. Multivariate regression analysis was used to evaluate associations between assessed variables. RESULTS Among 109 residents of four interdisciplinary ICUs, 63 (58%) participated in the survey and 95% (60/63) questionnaires were completed. The residents' perceived learning behavior was associated with number of skill repetitions (p < 0.0001), internal medicine as base specialty (p = 0.02), and skill type (p < 0.0001). Their expected teaching style was associated with learning behavior (p < 0.0001) and skill type (p < 0.0001). Their expected supervision level was associated with skill repetitions (p < 0.0001) and skill type (p < 0.0001). CONCLUSION For effective learner-centered education, it appears useful to recognize how the residents' learning behavior is affected by the number of skill repetitions and the skill type. Hence, faculty may wish to take into account the residents' learning behavior, driven mainly by skill complexity and the number of skill repetitions, to deliver the appropriate teaching style and supervision level.
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Affiliation(s)
- Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
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Battaglini D, Ionescu Maddalena A, Caporusso RR, Garofalo E, Bruni A, Bocci MG, Cingolani E, Giarratano A, Petrini F. Acquisition of skills in Critical Emergency Medicine: an experimental study on the SIAARTI Academy CREM experience. Minerva Anestesiol 2021; 87:1174-1182. [PMID: 34170097 DOI: 10.23736/s0375-9393.21.15427-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities. METHODS Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into 3 groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SAKit, n=124), those who received only a study kit (Kit, n=108), and Control (n=95). Eighty-five tests were administered to investigate skills at 3 timepoints: T0=baseline, T1=post-training/kit, and T2=4-months later. RESULTS TS differed among groups (p<0.0001), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control), and T2 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control). NTS differed among groups (p=0.0406), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p=0.0337 vs Kit; p=0.0416 vs Control), and T2 (post-hoc comparison, p=0.0073 vs Kit; p=0.3308 vs Control). SA-Kit group significantly improved TS (p<0.0001) and NTS (p=0.0006) over time. Involvement in corporate activities of SAkit was significantly higher than Kit and Control (p=0.0012). CONCLUSIONS SA-Kit improvement in TS and NTS was higher than Kit and Control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy - .,Department of Medicine, University of Barcelona, Barcelona, Spain -
| | - Alessandra Ionescu Maddalena
- UOC Anestesia e Rianimazione, Polo Ospedaliero Balcolle ASL, Viterbo, Italy.,Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Roberta R Caporusso
- Sezione anestesia e rianimazione, Dipartimento di Scienze mediche e chirurgiche, Università degli Studi di Foggia, Foggia, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Emiliano Cingolani
- Dipartimento di Emergenza Accettazione e delle Chirurgie specialistiche, UOSD Shock e Trauma, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Antonino Giarratano
- Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- Department of Anesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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