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Sabath E. Point of care ultrasonography as the new "Laennec Sthetoscope". World J Nephrol 2024; 13:90542. [PMID: 38596268 PMCID: PMC11000039 DOI: 10.5527/wjn.v13.i1.90542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Point of care ultrasonography (POCUS) has evolved to become the fifth pillar of the conventional physical examination, and use of POCUS protocols have significantly decreased procedure complications and time to diagnose. However, lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use. In rural and low-income areas POCUS may have a transformative effect on health care management.
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Affiliation(s)
- Ernesto Sabath
- Renal and Metabolism Unit, Hospital General de Querétaro, Queretaro 76180, Mexico
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2
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Hassabo M, Mc Cluskey P, Browne J, Ntlholang O. A survey of non-consultant hospital doctors' perspectives, knowledge, and practices toward delirium in a large Irish hospital. Ir J Med Sci 2024:10.1007/s11845-024-03661-1. [PMID: 38489126 DOI: 10.1007/s11845-024-03661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Delirium is a common condition in hospitals, particularly among older people. This refers to a dramatic decline in mental capabilities, which is marked by diminished concentration and consciousness. AIM The purpose of this study was to assess the views, knowledge, and behavior of non-consultant hospital doctors in managing delirium in a large Irish hospital. METHODS Questionnaires were administered to 28 healthcare professionals from various departments according to Davis and MacLullich (Age Ageing 38(5):559-563, 2009). It was conducted between July and September 2023, with an emphasis on determining the prevalence rate, diagnostic criteria, and management strategies for delirium. RESULTS The study established that the majority of respondents recognized the importance of delirium, but there appears to be a gap in the practical management of this clinical syndrome. Although many doctors agreed that delirium was significant, most lacked confidence in its diagnosis and management. The use of standardized assessment tools, such as the 4AT, was limited. CONCLUSIONS This study highlights the disparity between what is known and practiced by hospital doctors regarding delirium care. This implies increased training for delirium management with frequent use of assessment tools and ongoing education aimed at enhancing patient outcomes in cases of delirium.
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Affiliation(s)
- Mohamed Hassabo
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Patrick Mc Cluskey
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
| | - Joseph Browne
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
| | - Ontefetse Ntlholang
- Department of General Medicine/Acute Medicine, St James's Hospital, Dublin 8, Ireland
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3
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Requena-Pérez MV, Andrés-Cano P, Galán-Romero L, Suffo M. Comparative study of biomodels manufactured using 3D printing techniques for surgical planning and medical training. Expert Rev Med Devices 2024; 21:239-248. [PMID: 38270469 DOI: 10.1080/17434440.2024.2306884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To obtain 3D printed bone models with a haptic sensation similar to that of the real bone, which will help the surgeon to learn and improve based on practice. METHODS From computed tomography, 3 digital anatomical models of the human proximal femur were created and, by modifying the printing parameters, both cortical and trabecular tissues were simulated, which were combined in a different cortico-cancellous interface depending on the bone segment. The 3 equivalent models obtained were compared with a commercial Sawbone synthetic model and subjected to a series of blind surgical practice trials performed by 5 TOC specialists from a hospital, each of them with different degrees of expertise. A statistical analysis of the qualitative data collected based on the Wilcoxon test, the Spearman correlation matrix, and the Validity Ratio Coefficient was performed. RESULTS The deviations observed in the dimensional study are less than 0.2 millimeter, which confirms the validity of the 3DP-FFF technology to geometrically recreate personalized biomodels with high anatomical precision. CONCLUSIONS The reproductions obtained have given rise to a reliable method that professionals can refine to plan operations with the consequent reduction of time and risks for the patient, as well as for medical training.
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Affiliation(s)
- M V Requena-Pérez
- "Puerta del Mar" Universitiy Hospital, Virgen del Rocío University Hospital; Andalusian Public Foundation for Health Research Management in Seville (FISEVI), Seville, Spain
| | - P Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - L Galán-Romero
- Research Group "Biomedical innovation in osteoarticular surgery". Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, "Puerta del Mar" University Hospital. University of Cádiz, Cádiz, Spain
| | - M Suffo
- Department of Mechanical Engineering and Industrial Design, High Engineering School, Universidad de Cádiz; Avda. de la Universidad nº 10, Puerto Real (Cádiz), Spain
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Hao M, Guo J, Liu C, Chen C, Wang S. Development and preliminary testing of a prior knowledge-based visual navigation system for cardiac ultrasound scanning. Biomed Eng Lett 2024; 14:307-316. [PMID: 38374906 PMCID: PMC10874367 DOI: 10.1007/s13534-023-00338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 02/21/2024] Open
Abstract
Purpose Ultrasound is widely used to diagnose disease and guide surgery because it is versatile, inexpensive and radiation-free. However, image acquisition is dependent on the operation of a professional sonographer, which is a difficult skill to learn for a wider range of non-sonographers. Methods We propose a prior knowledge-based visual navigation method to obtain three important standard ultrasound views of the heart, based on the sonographer's skill learning and augmented reality prompts. The key information about the probe movement was captured using vision-based tracking and normalisation methods on 14 volunteers, based on a professional sonographer's practice. An augmented reality-based navigation method was then proposed to guide operators with no ultrasound experience to find standard views of the heart in a second set of three volunteers. Results Through quantitative analysis and qualitative scoring, the results showed that the proposed method can effectively guide non-sonographers to obtain standard views with diagnostic value. Conclusion It is believed that the method proposed in this paper has clear application value in primary care, and expansion of the data will allow the accuracy of the navigation to be further improved.
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Affiliation(s)
- Mingrui Hao
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190 China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100043 China
| | - Jun Guo
- Hangtian Center Hospital, Beijing, 100049 China
| | - Cuicui Liu
- Hangtian Center Hospital, Beijing, 100049 China
| | - Chen Chen
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190 China
| | - Shuangyi Wang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190 China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100043 China
- Centre for Artificial Intelligence and Robotics, Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences, Hong Kong, China
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McGrail M, Woolley T, Pinidiyapathirage J, Paton K, Smith D, Brumpton K, Teague PA. Exploring recent trends (2014-21) in preferencing and accepting Queensland medical internships in rural hospitals. BMC Health Serv Res 2024; 24:236. [PMID: 38395849 PMCID: PMC10885368 DOI: 10.1186/s12913-024-10683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools. METHODS Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts. RESULTS Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway. CONCLUSIONS The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.
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Affiliation(s)
- Matthew McGrail
- The University of Queensland, Rural Clinical School, Rockhampton, QLD, 4700, Australia.
| | - Torres Woolley
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Janani Pinidiyapathirage
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Kath Paton
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Deborah Smith
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Kay Brumpton
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Peta-Ann Teague
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
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Kunz JM, Maloca P, Allemann A, Fasler D, Soysal S, Däster S, Kraljević M, Syeda G, Weixler B, Nebiker C, Ochs V, Droeser R, Walker HL, Bolli M, Müller B, Cattin P, Staubli SM. Assessment of resectability of pancreatic cancer using novel immersive high-performance virtual reality rendering of abdominal computed tomography and magnetic resonance imaging. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-023-03048-0. [PMID: 38252362 DOI: 10.1007/s11548-023-03048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE Virtual reality (VR) allows for an immersive and interactive analysis of imaging data such as computed tomography (CT) and magnetic resonance imaging (MRI). The aim of this study is to assess the comprehensibility of VR anatomy and its value in assessing resectability of pancreatic ductal adenocarcinoma (PDAC). METHODS This study assesses exposure to VR anatomy and evaluates the potential role of VR in assessing resectability of PDAC. Firstly, volumetric abdominal CT and MRI data were displayed in an immersive VR environment. Volunteering physicians were asked to identify anatomical landmarks in VR. In the second stage, experienced clinicians were asked to identify vascular involvement in a total of 12 CT and MRI scans displaying PDAC (2 resectable, 2 borderline resectable, and 2 locally advanced tumours per modality). Results were compared to 2D standard PACS viewing. RESULTS In VR visualisation of CT and MRI, the abdominal anatomical landmarks were recognised by all participants except the pancreas (30/34) in VR CT and the splenic (31/34) and common hepatic artery (18/34) in VR MRI, respectively. In VR CT, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 22/24, 20/24 and 19/24 scans, respectively. Whereas, in VR MRI, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 19/24, 19/24 and 21/24 scans, respectively. Interobserver agreement as measured by Fleiss κ was 0.7 for CT and 0.4 for MRI, respectively (p < 0.001). Scans were significantly assessed more accurately in VR CT than standard 2D PACS CT, with a median of 5.5 (IQR 4.75-6) and a median of 3 (IQR 2-3) correctly assessed out of 6 scans (p < 0.001). CONCLUSION VR enhanced visualisation of abdominal CT and MRI scan data provides intuitive handling and understanding of anatomy and might allow for more accurate staging of PDAC and could thus become a valuable adjunct in PDAC resectability assessment in the future.
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Affiliation(s)
- Julia Madlaina Kunz
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Peter Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Mittlere Strasse 91, 4031, Basel, Switzerland
- Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland
- Moorfields Eye Hospital, NHS Foundation Trust, London, EC1V 2PD, UK
| | - Andreas Allemann
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - David Fasler
- Department of Radiology St. Claraspital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Savas Soysal
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Silvio Däster
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Gulbahar Syeda
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK
| | - Benjamin Weixler
- Department of General, Visceral and Vascular Sugery, Charité Campus Benjamin Franklin, Hindenburgdamm 20, 12203, Berlin, Germany
| | - Christian Nebiker
- Surgical Department, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Vincent Ochs
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167c, 4123, Allschwil, Switzerland
| | - Raoul Droeser
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | | | - Martin Bolli
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Beat Müller
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167c, 4123, Allschwil, Switzerland
| | - Sebastian Manuel Staubli
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK.
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da Cunha Oliveira M, Silva Menezes M, Cunha de Oliveira Y, Marques Vilas Bôas L, Villa Nova Aguiar C, Gomes Silva M. Novice medical students' perception about bad news training with simulation and spikes strategy. PEC Innov 2023; 2:100106. [PMID: 37214516 PMCID: PMC10194387 DOI: 10.1016/j.pecinn.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/18/2022] [Accepted: 11/21/2022] [Indexed: 05/24/2023]
Abstract
Objective To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol. Methods Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis. Results In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training. Conclusion The strategy used for the development of communication skills showed evidence of short-term effectiveness. Innovation The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.
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Affiliation(s)
| | | | | | | | | | - Mary Gomes Silva
- Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
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Swan LET, Cutler AS, Lands M, Schmuhl NB, Higgins JA. Physician beliefs about abortion safety and their participation in abortion care. Sex Reprod Healthc 2023; 38:100916. [PMID: 37722252 DOI: 10.1016/j.srhc.2023.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To document physicians' beliefs about abortion safety and the associations between these beliefs and physician support for, referral for, and participation in abortion care. METHODS In a 2019 survey at the University of Wisconsin School of Medicine and Public Health, we assessed physicians' abortion attitudes, beliefs, and practices (N = 893). We conducted bivariate analyses followed by logistic regression to document relationships between physician beliefs about abortion safety and their support for, referral to, and participation in abortion care. RESULTS Four-in-five physicians (78%, n = 690) believed that abortion is very or extremely safe. Medical specialty (Obstetrics-Gynecology vs. other; adjusted odds ratio [aOR] = 10.58, 95% CI: 1.41-79.56), educational exposure to abortion (aOR = 1.43, 95% CI: 1.02-2.01), and religiosity (aOR = 0.59, 95% CI: 0.41-0.85) were associated with physicians' beliefs about the safety of abortion. Providers who believed that abortion was very/extremely safe were more likely to support medication (aOR = 2.99, 95% CI: 1.93-4.65) and procedural abortion (aOR = 3.56, 95% CI: 2.31-5.50) and refer patients for abortion care (aOR = 3.14, 95% CI: 1.90-5.01). CONCLUSION Although abortions are associated with extremely few adverse events, a sizable portion of surveyed physicians had incorrect perceptions of the safety of abortion. These beliefs were associated with decreased support and referrals for abortion care. Educational exposure to abortion is associated with more accurate assessments of abortion safety, underscoring the importance of training in this area. Considering the current abortion policy landscape, it is imperative for physicians to hold accurate knowledge about abortion so they can provide comprehensive counseling and, when indicated, referrals for safe and legal care.
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Affiliation(s)
- Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, United States; Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, United States.
| | - Abigail S Cutler
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, United States; Department of Obstetrics and Gynecology, University of Wisconsin-Madison, United States
| | - Madison Lands
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, United States; Department of Obstetrics and Gynecology, University of Wisconsin-Madison, United States
| | - Nicholas B Schmuhl
- Population Health Institute, University of Wisconsin-Madison, United States
| | - Jenny A Higgins
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, United States; Department of Obstetrics and Gynecology, University of Wisconsin-Madison, United States
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Lu J, Leng A, Zhou Y, Zhou W, Luo J, Chen X, Qi X. An innovative virtual reality training tool for the pre-hospital treatment of cranialmaxillofacial trauma. Comput Assist Surg (Abingdon) 2023; 28:2189047. [PMID: 36974947 DOI: 10.1080/24699322.2023.2189047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Virtual reality (VR) surgery using the High Technology Computer Corporation Very Immersive Virtual Experience professional 2(HTC VIVE Pro2) suite is a multi-sensory, holistic surgical training experience. A multimedia combination including videos and three-dimensional interaction in VR has been developed to enable trainees to experience a realistic battlefield environment. The innovation allows trainees to interact with the individual components of the cranialmaxillofacial(CMF) anatomy and apply surgical instruments while watching close-up stereoscopic three-dimensional videos of the surgery. In this study, a novel training tool for the pre-hospital treatment of CMF trauma based on immersive virtual reality (iVR) was developed and validated. Twenty-five CMF surgeons evaluated the application for face and content validity. Using a structured assessment process, the surgeons commented on the content of the developed training tool, its realism and usability and the applicability of VR surgery for CMF trauma rescue simulation training. The results confirmed the applicability of VR for delivering training in the pre-hospital treatment of CMF trauma. Modifications were suggested to improve the user experience and interactions with the surgical instruments. This training tool is ready for testing with surgical trainees.
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Affiliation(s)
- Jin Lu
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ao Leng
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Ye Zhou
- Laboratory of Basic Medicine, General Hospital of Southern Theatre Command of the PLA, Guangzhou, Guangdong, China
| | - Weihao Zhou
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianfeng Luo
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Xiangdong Qi
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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10
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Rocchi C, Martel A. [Current status of French oculoplastics in France and in Europe]. J Fr Ophtalmol 2023; 46:1232-1243. [PMID: 37845142 DOI: 10.1016/j.jfo.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION In 2023, oculoplastics in France is experiencing a paradox with an imbalance between demand and supply of trainees. The goal of this study is to establish a factual overview of oculoplastics in France, with its limitations, and make proposals to optimize this sector. METHODS An observational study was conducted by compiling epidemiological data related to oculoplastics. This included full-time hospital practitioners (HPs) in French university hospitals (FUH), data from the distributed computerized system for health assessment (SIDES), the specialized cross-disciplinary training (FST) in oculoplastics, the interuniversity diploma (DIU) in oculoplastics, the French University Ophthalmologists College (COUF), and the French Society of Reconstructive and Aesthetic Ophthalmology (SOPREF). RESULTS Of the 32 FUH, only 11 full-time HPs (among them 5 academic) are specialized in oculoplastics. Several "priority" regions are underrepresented in oculoplastic surgeons. The number of ophthalmology residency coordinators and residents participating in the oculoplastics FST are decreasing over time and favoring other subspecialties. On the SIDES platform dedicated to residents, 26 (11.5%) of the 226 courses are devoted to oculoplastics. The role of women in oculoplastics is also discussed. CONCLUSION Despite offering quality theoretical training, the future of French oculoplastics is clouded by a lack of practical training. Corrective measures include increasing oculoplastic surgeons in the FUH, developing private practice fellowships, prioritizing residents from "priority" regions for the oculoplastics DIU, optimizing the inter-CHU network, creating innovative teaching resources, and organizing specific congresses for the residents.
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Affiliation(s)
- C Rocchi
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- University Hospital of Nice, 30 voie romaine, 06000 Nice, France.
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11
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Li Q, Qin Y. AI in medical education: medical student perception, curriculum recommendations and design suggestions. BMC Med Educ 2023; 23:852. [PMID: 37946176 PMCID: PMC10637014 DOI: 10.1186/s12909-023-04700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023]
Abstract
Medical AI has transformed modern medicine and created a new environment for future doctors. However, medical education has failed to keep pace with these advances, and it is essential to provide systematic education on medical AI to current medical undergraduate and postgraduate students. To address this issue, our study utilized the Unified Theory of Acceptance and Use of Technology model to identify key factors that influence the acceptance and intention to use medical AI. We collected data from 1,243 undergraduate and postgraduate students from 13 universities and 33 hospitals, and 54.3% reported prior experience using medical AI. Our findings indicated that medical postgraduate students have a higher level of awareness in using medical AI than undergraduate students. The intention to use medical AI is positively associated with factors such as performance expectancy, habit, hedonic motivation, and trust. Therefore, future medical education should prioritize promoting students' performance in training, and courses should be designed to be both easy to learn and engaging, ensuring that students are equipped with the necessary skills to succeed in their future medical careers.
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Affiliation(s)
- Qianying Li
- Antai College of economics and management, Shanghai Jiao Tong University, Shanghai, China
| | - Yunhao Qin
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
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12
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Solomon J, Goldfarb M. Family engagement in care for medical trainees and early career clinicians. BMC Med Educ 2023; 23:811. [PMID: 37891560 PMCID: PMC10605966 DOI: 10.1186/s12909-023-04792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Engaging family members in care improves person- and family-centered outcomes. Many healthcare professionals have limited awareness of the role and potential benefit of family engagement in care. This review describes the rationale for engaging families in care, and opportunities to engage family in various clinical care settings during training and early career practice.
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Affiliation(s)
- Joshua Solomon
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Michael Goldfarb
- Azrieli Heart Centre, Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Office E-212, H3T 1E2, Montreal, QC, Canada.
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Liew SC, Tan MP, Breen E, Krishnan K, Sivarajah I, Raviendran N, Aung T, Nimir A, Pallath V. Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum - a preliminary evaluation. BMC Med Educ 2023; 23:796. [PMID: 37880711 PMCID: PMC10601318 DOI: 10.1186/s12909-023-04777-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Virtual consultation is a synchronous mode of telemedicine provided remotely via information and communication technology. The projected growth of digitalization in healthcare delivery, however, necessitates medical student training in virtual consultation (VC) to ensure safe and effective patient care. This study describes the implementation and preliminary evaluation of a competency-based VC training module for undergraduate medical students. METHODS A newly developed six-week VC module was implemented online through asynchronous microlearning and synchronous simulation-based experiential learning modalities. Clinical students in years 4 and 5 and fresh graduates, who had not started pre-registration house officer or residency programmes, were invited to participate. Training outcomes using checklist-based video-recorded assessments of VC encounters between medical students and simulated patients were compared. Each video was independently assessed by two facilitators trained in VC teaching and assessment, using a direct observed virtual consultation skills checklist derived from established VC competencies. The participants completed course evaluations electronically as additional outcome measures. RESULTS Fifty-two clinical phase medical students and alumni completed both the instructional and practical phases of this module. Altogether, 45 (95.7%) students found the module beneficial, and 46 (95.9%) reported increased self-efficacy for conducting VC. In total, 46 (95.9%) students would recommend the course to others. Post-test results showed a significant increase in the students' abilities to conduct a VC (t-test = 16.33, p < 0.05). CONCLUSION Microlearning and simulation-based sessions were effective instructional delivery modalities for undergraduate medical students in their attainment of VC competencies.
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Affiliation(s)
- Siaw Cheok Liew
- Medical Education Research and Development Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
- VinUniversity, Hanoi, Vietnam
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Emer Breen
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
| | - Kuhan Krishnan
- Dean's Office, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Inthirani Sivarajah
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
| | - Nivashinie Raviendran
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
| | - Thidar Aung
- Department of Pathology, Manipal University College Malaysia, Malacca, Malaysia
| | - Amal Nimir
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
| | - Vinod Pallath
- Medical Education Research and Development Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Dumm M, Moll K, Helbach A, Leineweber CG, Böttrich T, Ruhtenberg CS, Polidori MC, Matthes J. Implementing nutritional medicine into medical curricula: A student-initiated course improves knowledge and attitudes. Clin Nutr ESPEN 2023; 57:181-189. [PMID: 37739654 DOI: 10.1016/j.clnesp.2023.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Although the risks and opportunities of nutrition in health trajectories are well known, it is rarely addressed in doctors' daily routine. This is partly related to physicians' lack of confidence in their ability to provide nutritional counselling, possibly due to insufficient training in medical school. Our study aimed at assessing the status quo of nutrition in the German medical curricula and the impact of a recently implemented, student-initiated online teaching initiative on perceived competence, knowledge and attitudes. METHODS "Eat This!" was the first Germany-wide initiative for online nutritional medicine (NM) education, consisting of 11 digital lectures on nutrition basics, nutrition medicine and public health nutrition. The contact time with NM during studies as well as the effects on students' attitudes towards NM, their self-perceived competence in NM and their nutrition knowledge were assessed from October 2020 to February 2021 in a cross-sectional as well as a prospective study using online questionnaires. RESULTS Over 1500 medical students from 42 German faculties participated in the lecture series and the online survey. One hundred and twenty-two students formed a control group. Although considering the topic relevant, students rated their training in NM as insufficient, in terms of both quality and quantity. Initially, they did not feel able to counsel patients and rated their knowledge as low. However, self-ratings and the score in a 33-item multiple-choice test knowledge improved by participating in Eat This! as did their attitude towards nutrition and planetary health. No such changes were observed in the control group of 122 students not attending the course. CONCLUSION Our results show that education in NM at German medical schools is perceived insufficient despite high student interest. But even low-threshold educational options like "Eat This!" can improve students' perceived competence, knowledge, and attitudes, and thus be an efficient and cost-effective way to address related deficits.
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Affiliation(s)
- Moritz Dumm
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany; Gemeinschaftskrankenhaus Havelhöhe, Department Intensive Care, First Aid & Cardiology, Kladower Damm 221, 14089 Berlin, Germany
| | - Katharina Moll
- University of Hamburg, Faculty of Medicine, Martinistraße 52, 20246 Hamburg, Germany
| | - Anna Helbach
- Institute of General Practice, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Straße 38, 16816, Germany
| | - Tim Böttrich
- University of Gießen, Faculty of Medicine, Klinikstraße 29, 35392 Gießen, Germany
| | | | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Matthes
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany.
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Kang C, Shin CJ, Scott IU, Greenberg PB. Virtual supervision in ophthalmology: a scoping review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2755-2762. [PMID: 37017740 PMCID: PMC10074343 DOI: 10.1007/s00417-023-06048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE The published information on virtual supervision (VS) in ophthalmology is not well described. This scoping review describes the evidence and potential role for VS in ophthalmic practice and education. METHODS A literature search strategy was developed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included full-text articles published in an English-language peer-reviewed journal that involved physician-physician or physician-trainee VS in ophthalmology. We excluded studies with direct (in-person) supervision. Two investigators independently extracted from each article the year of publication and study location, design, participant characteristics, sample size, and outcomes. We appraised the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS Seven articles were included in our qualitative synthesis. Supervisees ranged from physicians such as an ophthalmic surgeon and a general practitioner to medical trainees such as ophthalmology residents, vitreoretinal fellows, and emergency medicine residents. Study settings included emergency departments, operating rooms, eye clinics, and a rural hospital. All studies reported successful transmission of real-time images or videos of clinical examinations and surgical or in-office procedures. Various methods were used to ensure high image and video quality during VS, although some technical challenges remained. MMAT ratings revealed limitations in outcome measurement, statistical analysis, sampling strategy, and inclusion of confounding factors. CONCLUSION Virtual supervision in ophthalmology is technologically feasible and permits synchronous communication and transmission of clinical data, which can be used to formulate diagnostic and management plans and learn new surgical skills. Future studies with larger sample sizes and robust study designs should investigate factors that make VS effective in ophthalmic practice and education.
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Affiliation(s)
- Chaerim Kang
- Program in Liberal Medical Education, Brown University, Providence, RI, USA
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher J Shin
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA.
- Section of Ophthalmology, VA Providence Healthcare System, RI, Providence, USA.
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Fraidlin A, Van Stratton JE, McElroy A, Aljadeff E. Peer Feedback: Recommendations for Behavior Analysts' Training and Supervision. Behav Anal Pract 2023; 16:696-708. [PMID: 37680336 PMCID: PMC10480097 DOI: 10.1007/s40617-022-00761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/04/2022] Open
Abstract
The increase in demand for behavior analysts in recent years has also increased the importance of effective supervision practices in the field of behavior analysis. A critical supervisory skill is performance feedback, which entails proficiency with two distinct, yet inseparable repertoires of technical and nontechnical skills. Supervisors report never receiving explicit training in feedback (Sellers et al., 2019) and graduate training programs provide little to no training in nontechnical skills (LeBlanc, Taylor et al., 2020b; Pastrana et al., 2018). As with any skill, to develop proficiency with feedback delivery and reception, trainees may require ample practice opportunities. One mechanism to provide trainees routine practice opportunities is to use peers as behavior change agents and peer feedback as an instructional method. The utility of peer feedback has been recognized in the organizational behavior management (OBM) literature (e.g., behavior-based safety interventions; Lebbon et al., 2012; Wirth & Sigurdsson, 2008), and has been used successfully in medical student training and evaluation for several decades. In the context of behavior analytic training and supervision peer feedback has yet to be established as a training method. Similarities in the behavioral and medical fields (e.g., significance of professional and interpersonal skills for successful therapeutic relationships) make the medical field a good model from which behavior analysts can learn. Using peer feedback in training and supervision for behavior analysts may provide trainees with similar benefits to those reported in medical student training literature. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-022-00761-1.
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Affiliation(s)
- Avner Fraidlin
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Jessica E. Van Stratton
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Alyssa McElroy
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Elian Aljadeff
- Department of Behavioural Studies, Kinneret College, Sea of Galilee, Israel
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17
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Nnoromele CC, Pham D, Skelton F, Solinsky R. Diagnosis and management of cardiometabolic disease after spinal cord injury: Identifying gaps in physician training and practices. J Spinal Cord Med 2023:1-7. [PMID: 37534921 DOI: 10.1080/10790268.2023.2235744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
CONTEXT Cardiometabolic disease (CMD) frequently occurs in individuals with spinal cord injury (SCI), with growing awareness surrounding the expansive scope of this problem. As CMD has significant morbidity and mortality, early guidelines-based screening and management have been established. However, the extent to which these guidelines have been adopted are unclear. OBJECTIVE Describe physicians' screening and management pattern for CMD in patients with SCI, as compared to SCI-specific CMD screening guidelines, and elucidate variables linked to screening and management patterns. METHODS SCI medicine-boarded physicians were surveyed on screening timing for CMD following acute SCI, along with their practice pattern and comfort level managing common CMD risk factors. RESULTS Of the forty-seven SCI medicine physicians that responded, 62% felt the ideal timing for CMD screening is 6 months after the acute injury. Of these same physicians, few were screening for insulin resistance and lipid dysregulation prior to 6 months after injury. In addition, less than half felt comfortable writing new prescriptions for anti-glycemic and anti-lipid medications. Furthermore, no association was found between the amount of CMD education with screening or management patterns. Finally, VA-based providers were more likely to screen for CMD within 6 months of injury and were more comfortable managing/starting anti-glycemic medications and statins. CONCLUSIONS Despite the presence of SCI-specific CMD guidelines, gaps in screening and management practices still exist, most notably with insulin resistance and lipid dysregulation. VA-based providers generally screen and manage CMD risk factors more effectively, and further CMD education could consider emulating VA training modules.
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Affiliation(s)
- Chinenye Christa Nnoromele
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Du Pham
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | - Felicia Skelton
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
- Department of Physical Medicine and Rehabilitation, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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Dissanayaka N, Maclachlan LR, Alexander H, Redmond M, Carluccio D, Jules-Vandi L, Novak JI. Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials. World Neurosurg 2023; 176:e651-e663. [PMID: 37295464 DOI: 10.1016/j.wneu.2023.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE 3D printing is increasingly used to fabricate three-dimensional neurosurgical simulation models, making training more accessible and economical. 3D printing includes various technologies with different capabilities for reproducing human anatomy. This study evaluated different materials across a broad range of 3D printing technologies to identify the combination that most precisely represents the parietal region of the skull for burr hole simulation. METHODS Eight different materials (polyethylene terephthalate glycol, Tough PLA, FibreTuff, White Resin, BoneSTN, SkullSTN, polymide [PA12], glass-filled polyamide [PA12-GF]) across 4 different 3D printing processes (fused filament fabrication, stereolithography, material jetting, selective laser sintering) were produced as skull samples that fit into a larger head model derived from computed tomography imaging. Five neurosurgeons conducted burr holes on each sample while blinded to the details of manufacturing method and cost. Qualities of mechanical drilling, visual appearance, skull exterior, and skull interior (i.e., diploë) and overall opinion were documented, and a final ranking activity was performed along with a semistructured interview. RESULTS The study found that 3D printed polyethylene terephthalate glycol (using fused filament fabrication) and White Resin (using stereolithography) were the best models to replicate the skull, surpassing advanced multimaterial samples from a Stratasys J750 Digital Anatomy Printer. The interior (e.g., infill) and exterior structures strongly influenced the overall ranking of samples. All neurosurgeons agreed that practical simulation with 3D printed models can play a vital role in neurosurgical training. CONCLUSIONS The study findings reveal that widely accessible desktop 3D printers and materials can play a valuable role in neurosurgical training.
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Affiliation(s)
- Nalinda Dissanayaka
- School of Chemical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Liam R Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Hamish Alexander
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michael Redmond
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Danilo Carluccio
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Luigi Jules-Vandi
- School of Mechanical and Mining Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, Brisbane, Australia
| | - James I Novak
- School of Architecture, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.
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Mergen M, Meyerheim M, Graf N. Reviewing the current state of virtual reality integration in medical education - a scoping review protocol. Syst Rev 2023; 12:97. [PMID: 37337293 DOI: 10.1186/s13643-023-02266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Due to an increasing focus of medical curricula on clinical decision-making skills, new learning tools are constantly developed. Virtual reality (VR) is one of the emerging technologies with the potential to improve health professionals' education. Highly realistic learning experiences with repeatable training scenarios can be created within a protected environment that is independent from real patients' presence. Our project "medical tr.AI.ning" is following this approach aiming to simulate immersive virtual first-person scenarios with intelligent, interactable virtual patients. So far, VR has been mainly used in surgical training, but there is evidence for effectiveness in training different procedural skills, such as cardiopulmonary resuscitation, knowledge acquisition, and improvement of reasoning and creativity, while still being cost-effective. The objective of this scoping review is to explore the usage and identify key areas of VR applications in the field of medical education. Furthermore, the corresponding requirements, evaluation methods and outcomes, advantages, and disadvantages will be covered. METHODS This scoping review protocol implements the updated JBI Scoping Review Methodology. In March 2022, a preliminary literature research in PubMed was performed by two independent reviewers to refine search terms and strategy as well as inclusion criteria of the protocol, accounting for actuality and scientific relevance. The final search will be conducted using PubMed, ScienceDirect, Cochrane Library, Web of Science Core Collection, and JBI Evidence Synthesis. Search, study screening, and data extraction will be done in parallel and independently by two reviewers. Discrepancies will be handled by consensus or consulting a third review author. DISCUSSION With this scoping review, we anticipate collating the range of application of VR in medical education while using a transparent and reproducible search strategy. This may contribute to the design and development of novel educational VR platforms and their integration into medical curricula while pointing out previous omissions and pitfalls.
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Affiliation(s)
- Marvin Mergen
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany.
| | - Marcel Meyerheim
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany
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Krass P, Sieke EH, Joshi P, Akers AY, Wood SM. Pediatric Resident Perspectives on Long-Acting Reversible Contraception Training: A Cross-Sectional Survey of Accreditation Council for Graduate Medical Education Trainees. J Adolesc Health 2023; 72:964-971. [PMID: 36907801 PMCID: PMC10198905 DOI: 10.1016/j.jadohealth.2023.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Although pediatricians are primary care providers for most adolescents, pediatric residents receive limited training on long-acting reversible contraceptive (LARC) methods. This study aimed to characterize pediatric resident comfort with placing contraceptive implants and intrauterine devices (IUDs) and assess pediatric resident interest in obtaining this training. METHODS Pediatric residents in the United States were invited to participate in a survey assessing comfort with LARC methods and interest in LARC training during pediatric residency. Bivariate comparisons used Chi-square and Wilcoxon rank sum testing. Multivariate logistic regression was used to assess associations between primary outcomes and covariates including geographic region, training level, and career plans. RESULTS Six hundred twenty seven pediatric residents across the United States completed the survey. Participants were predominantly female (68.4%, n = 429), self-identified their race as White (66.1%, n = 412), and anticipated a career in a subspecialty other than Adolescent Medicine (53.0%, n = 326). Most residents were confident counseling patients on the risks and benefits, side effects, and effective use of contraceptive implants (55.6%, n = 344) and both hormonal and nonhormonal IUDs (53.0%, n = 324). Few residents reported comfort with inserting contraceptive implants (13.6%, n = 84) or IUDs (6.3%, n = 39), with most of these respondents having learned these skills as a medical student. Most participants believed that residents should receive training on insertion of contraceptive implants (72.3%, n = 447) and IUDs (62.5%, n = 374). DISCUSSION Although most pediatric residents believe LARC training should be a component of pediatric residency training, few pediatric residents are comfortable with provision of this care.
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Affiliation(s)
- Polina Krass
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Erin H Sieke
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Priyanka Joshi
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Sarah M Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadephia, Pennsylvania
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Pedram S, Kennedy G, Sanzone S. Toward the validation of VR-HMDs for medical education: a systematic literature review. Virtual Real 2023; 27:1-26. [PMID: 37360815 PMCID: PMC10182357 DOI: 10.1007/s10055-023-00802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/24/2023] [Indexed: 06/28/2023]
Abstract
The latest technological advancements in the domain of virtual reality (VR) have created new opportunities to use VR as a training platform for medical students and practitioners more broadly. Despite the growing interest in the use of VR as a training tool, a commonly identified gap in VR-training for medical education is the confidence in the long-term validity of the applications. A systematic literature review was undertaken to explore the extent of VR (in particular head-mounted displays) applications for medical training with an additional focus on validation measures. The papers included in this review discussed empirical case studies of specific applications; however, these were mostly concerned with human-computer interaction and were polarized between demonstrating that a conceptual technology solution was feasible for simulation or looked at specific areas of VR usability with little discussion on validation measures for long-term training effectiveness and outcomes. The review uncovered a wide range of ad hoc applications and studies in terms of technology vendors, environments, tasks, envisaged users and effectiveness of learning outcomes. This presents decision-making challenges for those seeking to adopt, implement and embed such systems in teaching practice. The authors of this paper then take a wider socio-technical systems perspective to understand how the holistic training system can be engineered and validated effectively as fit for purpose, through distillation of a generic set of requirements from the literature review to aid design specification and implementation, and to drive more informed and traceable validation of these types of systems. In this review, we have identified 92 requirement statements in 11 key areas against which a VR-HMD training system could be validated; these were grouped into design considerations, learning mechanisms and implementation considerations.
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Affiliation(s)
- Shiva Pedram
- SMART Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Grace Kennedy
- SMART Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Sal Sanzone
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
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Steele S, Andrade G. A national analysis of the medical schools of training for merit award-winning laboratory medical doctors working in Britain. BMC Med Educ 2023; 23:222. [PMID: 37029376 PMCID: PMC10082534 DOI: 10.1186/s12909-023-04161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
AIMS To inform the discussion regarding the origins of Laboratory Medical Consultant clinical merit award holders (LMC) whether the awards came from the Clinical Excellence Awards (CEA) or Distinction Awards (DA) schemes. METHODS Setting - CEA is a scheme to financially reward senior doctors in England and Wales who are assessed to be working over and above the standard expected of their role. The DA scheme is the parallel and equivalent scheme in Scotland. Participants - All of the merit award holders in the 2019 round. Design - This involved a secondary analysis of the complete 2019 published dataset of award winners. Statistical analyses were performed with Chi-square tests set at p < 0.05 level for statistical significance. RESULTS The top five medical schools (London University, Glasgow, Edinburgh, Aberdeen and Oxford) were responsible for 68.4% of the LMC merit award holders in the 2019 round. 97.9% of the LMC merit award holders were from European medical schools, whereas 90.9% of the non-LMC award holders were from European medical schools. The LMCs with A plus or platinum awards came from only six medical schools: Aberdeen, Edinburgh, London University, Oxford, Sheffield and Southampton. In contrast, the B or silver/bronze LMC award holders came from a more diverse background of 13 medical schools. CONCLUSIONS The majority of LMC merit award holders originated from only five university medical schools. All the LMCs with A plus or platinum awards came from only six university medical schools. There is an apparent overrepresentation of a small number of medical schools of origin amongst those LMCs that hold national merit awards.
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Dinoff A, Lynch S, Hameed AS, Koestler J, Ferrando SJ, Klepacz L. When Did the Empathy Die?: Examining the Correlation Between Length of Medical Training and Level of Empathy. Med Sci Educ 2023; 33:489-497. [PMID: 37251206 PMCID: PMC10020755 DOI: 10.1007/s40670-023-01768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/31/2023]
Abstract
Purpose Empathy is an important skill for physicians as it can lead to improved patient outcomes and satisfaction. This study assessed self-reported empathy by medical students across all four years of medical school and potential differences in empathy across students interested in different subspecialties. Method All medical students enrolled at New York Medical College in August 2020 were invited to participate in this study. Participants completed the student version of the Jefferson Scale of Empathy. Results A total of 179 medical students participated. Mean empathy score in fourth-year students was significantly lower than that in first-year students. Mean empathy score was greatest among students interested in Pediatrics and was greater in participants who identified as women. Conclusions Self-reported empathy may be lower in upper-year medical students when compared to lower-year students. The potential reasons for lower empathy in the later years of training are discussed. A systematic curriculum for teaching and maintaining empathy should be developed and uniformly implemented across medical schools to combat a potential decline in empathy.
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Affiliation(s)
- Adam Dinoff
- School of Medicine, New York Medical College, Valhalla, USA
| | - Sean Lynch
- Department of Psychiatry, Mount Sinai Beth Israel, 9 Nathan D Perlman Pl, New York, NY 10003 USA
| | | | - Jennifer Koestler
- Department of Pediatrics, New York Medical College, Valhalla, USA
- Department of Internal Medicine, New York Medical College, Valhalla, USA
| | - Stephen J. Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, USA
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, USA
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, USA
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, USA
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Silkens MEWM, Alexander K, Viney R, O'Keeffe C, Taylor S, Noble LM, Griffin A. A national qualitative investigation of the impact of service change on doctors' training during Covid-19. BMC Med Educ 2023; 23:174. [PMID: 36941665 PMCID: PMC10027255 DOI: 10.1186/s12909-023-04143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated. METHODS Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding. RESULTS Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic. CONCLUSIONS The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.
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Affiliation(s)
- M E W M Silkens
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
- Centre for Healthcare Innovation Research, Department of Health Services Research and Management, City University of London, London, UK
| | - K Alexander
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - R Viney
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
| | - C O'Keeffe
- UCL Medical School, University College London, London, UK
| | - S Taylor
- Institute of Education, University College London, London, UK
| | - L M Noble
- UCL Medical School, University College London, London, UK
| | - A Griffin
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK.
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Barbadoro P, Brunzini A, Dolcini J, Formenti L, Luciani A, Messi D, Papetti A, Ponzio E, Germani M, Adrario E. Stress responses in high-fidelity simulation and standard simulation training among medical students. BMC Med Educ 2023; 23:116. [PMID: 36797725 PMCID: PMC9936714 DOI: 10.1186/s12909-023-04101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Simulation has been recognized as a shift in healthcare education that can improve skills and patient safety and outcomes. High-fidelity simulation of critical medical situations can be a source of stress among participants that can interfere with students' abilities leading to unexpected emotional responses. The aim of this study is to determine if two simulation methods, high-fidelity (HF) and procedural simulation (PS), may be associated with stress responses at a self-perceived and biological level (salivary cortisol variations), and to compare stress levels of the two different simulation method. We also wanted to find independent variables associated with cortisol total hormonal output. METHODS A quasi-experimental before-after study was used including the administration of questionnaires, and biomarkers evaluation by salivary cortisol samples before and after simulation. A total of 148 students were eligible and agreed to participate in the study. We used paired T-test for mean comparison regarding State-trait anxiety for both HF and PT simulations. For NASA-TLX we performed a T-test mean comparison between groups. We used paired T-test mean comparison for cortisol analysis. Multivariable linear regression has been used to assess variables associated with AUCg values and perceived stress. RESULTS values of STAI-Y scores were relatively higher at the end of the HF and PS sessions. NASA-TLX was significantly higher at baseline for the HF simulations, with respect to the PS simulation. Cortisol fold increase was significantly different in the two groups. Linear regression showed that cortisol AUCg was related to the STAI-Y score in both groups. CONCLUSION Participating students developed a stress response both after in the HF and PS training, testified by psychological and biological outputs. According to our results, stress levels were increased for simply being in a simulation scenario than to the intrinsic complexity of the task required. More studies are needed to confirm this trend and to clarify the role of simulated stress response in a long-term learning scenario.
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Affiliation(s)
- Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Agnese Brunzini
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of the Marche Region, 60131, Ancona, Italy
| | - Jacopo Dolcini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy.
| | - Luca Formenti
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Aurora Luciani
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Daniele Messi
- Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Alessandra Papetti
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of the Marche Region, 60131, Ancona, Italy
| | - Elisa Ponzio
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Michele Germani
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of the Marche Region, 60131, Ancona, Italy
| | - Erica Adrario
- Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
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Gaytán-Fernández S, Barragan-Hervella RG, Quiroz-Williams J, Rodríguez Palacios CL, Sánchez-González G. Exposición a radiación ionizante en médicos residentes de ortopedia en un hospital de referencia. CIR CIR 2023; 91:64-72. [PMID: 36787603 DOI: 10.24875/ciru.21000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To describe and analyze the exposure to ionizing radiation of orthopedic residents. METHOD A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety. RESULTS 54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424). CONCLUSIONS Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.
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Affiliation(s)
- Suemmy Gaytán-Fernández
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Pue., México
| | - Rodolfo G Barragan-Hervella
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Pue., México
| | - Jorge Quiroz-Williams
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Pue., México
| | - Carlos L Rodríguez Palacios
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Pue., México
| | - Gilberto Sánchez-González
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Pue., México
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Christodoulou N, Maruani J, d'Ortho MP, Lejoyeux M, Geoffroy PA. Sleep quality of medical students and relationships with academic performances. Encephale 2023; 49:9-14. [PMID: 34876277 DOI: 10.1016/j.encep.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Sleep health is a major public health concern because of its correlation with physical and mental health, and it may be particularly altered in medical students. This study aims: i) to examine the sleep characteristics of French medical students and their knowledge about basic sleep hygiene rules and; ii) to examine the correlations between sleep quality and academic performances, as well as between sleep quality and sleep knowledge. METHODS Students from 4th, 5th and 6th years of medicine, of the Faculty of Paris Diderot, voluntarily responded to an online questionnaire including PSQI and multiple-choice quizzes (MCQ) about basic sleep hygiene rules. RESULTS From the 177 participants, 49.7% had a poor sleep (PSQI>5). Regarding sleep latency, 44.6% needed>30min to fall asleep at least once a week, 26.5% slept 6 hours or less by night, 42.4% of them qualified their sleep quality as bad or very bad. A serious lack of knowledge about basic sleep hygiene rules was observed, with an average score at the MCQ of 6.61/10, and only 31% of medical students were aware of basic good sleep habits. Significant correlations were observed between sleep efficiency and all academic mean scores (both regarding the morning, afternoon, and pooled mean scores), and between sleep disturbances and the morning mean score. CONCLUSIONS French medical students have a poor sleep quality, correlating with academic performances, and present a poor knowledge of basic sleep rules. These findings are a call to improve medical training schedules and to develop prevention and training programs.
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Affiliation(s)
- N Christodoulou
- Université de Paris, 45, rue des Saints-Pères, 75006 Paris, France; Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France.
| | - J Maruani
- Université de Paris, 45, rue des Saints-Pères, 75006 Paris, France; Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France
| | - M-P d'Ortho
- Université de Paris, 45, rue des Saints-Pères, 75006 Paris, France; Inserm U1141, université de Paris, NeuroDiderot, 75019 Paris, France; Explorations fonctionnelles et centre du sommeil, département de physiologie clinique, GHU Paris Nord, DMU DREAM, hôpital Bichat, AP-HP, 75018 Paris, France
| | - M Lejoyeux
- Université de Paris, 45, rue des Saints-Pères, 75006 Paris, France; Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France
| | - P A Geoffroy
- Université de Paris, 45, rue des Saints-Pères, 75006 Paris, France; Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France.
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28
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Buckley L, Curtin M, Cornally N, Harford K, Gibson L. Exploring Undergraduate Medical Student Experiences of Training Within a Community-Based Paediatric Clinic. Med Sci Educ 2023; 33:73-81. [PMID: 37008434 PMCID: PMC10060458 DOI: 10.1007/s40670-022-01699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/19/2023]
Abstract
Background Undergraduate medical education in Ireland comprises of clinical training largely within teaching hospitals, with less emphasis on training in community settings. Studies show a move beyond traditional models of training is needed, particularly in the domain of community child health. A multi-agency, inter-disciplinary community paediatric clinic was established in a disadvantaged area of southern Ireland. Kidscope provides health and developmental assessment for children aged 0-6 years and acts as a training clinic for medical students who complete a one day placement during the final year of their undergraduate medical degree. The aim of this study was to capture student experiences and to understand the perceived impact of community-based training on undergraduate medical education. Methods A descriptive study design was used. Research tools included a mixed-methods online questionnaire and qualitative reflective essays. Microsoft Excel generated descriptive statistics from quantitative questionnaire responses. Braun and Clarke's framework guided thematic analysis of qualitative data. Data integration and reporting were conducted in line with mixed-methods research design standards. Results Fifty-two medical students consented to participate. Thirty-two (62%) responded to the online questionnaire. Twenty reflective essays were randomly selected. Ninety-four percent felt the clinic provided an opportunity to apply knowledge and skills, 96% reported the experience strongly improved their understanding of child health and development, and 90% reported the experience was extremely valuable to their overall learning. Qualitative analysis showed engagement with a vulnerable population in the community increased student knowledge, informed practice, and heightened awareness of social deprivation and its impact on child development. Conclusion Exposure to a community-based paediatric clinic influenced undergraduate medical student training through experiential and transformative learning. Our experience of teaching clinical skills in the community could be replicated across medical fields to the benefit of the wider community. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01699-3.
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Affiliation(s)
- Lynn Buckley
- School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Margaret Curtin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Katherine Harford
- Let’s Grow Together! Infant & Childhood Partnerships CLG, Cork, Ireland
| | - Louise Gibson
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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29
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Liu TC, Liu AS, Bai ZG, Zhao L. Conception of metaverse training room for cardiovascular interventional surgery. Asian J Surg 2023:S1015-9584(23)00096-9. [PMID: 36732186 DOI: 10.1016/j.asjsur.2023.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tai-Cheng Liu
- Department of the First Clinical Medical College, Inner Mongolia Medical University, No.5 Tongdao North Street, Hohhot, 010059, Inner Mongolia, China.
| | - Ai-Shi Liu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, No.1 Tongdao North Street, Hohhot, 010050, Inner Mongolia, China
| | - Zhi-Gang Bai
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, No.1 Tongdao North Street, Hohhot, 010050, Inner Mongolia, China
| | - Lei Zhao
- Department of the First Clinical Medical College, Inner Mongolia Medical University, No.5 Tongdao North Street, Hohhot, 010059, Inner Mongolia, China; Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, No.1 Tongdao North Street, Hohhot, 010050, Inner Mongolia, China.
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30
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Rivière P, Penel N, Faure K, Marie G, Najem A, Rivière MK, Panaget S. Effect of medical staff training on vaccination coverage in outpatients with cancer: An interventional multicenter before-and-after study. Vaccine X 2023; 13:100261. [PMID: 36654840 DOI: 10.1016/j.jvacx.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Purpose Despite widely disseminated guidelines, pneumococcal and influenza vaccination coverage (VC) remains insufficient in patients with cancer receiving cancer treatment. We performed an interventional study to evaluate VC in patients with cancer treated at the medical oncology departments of three North-of-France hospitals and to assess the effect of medical staff training on VC in these patients. Methods A standardized questionnaire assessed VC in adult patients with cancer receiving anticancer treatment at three day hospitals during December 2-7, 2019. Subsequently (January 2020), we organized educational training sessions for medical staff from each hospital to discuss the current vaccination guidelines. To assess the impact of training on pneumococcal and influenza VC, we re-administered the same questionnaire in March 2020. Because there are no specific guidelines on Diphtheria-Tetanus-Pertussis (DTP) vaccination and no improvement was expected, DTP VC acted as an internal control. Results In total, 272 patients from all three hospitals were enrolled in the "before study"; 156 patients from only two hospitals were enrolled in the "after study" as medical training and data collection at the third were impossible because of administrative reasons and COVID-19 pandemic. The predictors were age for DTP VC; treatment center for pneumococcal VC; and age, sex, and tumor histology (adenocarcinoma vs. others) for influenza VC. Neither influenza VC (42.6% vs. 55.1%, p = 0.08), nor pneumococcal VC were significantly improved post-intervention (11.8% vs. 15.4%, p = 1). There seems to be a small effect in the most fragile for influenza VC. Conclusion As expected, VC was very low in patients with cancer, consistent with the literature. There was no impact of the intervention for pneumococcal and influenza VC.
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Burian BK, Ebnali M, Robertson JM, Musson D, Pozner CN, Doyle T, Smink DS, Miccile C, Paladugu P, Atamna B, Lipsitz S, Yule S, Dias RD. Using extended reality (XR) for medical training and real-time clinical support during deep space missions. Appl Ergon 2023; 106:103902. [PMID: 36162274 DOI: 10.1016/j.apergo.2022.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/14/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Medical events can affect space crew health and compromise the success of deep space missions. To successfully manage such events, crew members must be sufficiently prepared to manage certain medical conditions for which they are not technically trained. Extended Reality (XR) can provide an immersive, realistic user experience that, when integrated with augmented clinical tools (ACT), can improve training outcomes and provide real-time guidance during non-routine tasks, diagnostic, and therapeutic procedures. The goal of this study was to develop a framework to guide XR platform development using astronaut medical training and guidance as the domain for illustration. We conducted a mixed-methods study-using video conference meetings (45 subject-matter experts), Delphi panel surveys, and a web-based card sorting application-to develop a standard taxonomy of essential XR capabilities. We augmented this by identifying additional models and taxonomies from related fields. Together, this "taxonomy of taxonomies," and the essential XR capabilities identified, serve as an initial framework to structure the development of XR-based medical training and guidance for use during deep space exploration missions. We provide a schematic approach, illustrated with a use case, for how this framework and materials generated through this study might be employed.
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Affiliation(s)
- B K Burian
- Human Systems Integration Division, NASA Ames Research Center, USA
| | - M Ebnali
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA; Department of Emergency Medicine, Harvard Medical School, USA
| | | | - D Musson
- Faculty of Health Science, McMaster University, Canada; Department of Electrical and Computer Engineering, McMaster University, Canada
| | | | - T Doyle
- Department of Electrical and Computer Engineering, McMaster University, Canada
| | - D S Smink
- Department of Surgery, Harvard Medical School, USA
| | - C Miccile
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA
| | - P Paladugu
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA
| | | | - S Lipsitz
- Department of Surgery, Harvard Medical School, USA
| | - S Yule
- Department of Clinical Surgery, University of Edinburgh, Scotland, United Kingdom
| | - R D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA; Department of Emergency Medicine, Harvard Medical School, USA.
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Nguyen MT, Nguyen TG, Tran TTA, Nguyen TTN, Le DD, Nguyen TTB, Hoang HH, Ho TLD, Tran BT. Network analysis of psychological factors related to academic pressure faced by medical students in the central and highland regions of Vietnam. Med Educ Online 2022; 27:2007577. [PMID: 34821211 PMCID: PMC9639564 DOI: 10.1080/10872981.2021.2007577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
Medical students experience extensive pressure during their undergraduate courses. Given the complex associations between psychological factors in association with academic pressure. We investigated the study with objectives: To examine psychological factors related to academic pressure by analysing interactions between 'study motivation', 'study environment', 'study conditions', 'teacher quality', 'training programme', 'management system', 'evaluation', and 'extracurricular activities' using a network analysis approach. A total of 878 medical students majoring in general medicine from the first, third, and fifth years of a six-year course at the largest medical university in central and highland regions of Vietnam were involved in this cross-sectional study. The approach used was convenient cluster sampling with a self-administered questionnaire by the participants. Network analysis for pairwise correlations between psychological factors was estimated . Important factors in the network analysis were calculated using centrality indices including node strength (S), closeness (C), and betweenness (B). The higher score of S, C, and B indicate the more importance of the node. The results obtained from the network analysis of eight psychological factors showed that 'teaching quality' was mostly connected with other factors overall, while the 'training programme' was seen in both genders and freshman students. 'Study conditions' and 'training programme' were mostly connected with other factors in junior and senior students, respectively. The strong pairwise correlation was confirmed: management system and evaluation activity, followed by study environment and study conditions, and teaching quality and training programme. Additionally, nodes with high centrality were shown to be 'management system' (S = 0.97, C = 0.019, B = 1), and 'training programme' (S = 0.96, C = 0.021, B = 4). Our study findings indicate that satisfaction with the training programme amongst eight psychological factors is the most important factor affecting academic pressure among medical students. The training programme is linked with teaching quality, whereas the management system is correlated with evaluation activity.
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Affiliation(s)
- Minh Tu Nguyen
- Undergraduate Training Office, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thanh Gia Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Tho Thi Anh Tran
- Department of Gastroenterology and Hepatology, Nghe An Oncology Hospital, Nghe An, Vietnam
| | - Thi Thanh Nhan Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Duong Le
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Thanh Binh Nguyen
- Department of Pediatrics, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Huu Hai Hoang
- Student’s Affairs Office, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Linh Dan Ho
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Binh Thang Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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Rezaiefar P, Abou-Hamde Y, Naz F, Alborhamy YS, LaDonna KA. "Walking on eggshells": experiences of underrepresented women in medical training. Perspect Med Educ 2022; 11:325-332. [PMID: 36417160 PMCID: PMC9684928 DOI: 10.1007/s40037-022-00729-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Medicine remains an inequitable profession for women. Challenges are compounded for underrepresented women in medicine (UWiM), yet the complex features of underrepresentation and how they influence women's career paths remain underexplored. This qualitative study examined the experiences of trainees self-identifying as UWiM, including how navigating underrepresentation influenced their envisioned career paths. METHODS Ten UWiM family medicine trainees from one Canadian institution participated in semi-structured group interviews. Thematic analysis of the data was informed by feminist epistemology and unfolded during an iterative process of data familiarization, coding, and theme generation. RESULTS Participants identified as UWiM based on visible and invisible identity markers. All participants experienced discrimination and "otherness", but experiences differed based on how identities intersected. Participants spent considerable energy anticipating discrimination, navigating otherness, and assuming protective behaviours against real and perceived threats. Both altruism and a desire for personal safety and inclusion influenced their envisioned careers serving marginalized populations and mentoring underrepresented trainees. DISCUSSION Equity, diversity, and inclusion initiatives in medical education risk being of little value without a comprehensive and intersectional understanding of the visible and invisible identities of underrepresented trainees. UWiM trainees' accounts suggest that they experience significant identity dissonance that may result in unintended consequences if left unaddressed. Our study generated the critical awareness required for medical educators and institutions to examine their biases and meet their obligation of creating a safer and more equitable environment for UWiM trainees.
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Affiliation(s)
- Parisa Rezaiefar
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada.
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Yara Abou-Hamde
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Farah Naz
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yasmine S Alborhamy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Shum JW, Dierks EJ. Fellowship Training in Oral and Maxillofacial Surgery: Opportunities and Outcomes. Oral Maxillofac Surg Clin North Am 2022; 34:545-554. [PMID: 36224071 DOI: 10.1016/j.coms.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pursuit of fellowship training stems from one's desire to master a focused area of surgery. Successful applicants tend to have published articles and participated in other scholarly activities. They commonly have a mentor within the subspecialty of their interest. Selection of the program is generally based on the breadth of experience available followed by faculty reputation and location. Advantages to the successful fellowship graduate include the experience and confidence to provide specialized and efficient care to patients. Enhancements to an academic department with a fellowship program include mentorship for residents and guidance toward fellowship, as well as an increased level of scholarly activity.
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Affiliation(s)
- Jonathan W Shum
- Oral, Head and Neck Oncologic and Reconstructive Surgery Fellowship, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, 6560 Fannin Street Suite 1900#, Houston, TX 77054, USA.
| | - Eric J Dierks
- Department of Oral and Maxillofacial Surgery, Oregon and Health Sciences University, Head and Neck Surgical Associates, 1849 NW Kearney, Suite 300, Portland, OR 97209, USA
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Kurz S, Buggenhagen H, Wachter N, Penzkofer L, Dietz SO, König TT, Heinemann MK, Neulen A, Hanke LI, Huber T. [Testing of practical surgical teaching at a distance-Experiences with a hybrid OSCE in surgery]. Chirurgie (Heidelb) 2022; 93:976-982. [PMID: 35925137 PMCID: PMC9122243 DOI: 10.1007/s00104-022-01650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has changed medical teaching worldwide. Digital teaching and examinations are successful for cognitive learning objectives, whereas practical skills had to be carried out predominantly in person under strict hygiene standards. AIM This study presents the opportunities and challenges of using a presence objective structured clinical examination (OSCE) at a distance with digital support. METHOD Following surgical practical teaching an OSCE was conducted in presence, where students demonstrated practical skills in one room while the examiners were connected via videoconference from another room. Students were surveyed about the OSCE and sustained learning via a standardized online questionnaire after completion of the surgical teaching. Additionally, examiners were surveyed on their experiences. RESULTS In the online survey 40 students participated (25% of n = 157 students contacted) and 36 completed questionnaires were analyzed. Overall, the implementation of an OSCE even under pandemic conditions was perceived as very positive by the students (92% of students n = 33). In particular, the acquisition of practical skills was rated as very high. For 78% (n = 28) of the students, the acquisition of competencies through the practical examination was particularly sustainable. The vast majority of students and examiners felt safe regarding infection control because of the hygiene concept (92%, n = 33). Overall, 80 students achieved grade 1 (51%), 71 students grade 2 (45.2%) and 6 students grade 3 (3.8%) (grade 1 = very good, grade 6 = very bad). CONCLUSION Practical examinations are essential for checking practical learning objectives and can be implemented at a distance with a well-developed hygiene concept and digital support.
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Affiliation(s)
- S Kurz
- Rudolf Frey Lernklinik, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - H Buggenhagen
- Rudolf Frey Lernklinik, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - N Wachter
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - L Penzkofer
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - S O Dietz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T T König
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - M K Heinemann
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Neulen
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - L I Hanke
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - T Huber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Collier K, Gupta A, Vinson A. Motivating change in resident language use through narrative medicine workshops. BMC Med Educ 2022; 22:663. [PMID: 36071430 PMCID: PMC9449284 DOI: 10.1186/s12909-022-03721-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19-20 about their experiences both in participating in narrative medicine workshops and giving patient care. METHODS The framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18-19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed. RESULTS We found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews. CONCLUSIONS Our research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.
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Affiliation(s)
| | - Amit Gupta
- University of North Carolina at Chapel Hill, North Carolina, USA
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Yuste JR, Matteo ABD, Gruber F. Impact of Infectious Diseases training in the perception of antibiotic resistance and rational use of antibiotics among Spanish medical students - a cross-sectional study. BMC Med Educ 2022; 22:550. [PMID: 35840970 PMCID: PMC9287956 DOI: 10.1186/s12909-022-03580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Antibiotic resistance is one of the main public health problems worldwide. One key tool to optimize antibiotic prescription is medical training. The aim of this study is to compare the impact of training in infectious diseases on students' knowledge of the antibiotic resistance problem and the rational use of antibiotics. METHODS We performed a cross-sectional study in the medical school of the University of Navarra. We conducted an anonymous in situ survey of students in each year of training. Data were analyzed grouping the students as follows: GROUP 1: first three years of education, no training in Clinical Microbiology (CM) or in Infectious Diseases (ID); GROUP 2: fourth-year students, training in CM but not ID; GROUP 3: Fifth and sixth-year students who have completed the training in CM and ID. Chi-square test (or Fisher's exact test when appropriate) was performed to evaluate potential associations. Wilcoxon's test was used to compare the median correct answers between groups. We used Spearman's test for correlation between year of training and performance in questionnaire. RESULTS A total of 994 students respond to the survey, 80.4% of the eligible students. Almost all students who had completed infectious diseases training perceive antibiotic resistance as an important problem in comparison with students who had not completed the formation (99.5% in group 3 vs 94.5% in group 1, p = 0.02). Knowledge of antibiotic stewardship underwent a statistically significant change after training in infectious diseases (from 9.2% in group 1 to 52.2% in group 3, p < 0.001). In the training questions block we also found an increase in the average number of correct answers (21.4% in group 1 vs 44.7% in group 3, p < 0.001). When comparing the results of subgroups 3A and 3B we found a significant loss of knowledge as we moved away from training (49% vs 40.9%, p < 0.001). CONCLUSIONS The training of medical students is the key to improving both perception and knowledge of infectious diseases. However, we have an opportunity for educational improvement as far as infectious diseases are concerned, regarding both the acquisition of knowledge and its loss as time lapses after training.
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Affiliation(s)
- José Ramón Yuste
- Division of Infectious Diseases, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain.
- Department of Internal Medicine, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain.
| | - Andrés Blanco-Di Matteo
- Division of Infectious Diseases, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Internal Medicine, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
| | - Fernando Gruber
- Division of Infectious Diseases, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
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Li H, Sun Y, Barwise A, Cui W, Dong Y, Tekin A, Yuan Q, Qiao L, Gajic O, Niven A. A novel multimodal needs assessment to inform the longitudinal education program for an international interprofessional critical care team. BMC Med Educ 2022; 22:540. [PMID: 35831867 PMCID: PMC9281106 DOI: 10.1186/s12909-022-03605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The current global pandemic has caused unprecedented strain on critical care resources, creating an urgency for global critical care education programs. Learning needs assessment is a core element of designing effective, targeted educational interventions. In theory, multimodal methods are preferred to assess both perceived and unperceived learning needs in diverse, interprofessional groups, but a robust design has rarely been reported. Little is known about the best approach to determine the learning needs of international critical care professionals. METHOD We conducted multimodal learning needs assessment in a pilot group of critical care professionals in China using combined quantitative and qualitative methods. The assessments consisted of three phases: 1) Twenty statements describing essential entrustable professional activities (EPAs) were generated by a panel of critical care education experts using a Delphi method. 2) Eleven Chinese critical care professionals participating in a planned education program were asked to rank-order the statements according to their perceived learning priority using Q methodology. By-person factor analysis was used to study the typology of the opinions, and post-ranking focus group interviews were employed to qualitatively explore participants' reasoning of their rankings. 3) To identify additional unperceived learning needs, daily practice habits were audited using information from medical and nursing records for 3 months. RESULTS Factor analysis of the rank-ordered statements revealed three learning need patterns with consensual and divergent opinions. All participants expressed significant interest in further education on organ support and disease management, moderate interest in quality improvement topics, and relatively low interest in communication skills. Interest in learning procedure/resuscitation skills varied. The chart audit revealed suboptimal adherence to several evidence-based practices and under-perceived practice gaps in patient-centered communication, daily assessment of antimicrobial therapy discontinuation, spontaneous breathing trial, and device discontinuation. CONCLUSIONS We described an effective mixed-methods assessment to determine the learning needs of an international, interprofessional critical care team. The Q survey and focus group interviews prioritized and categorized perceived learning needs. The chart audit identified additional practice gaps that were not identified by the learners. Multimodal methods can be employed in cross-cultural scenarios to customize and better target medical education curricula.
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Affiliation(s)
- Heyi Li
- Department of Medicine, Division of Pulmonary and Clinical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yuqiang Sun
- Department of Emergency Medicine, China Medical University, Shenyang, China
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Department of Medicine, Division of Pulmonary and Clinical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wenjuan Cui
- Department of Intensive Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Qingzhong Yuan
- Department of Intensive Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Clinical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander Niven
- Department of Medicine, Division of Pulmonary and Clinical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Alcaraz-Mateos E, Mirza KM, Molina-Valverde S, Togkaridou M, Caballero-Alemán F, Poblet E. The utility of a gross dissection anatomical model for simulation-based learning in pathology. Rev Esp Patol 2022; 55:149-155. [PMID: 35779880 DOI: 10.1016/j.patol.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. METHODS Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). RESULTS The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). CONCLUSIONS This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.
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Affiliation(s)
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, USA
| | - Sara Molina-Valverde
- Internal Medicine Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | - Enrique Poblet
- Department of Pathology, Reina Sofía University Hospital, Murcia, Spain; Faculty of Medicine, University of Murcia, Spain
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Schwindt EM, Stockenhuber R, Kainz T, Stumptner N, Henkel M, Hefler L, Schwindt JC. Neonatal simulation training decreases the incidence of chest compressions in term newborns. Resuscitation 2022; 178:109-115. [PMID: 35700883 DOI: 10.1016/j.resuscitation.2022.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters. METHODS This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions. RESULTS Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001). CONCLUSION Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.
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Affiliation(s)
- Eva M Schwindt
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria; STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
| | | | - Theresa Kainz
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Nicola Stumptner
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Henkel
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Lukas Hefler
- Department of Obstetrics and Gynecology, Konventhospital Barmherzige Brueder and Ordensklinikum Linz, Seilerstaette 2-4, 4010 Linz, Austria
| | - Jens C Schwindt
- STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
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Repine KM, Bawmann O, Mendlen M, Lowenstein SR. Investigating Wellness and Burnout Initiatives for Anesthesiology Resident Physicians: Time for Evidence-Based Investigation and Implementation. Anesthesiol Clin 2022; 40:275-285. [PMID: 35659400 DOI: 10.1016/j.anclin.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Resident physician burnout and well-being are increasingly important and salient topics in medical training. Unfortunately, limited research exists regarding the efficacy of various burnout and wellness interventions for resident physicians. Better characterization of the causes of burnout and the components of well-being must necessarily precede implementation and evaluation of interventions. The authors advocate for an increased role for technology in implementing and studying wellness programming for resident physicians. In addition, they describe an intervention under development at the University of Colorado School of Medicine that uses a "Gratitude Journal" smartphone app to support trainee wellness.
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Affiliation(s)
- Kelsey M Repine
- Anesthesiology Department, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO 80045 USA.
| | - Oliver Bawmann
- Internal Medicine-Pediatrics Department, University of Colorado School of Medicine, 12631 East 17th Avenue, 8601, Aurora, CO 80045
| | - Madelyn Mendlen
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO 80045
| | - Steven R Lowenstein
- University of Colorado School of Medicine, 13001 East 17th Place, Campus Box C-290, Aurora, CO 80045, USA
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Sun Q, Chang W, Liu X, Xie J, Qiu H, Yang Y, Liu L. Aerosol therapy during mechanical ventilation in intensive care units: A questionnaire-based survey of 2203 ICU medical staff in China. J Intensive Med 2022; 2:189-194. [PMID: 36789017 PMCID: PMC9923942 DOI: 10.1016/j.jointm.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/28/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
Background To describe the current status of aerosol therapy during mechanical ventilation (MV) and the practice, knowledge, and beliefs about aerosol therapy in physicians working in the intensive care unit (ICU) in China. Methods A physician self-administered questionnaire-based cross-sectional survey was carried out from January 2019 to July 2019. An electronic questionnaire was designed, and physicians who worked regularly in ICUs across several hospitals were contacted through WeChat. Answers to all questions and the general characteristics of physicians who answered the questionnaire were collected and analyzed. Results A total of 2203 medical staff who regularly worked in the ICUs completed this questionnaire (9.0% missing data); 87.7% of the participants were doctors. Most respondents claimed that they often administered aerosolization therapy. Ultrasonic atomizer (50.7%) and jet nebulizer (48.6%) were the most commonly used atomization devices. Bronchodilators (65.8%) and steroids (66.3%) were the most frequently aerosolized drugs during MV. During nebulization, ventilator settings were never changed by 32.7% of respondents. Only 49.1% of respondents knew the appropriate place for a nebulizer. Further, 62.7% of respondents using heated humidifiers reported turning them off during nebulization. Specific knowledge about droplet size and nebulization yield was poor. Respondents from tertiary hospitals and those with higher technical title or work experience tended to have better accuracy than those from primary hospitals or with lower technical titles (P < 0.050). Conclusions Aerosol therapy was commonly used during MV, and the most frequent drugs were bronchodilators and steroids. Scientific knowledge about the optimal implementation of aerosol therapy during MV seemed deficient.
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Affiliation(s)
- Qin Sun
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Wei Chang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Xu Liu
- School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Yi Yang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China,Corresponding author: Ling Liu, Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, Jiangsu 210009, China
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Hu P, Sun J, Wei F, Liu X. Patient-Tailored 3D-Printing Models in the Subspecialty Training of Spinal Tumors: A Comparative Study and Questionnaire Survey. World Neurosurg 2022; 161:e488-e494. [PMID: 35189420 DOI: 10.1016/j.wneu.2022.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Training in the subspecialty of spinal tumors is challenging and less researched. The anatomic variations and complex relationship with paraspinal structures tend to be the main obstacle for the trainees in this field. Three-dimensional (3D)-printing technique has the advantage of individual customization and high fidelity, and can produce case-tailored models as auxiliary tools in medical training. METHODS The main parts of the study included case-based lectures with tailored 3D-printing models, evaluating their performances in a controlled examination and anonymous questionnaire survey regarding the trainees' opinion towards the tailored models. The examination was designed as case-based clinical analysis. All trainees were randomly allocated to the study group and control group, and the former group was additively provided a case-tailored model. RESULTS Thirty-six participants were recruited in this study, including 16 residents and 20 fellows. In the section of examination, there was significant difference in the aspects of describing the involvement of paraspinal structures and discriminating the relationship between the tumor and large vessels (P < 0.05), but similar in the aspects of surgical planning and relevant complications (P > 0.05). In the survey, most participants gave favorable responses to 3D-printing models in the aspects of understanding anatomic structures and relationship, inter-trainee communication, surgical planning, and enhancement of interest and confidence (50.0% to 94.4%, respectively). CONCLUSIONS The 3D-printing model is a valuable tool in the training of new residents and fellows in the subspecialty of spinal tumors. It can facilitate the trainees' understanding of tumor anatomy, surgical readiness, and confidence as well.
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Affiliation(s)
- Panpan Hu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
| | - Xiaoguang Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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Taha MB, Rao N, Vaduganathan M, Cainzos-Achirica M, Nasir K, Patel KV. Implementation of Cardiometabolic Centers and Training Programs. Curr Diab Rep 2022; 22:203-212. [PMID: 35316465 DOI: 10.1007/s11892-022-01459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Type 2 diabetes is frequently accompanied by obesity, nonalcoholic fatty liver disease, chronic kidney disease, and cardiovascular disease, which collectively contribute to the high burden of cardiometabolic disease. This review discusses cardiometabolic disease management, strategies to implement cardiometabolic centers to deliver care, and dedicated programs to train the next generation of cardiometabolic experts. RECENT FINDINGS Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist have demonstrated beneficial effects across cardiometabolic conditions. However, utilization of effective pharmacotherapies is low in clinical practice, in part due to clinical inertia and traditional sharp delineation in clinical responsibilities of specialists. Multidisciplinary clinics and population-health models can provide comprehensive care but require investment in physical and information technology infrastructure as well as in training and accreditation. Post-internal medicine residency cardiometabolic health training programs have been proposed. Implementing cardiometabolic centers in health systems involves reshaping current practices. Training programs focused on cardiometabolic health are needed to address the growing burden of disease and specific training needs in this ever-expanding area.
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Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Neha Rao
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA.
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Pusztai G, Demeter-Karászi Z, Alter E, Marincsák R, Dabney-Fekete ID. Administrative data analysis of student attrition in hungarian medical training. BMC Med Educ 2022; 22:317. [PMID: 35473804 PMCID: PMC9040316 DOI: 10.1186/s12909-022-03276-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is numerous empirical evidence supporting that college students studying in fields with rigorous curriculum and high requirements, such as medical training, are characterized by a higher risk of attrition than their peers. Since Hungarian medical training attracts more and more international students every year, the issue of dropout can have a global impact. Our study aimed to examine attrition risks of local and international students in Hungarian medical training. METHODS In our study, we examined the dropout behaviour of all medical students who started their studies in 2010 in Hungary (N = 2391) by analysing longitudinal administrative data of those who studied between 2010 and 2017. Doing this, we conducted descriptive statistics and uncovered the risks of dropout using binary logistic regression. RESULTS Our results indicate that the danger is primarily increased by factors directly linked to or indicating poor academic performance (slow pace of credit accumulation, tuition-based forms of finance). Individual characteristics, namely gender, and citizenship, also have a moderate but significant effect on the latter. CONCLUSIONS Thus a policy proposal can be formulated consisting of making the training network less rigid, devoting more educational attention to and providing targeted mentoring for students with learning difficulties and academic hardships. Foreign medical students studying in Hungary comprise a large group that has a high attrition rate, making it a prime target for dropout-reducing programs.
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Affiliation(s)
- Gabriella Pusztai
- Institute of Educational Studies and Cultural Management, University of Debrecen, Debrecen, Hungary
| | | | - Emese Alter
- Institute of Educational Studies and Cultural Management, University of Debrecen, Debrecen, Hungary
| | - Rita Marincsák
- Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Ilona Dóra Dabney-Fekete
- Institute of Educational Studies and Cultural Management, University of Debrecen, Debrecen, Hungary
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Sanchez-Ferrer F, Grima-Murcia MD, Sánchez-Del-Campo F, Sánchez-Ferrer ML, Fernández-Jover E. Thiel embalming in neonates: methodology and benefits in medical training. Anat Sci Int 2022. [PMID: 35137346 DOI: 10.1007/s12565-022-00650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Current teaching and training methods for surgical techniques in the pediatric population involve artificial models (manikins), animals or adult human cadavers embalmed using various techniques. We found no references in the literature concerning the use of the Thiel method in the pediatric population. The aim of this study, therefore, was to assess the viability of using pediatric human cadavers embalmed through Thiel’s technique and to compare them with standard pediatric manikins. After donation of a 24-week stillborn, the Thiel technique was carried out for fixation following the usual protocol. A video recording with eye-tracking glasses was used to perform an examination, and techniques. The same procedures were conducted on a pediatric manikin. Medical students, medical residents and physicians were asked to respond to questions in an online survey after being shown the video. A total of 92 responses were obtained. The Thiel-embalmed stillborn was assessed as superior to the manikin in all items. Our study confirmed that this technique is feasible even with extremely small donors. The value of this form of preservation for medical training is not widely known though it is receiving increasing interest. Our results show that Thiel fixation in pediatrics is clearly more highly valued than a manikin and offers great potential. This innovative application of the Thiel method in the pediatric population is technically possible. It poses no additional difficulties and is very positively assessed for undergraduate and postgraduate teaching.
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Pallin R, Teasdale S, Agnoli A, Spitzer S, Asif-Sattar R, Wintemute GJ, Barnhorst A. Talking about firearm injury prevention with patients: a survey of medical residents. BMC Med Educ 2022; 22:14. [PMID: 34980095 PMCID: PMC8725249 DOI: 10.1186/s12909-021-03024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Firearm injury and death are significant public health problems in the U.S. and physicians are uniquely situated to help prevent them. However, there is little formal training in medical education on identifying risk for firearm injury and discussing safe firearm practices with patients. This study assesses prior education, barriers to counseling, and needs for improved training on firearm safety counseling in medical education to inform the development of future education on clinical strategies for firearm injury prevention. METHOD A 2018 survey administered to 218 residents and fellows at a large, academic medical center asked about medical training on firearm injury prevention, frequency of asking patients about firearm access, and perceived barriers. RESULTS The most common barriers cited were not knowing what to do with patients' answers about access to firearms (72.1%), not having enough time (66.2%), not feeling comfortable identifying patients at-risk for firearm injury (49.2%), and not knowing how to ask patients about firearm access (48.6%). Prior education on firearm injury prevention was more strongly associated with asking than was personal exposure to firearms: 51.5% of respondents who had prior medical education reported asking compared with who had not received such education (31.8%, p=0.004). More than 90% of respondents were interested in further education about interventions, what questions to ask, and legal mechanisms to separate dangerous people from their firearms. CONCLUSIONS Education on assessing risk for firearm-related harm and, when indicated, counseling on safe firearm practices may increase the likelihood clinicians practice this behavior, though additional barriers exist.
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Affiliation(s)
- Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95819, USA.
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA.
- Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Sara Teasdale
- Department of Internal Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
| | - Alicia Agnoli
- Department of Family and Community Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
| | - Sarabeth Spitzer
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis Street, Carrie Hall 103, Boston, MA, 02115, USA
| | - Rameesha Asif-Sattar
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
| | - Amy Barnhorst
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA, 95819, USA
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Petrie K, Deady M, Lupton D, Crawford J, Boydell KM, Harvey SB. 'The hardest job I've ever done': a qualitative exploration of the factors affecting junior doctors' mental health and well-being during medical training in Australia. BMC Health Serv Res 2021; 21:1342. [PMID: 34906133 PMCID: PMC8672528 DOI: 10.1186/s12913-021-07381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training. Method Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach. Results Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being. Conclusion The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07381-5.
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Affiliation(s)
- Katherine Petrie
- School of Psychiatry, University of New South Wales, Sydney, NSW, 2000, Australia. .,Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia.
| | - Mark Deady
- School of Psychiatry, University of New South Wales, Sydney, NSW, 2000, Australia.,Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
| | - Deborah Lupton
- Vitalities Lab, Centre for Social Research in Health and Social Policy Research Centre, University of New South Wales, Sydney, NSW, 2000, Australia
| | - Joanna Crawford
- Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
| | | | - Samuel B Harvey
- Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
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Schlanser VL, Tatebe LC, Karalius VP, Liesen E, Pekarek S, Impens A, Ivkovic K, Bajani F, Khalifa A, Dennis AJ. The Windlass Tourniquet: Is It Taking the Wind Out of the "Stop the Bleed" Sails? J Surg Res 2021; 271:91-97. [PMID: 34856457 DOI: 10.1016/j.jss.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Civilians are often first-line responders in hemorrhage control; however, windlass tourniquets are not intuitive. Untrained users reading enclosed instructions failed in 38.2% of tourniquet applications. This prospective follow-up study replicated testing following Stop the Bleed (STB) training. MATERIALS AND METHODS One and six months following STB, first-year medical students were randomly assigned a windlass tourniquet with enclosed instructions. Each was given one minute to read instructions and two minutes to apply the windlass tourniquet on the TraumaFX HEMO trainer. Demographics, time to read instructions and stop bleeding, blood loss, and simulation success were analyzed. RESULTS 100 students received STB training. 31 and 34 students completed tourniquet testing at one month and six months, respectively. At both intervals, 38% of students were unable to control hemorrhage (P = 0.97). When compared to the pilot study without STB training (median 48 sec, IQR 33-60 sec), the time taken to read the instructions was shorter one month following STB (P <0.001), but there was no difference at 6 months (P = 0.1). Incorrect placement was noted for 19.4% and 23.5% of attempts at 1 and 6 months. Male participants were more successful in effective placement at one month (93.3% versus 31.3%, P = 0.004) and at six months (77.8% versus 43.8%, p = 0.04). CONCLUSIONS Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STB produced the same hemorrhage control rates as reading enclosed instructions without prior training. Training efforts must continue; but an intuitive tourniquet relying less on mechanical advantage is needed.
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Affiliation(s)
- Victoria L Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois.
| | - Leah C Tatebe
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois
| | - Vytas P Karalius
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Erik Liesen
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois
| | - Sydney Pekarek
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois
| | - Ann Impens
- Institute for Healthcare Innovation, Midwestern University, Downers Grove, Illinois
| | - Katarina Ivkovic
- Institute for Healthcare Innovation, Midwestern University, Downers Grove, Illinois
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew Khalifa
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew J Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois
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Laupland KB, Edwards F, Dhanani J. Determinants of research productivity during postgraduate medical education: a structured review. BMC Med Educ 2021; 21:567. [PMID: 34753470 PMCID: PMC8579624 DOI: 10.1186/s12909-021-03010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/29/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees. METHODS A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included. RESULTS Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements. CONCLUSION This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Brisbane, Queensland, 4029, Australia.
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Jayesh Dhanani
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Brisbane, Queensland, 4029, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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