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Gardner NP, Gormley GJ, Kearney GP. Learning to navigate uncertainty in primary care: a scoping literature review. BJGP Open 2024:BJGPO.2023.0191. [PMID: 38097267 DOI: 10.3399/bjgpo.2023.0191] [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: 09/21/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Clinical practice occurs in the context of uncertainty. Primary care is a clinical environment that accepts and works with uncertainty differently from secondary care. Recent literature reviews have contributed to understanding how clinical uncertainty is taught in educational settings and navigated in secondary care, and, to a lesser extent, by experienced GPs. We do not know how medical students and doctors in training learn to navigate uncertainty in primary care. AIM To explore what is known about primary care as an opportunity for learning to navigate uncertainty. DESIGN & SETTING Scoping review of articles written in English. METHOD Using a scoping review methodology, Embase, MEDLINE, and Web of Science databases were searched, with additional articles obtained through citation searching. Studies were included in this review if they: (a) were based within populations of medical students and/or doctors in training; and (b) considered clinical uncertainty or ambiguity in primary care or a simulated primary care setting. Study findings were analysed thematically. RESULTS Thirty-six studies were included from which the following three major themes were developed: uncertainty contributes to professional identity formation (PIF); adaptive responses; and maladaptive behaviours. Relational and social factors that influence PIF were identified. Adaptive responses included adjusting epistemic expectations and shared decision making (SDM). CONCLUSION Educators can play a key role in helping learners navigate uncertainty through socialisation, discussing primary care epistemology, recognising maladaptive behaviours, and fostering a culture of constructive responses to uncertainty.
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Affiliation(s)
- Nick P Gardner
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
| | - Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
| | - Grainne P Kearney
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, Northern Ireland
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Hasdarngkul A, Hennessy A, Vignarajan S. Short communication: Where is women's cardiovascular health taught in Australian and New Zealand medical schools? Aust N Z J Obstet Gynaecol 2024; 64:165-167. [PMID: 37932912 DOI: 10.1111/ajo.13760] [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: 06/13/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
Cardiovascular disease is a major cause of mortality in women and is the leading cause of pregnancy-related mortality in Australia. This study aims to discover the extent of teaching regarding women's cardiovascular health in Australian and New Zealand medical schools. All 22 medical schools in Australia and New Zealand were approached for participation in completing this survey. Seven medical schools (32%) completed the survey and demonstrated that within our sample population, findings suggest that while women's cardiovascular health is present in medical curricula, there is a large variability in the rigour and depth as to which it is taught, as well as possible lack of explicit teaching and examination regarding this topic.
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Affiliation(s)
- Aphakorn Hasdarngkul
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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de Leng B, Helle L, Jokelainen O, Kainulainen M, Kronqvist P, Mol C, Pawelka F, Pohjanen VM, Vincken K. Joint online distance learning to complement postgraduate pathology training in preparation for national board examinations. J Clin Pathol 2024:jcp-2023-209311. [PMID: 38458748 DOI: 10.1136/jcp-2023-209311] [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: 11/24/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
AIMS To meet the flexible learning needs of pathology residents preparing for national board examinations, a joint distance learning approach was developed using both asynchronous and synchronous activities with whole slide images, drawing on empirical educational research on online distance learning. METHODS In a case study of an implementation of the designed joint distance learning approach with a geographically dispersed group of pathology residents in Finland, the participants' perceptions were measured with a 12-item questionnaire covering the value of the learning opportunity, the quality of the sociocognitive processes and their emotional engagement and social cohesion. Communication during the online session was also recorded and analysed to provide objectivity to the self-report data. RESULTS The effectiveness of joint online learning for knowledge acquisition and preparation for national board examinations was highly rated. However, despite strong emotional engagement during synchronous activities, participants reported minimal interpersonal interaction, which was also reflected in the recordings of the online session. CONCLUSION Using a technology integration framework and guided by the principles of self-determination theory, joint distance learning is emerging as a beneficial addition to postgraduate pathology programmes in preparation for national examinations. However, to realise the full potential of interpersonal interaction, participants should be prepared for an appropriate mindset.
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Affiliation(s)
- Bas de Leng
- Educational Institute (IfAS), University of Münster Faculty of Medicine, Munster, Germany
| | - Laura Helle
- Centre for Research on Learning and Instruction, University of Turku Faculty of Education, Turku, Finland
| | - Otto Jokelainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Kainulainen
- Centre for Research on Learning and Instruction, University of Turku Faculty of Education, Turku, Finland
| | | | - Christian Mol
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Friedrich Pawelka
- Educational Institute (IfAS), University of Münster Faculty of Medicine, Munster, Germany
| | | | - Koen Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
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Cima L, Bussola N, Hassell LA, Kiehl TR, Schukow C, Zerbe N, Munari E, Torresani E, Barbareschi M, Cecchini MJ, Cirielli V, Pagliuca F, Ahsan M, Mohanty SK, Arbitrio E, Hughes G, Mirza KM. Evolving educational landscape in pathology: a comprehensive bibliometric and visual analysis including digital teaching and learning resources. J Clin Pathol 2024; 77:87-95. [PMID: 38123966 DOI: 10.1136/jcp-2023-209203] [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: 09/20/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
AIMS Pathology education is a core component of medical training, and its literature is critical for refining educational modalities. We performed a cross-sectional bibliometric analysis to explore publications on pathology education, focusing on new medical education technologies. METHODS The analysis identified 64 pathology journals and 53 keywords. Relevant articles were collected using a web application, PaperScraper, developed to accelerate literature search. Citation data were collected from multiple sources. Descriptive statistics, with time period analysis, were performed using Microsoft Excel and visualised with Flourish Studio. Two article groups were further investigated with a bibliometric software, VOSViewer, to establish co-authorship and keyword relationships. RESULTS 8946 citations were retrieved from 905 selected articles. Most articles were published in the last decade (447, 49.4%). The top journals were Archives of Pathology & Laboratory Medicine (184), Human Pathology (122) and the American Journal of Clinical Pathology (117). The highest number of citations was found for Human Pathology (2120), followed by Archives of Pathology & Laboratory Medicine (2098) and American Journal of Clinical Pathology (1142). Authors with different backgrounds had the greatest number of articles and citations. 12 co-authorship, 3 keyword and 8 co-citation clusters were found for the social media/online resources group, 8 co-authorship, 4 keyword and 7 co-citation clusters for the digital pathology/virtual microscopy/mobile technologies group. CONCLUSIONS The analysis revealed a significant increase in publications over time. The emergence of digital teaching and learning resources played a major role in this growth. Overall, these findings underscore the transformative potential of technology in pathology education.
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Affiliation(s)
- Luca Cima
- Department of Laboratory Medicine, Pathology Unit, Santa Chiara University Hospital, APSS, Trento, Italy
| | - Nicole Bussola
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tim-Rasmus Kiehl
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Casey Schukow
- Department of Pathology, Corewell Health's Beaumont Hospital, Royal Oak, Michigan, USA
| | - Norman Zerbe
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Enrico Munari
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia, Brescia, Italy
| | - Evelin Torresani
- Department of Laboratory Medicine, Pathology Unit, Santa Chiara University Hospital, APSS, Trento, Italy
| | - Mattia Barbareschi
- Department of Laboratory Medicine, Pathology Unit, Santa Chiara University Hospital, APSS, Trento, Italy
- CISMED, Centro Interdipartimentale di Scienze Mediche, University of Trento, Trento, Italy
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Vito Cirielli
- Department of Prevention, Legal Medicine Unit, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Francesca Pagliuca
- Department of Mental and Physical Health and Preventive Medicine, Pathology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Muhammad Ahsan
- Histopathology Department, Chughtai Institute of Pathology, Lahore, Pakistan
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Delhi, India
| | | | - Griffin Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Maass AH. Inequities in access and use of automated external defibrillators. Heart 2024; 110:154-155. [PMID: 37666649 DOI: 10.1136/heartjnl-2023-323200] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hegde S, Hofman E, Dubagunta S, Awad D, Khan O, Eisaman K, Hossain I, Walker J, Sherman B, Kadakia Y, Najjar A, Park C. Implementation of a novel thoracostomy tube trainer with real-time feedback. Trauma Surg Acute Care Open 2023; 8:e001131. [PMID: 38115971 PMCID: PMC10729290 DOI: 10.1136/tsaco-2023-001131] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Simulation-based training leads to improved clinical performance but may be influenced by quality and frequency of training. Within simulation training, chest tube insertion remains a challenge as one of the main pitfalls of insertion is a controlled pleural entry. This study evaluates the efficacy of a novel training model with real-time pressure monitoring, the average force to pleural entry in a model and the utility of audio and visual feedback. Methods This proprietary training model comprised a modified Kelly clamp device with three force sensors at the index finger (sensor 1) and two finger loops (sensors 2 and 3), and a manikin with a replaceable chest wall pad. Standard force values (Newtons (N)) were obtained by experts; expert data revealed that 3-5 s was an acceptable time range to complete the chest tube insertion. Participant level ranged from Post-graduate Year (PGY)-1 to PGY-6 with 13 total participants. Each individual was provided an introduction to the procedure and chest tube trainer. Force (N) and time (ms) measurements were obtained from entry through dermis to pleural space puncture. A significant pressure drop suggested puncturing through the chest wall (completion of the procedure). Results Force data were captured during each phase of the procedure-linear, plateau, and drop. Linear phase (~3000 ms) was from start of procedure to point of maximum force (<30 N). Plateau phase was from maximum force to just before a drop in pressure. Drop phase was a drop in pressure by 5+ N in a span of 150 ms signaling completion of procedure. All participants were able to complete the task successfully. Force for pleural entry ranged from 17 N to 30 N; time to pleural entry ranged from 7500 to 15 000 ms. There was variability in use of all three sensors. All participants used the index sensor, however there was variability in the use of the loop sensors depending on the handedness of the participant. Left-handed users relied more on sensors 1 and 3 while right-handed users relied more on sensors 1 and 2. Given this variability, only force measurements from sensor 1 were used for assessment. Conclusions This novel force-sensing chest tube trainer with continuous pressuring monitoring has a wide range of applications in simulation-based training of emergency surgical tasks. Next steps include evaluating its impact on accuracy and efficiency. Applications of real-time feedback measuring force are broad, including vascular access, trocar placement and other common procedures. Level of evidence Level IV, prospective study.
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Affiliation(s)
- Shruti Hegde
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Emily Hofman
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Sruthi Dubagunta
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Daniel Awad
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Omar Khan
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Kraigen Eisaman
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Ifti Hossain
- Department of Engineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - James Walker
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Bradley Sherman
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Yash Kadakia
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Alex Najjar
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Caroline Park
- Surgery, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
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Gao R, Kurenov S, Black EW, Peters J. Adding Safety Rules to Surgeon-Authored Virtual Reality Training. Simul Healthc 2023; 18:400-407. [PMID: 37342919 PMCID: PMC10739635 DOI: 10.1097/sih.0000000000000688] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION The Toolkit for Illustration of Procedures in Surgery (TIPS) is an open source virtual reality (VR) laparoscopic simulation-based training environment with force feedback. The TIPS-author is a content creation interface that allows a surgeon educator (SE) to assemble new laparoscopic training modules. New technology enables safety rules to be specified by the SE, automatically tracks specified safety errors, and summarizes and communicates achievements and errors to the surgical trainee. METHODS The TIPS-author combines and initializes building blocks of anatomy with their physical properties, as selected by the SE from a database. The SE can add any safety rule that can be tested in terms of location, proximity, separation, clip count, and force. Errors are then automatically monitored during simulation and recorded as visual snapshots for feedback to the trainee. The TIPS was field tested at 2 surgical conferences, one before and one after adding the error snapshot feature. RESULTS Sixty-four respondents at 2 surgical conferences assessed the utility of TIPS on a Likert scale. While other ratings remained unchanged for an overall score of 5.24 of 7 (7 = very useful), the rating of the statement "The TIPS interface helps learners understand the force necessary to explore the anatomy" improved from 5.04 to 5.35 of 7 after the snapshot mechanism was added. CONCLUSIONS The ratings indicate the viability of the TIPS open source SE-authored surgical training units with safety rules. Presenting SE-determined procedural missteps via the snapshot mechanism at the end of the training increases perceived utility.
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Affiliation(s)
- Ruiliang Gao
- University of Florida, Gainesville, FL32611, USA
| | - Sergei Kurenov
- Roswell Park Comprehensive Cancer Center, Buffalo, NY14263, USA
| | | | - Jörg Peters
- University of Florida, Gainesville, FL32611, USA
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Yamamoto LM, Pavin ML, de Souza GBD, de Oliveira JLHB, Costa RRDO, Fernandes AY, Mazzo A. Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study. SAO PAULO MED J 2023; 141:e2022564. [PMID: 37991092 PMCID: PMC10665003 DOI: 10.1590/1516-3180.2022.0564.r1.10042023] [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] [Received: 10/24/2022] [Revised: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.
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Affiliation(s)
- Lucas Moura Yamamoto
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | - Matheus Landi Pavin
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | - Giordano Bruno Duarte de Souza
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | | | - Raphael Raniere de Oliveira Costa
- MD, MSc, PhD. Adjunct Professor, Medicine Course, Escola Multicampi de Ciências Médicas (EMCM), Universidade Federal do Rio Grande do Norte (UFRN), Caicó (RN), Brazil
| | - Adriano Yacubian Fernandes
- MD, PhD. Associated Professor, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil. Associated Professor, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil
| | - Alessandra Mazzo
- PhD. Associate Professor, Medicine Course, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
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Fernandes CO, Rodrigues LR, Amaral MLBSD, Rodrigues SJDM, Marton-Filho MA. Low-cost simulator for intra-abdominal bleeding. Rev Col Bras Cir 2023; 50:e20233512. [PMID: 37971114 PMCID: PMC10618030 DOI: 10.1590/0100-6991e-20233512-en] [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: 12/15/2022] [Accepted: 08/15/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers. METHODS we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9. RESULTS the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing. CONCLUSION the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.
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Price N. Trained, not Born: a Journey to Acute Care Surgery. Trauma Surg Acute Care Open 2023; 8:e001284. [PMID: 37954920 PMCID: PMC10632907 DOI: 10.1136/tsaco-2023-001284] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Niosha Price
- Clincal Sciences, Ross University School of Medicine, Plaquemine, Louisiana, USA
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Starosolski M, Kapłan C, Kalemba A, Majewska K. The Impact of Implementing the Vortex Approach on Airway Management Performance in Stressed Medical Students: A Randomized Controlled Simulation Study. Med Sci Monit 2023; 29:e940372. [PMID: 37817571 PMCID: PMC10548838 DOI: 10.12659/msm.940372] [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: 03/15/2023] [Accepted: 08/16/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The ability to manage airways in emergencies is paramount, especially for less experienced medical students. Although the Vortex Approach, a useful scheme to support decision-making during airway management, promises structured guidance, there's limited research on its benefits among students. Our study aimed to evaluate student proficiency in a simulated difficult airway scenario and assess the advantages of the Vortex Approach. MATERIAL AND METHODS Medical students initially practiced on low-fidelity mannequins. Subsequently, they were divided into Vortex (n=48) and control groups (n=48). The Vortex group received specialized training. Both groups encountered a simulated scenario focusing on proper ventilation and supraglottic device insertion when traditional intubation failed. Performance was assessed using the airway management outcome score (AMOS). RESULTS The Vortex-trained group demonstrated superior capabilities. Fewer participants exceeded 3 lifeline interventions (4.2% vs 16.7%, P=0.046). The Vortex group consistently optimized subsequent attempts (31.3% vs 10.4%, P=0.01) and reduced prolonged apnea episodes (47.9% vs 81.3%, P=0.0009). Their AMOS scores were notably higher (56.3% vs 27.1%, AMOS=2, P=0.002), reflecting better patient outcomes (41.7% vs 10.4%, P=0.0005). CONCLUSIONS There is a marked need to enhance airway management skills among senior medical students. The Vortex Approach, even after brief exposure, yields significant skill improvements, underscoring its potential as a pivotal component in medical training. Integrating it into the curriculum could bridge the evident skill gap, optimizing future patient care.
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Affiliation(s)
- Michał Starosolski
- Department of Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Cezary Kapłan
- Student Scientific Society at the Department of Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Alicja Kalemba
- Student Scientific Society at the Department of Emergency Medicine, Medical University of Silesia, Katowice, Poland
| | - Karolina Majewska
- Student Scientific Society at the Department of Emergency Medicine, Medical University of Silesia, Katowice, Poland
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Reece-Mills M, Baxter JAB. The SickKids Caribbean Initiative to improve care for children with cancer and blood disorders. Rev Panam Salud Publica 2023; 47:e130. [PMID: 37750055 PMCID: PMC10516326 DOI: 10.26633/rpsp.2023.130] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/23/2023] [Indexed: 09/27/2023] Open
Abstract
To improve pediatric hematology and oncology outcomes, there is a recognized potential for partnerships between low- and high-resource institutions within health care systems. The SickKids Caribbean Initiative is a partnership between health care professionals at the Hospital for Sick Children in Toronto, Canada, and seven Caribbean institutions across six countries (Bahamas, Barbados, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, and Trinidad and Tobago). The primary aim of the SickKids Caribbean Initiative has been to improve the outcomes and the quality of life of children in the Caribbean aged <18 years who have cancer and blood disorders. This article describes five key activities undertaken within the SickKids Caribbean Initiative, including providing education and training, assisting with case consultations and diagnostic services, developing local oncology databases, engaging in advocacy and ensuring stakeholder engagement, and coordinating administration and project management.
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Affiliation(s)
- Michelle Reece-Mills
- Department of Child and Adolescent HealthFaculty of Medical SciencesUniversity of the West IndiesKingstonJamaicaDepartment of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Jo-Anna B. Baxter
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanadaCentre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Affiliation(s)
- Francisco I Farias
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Samuel M Kim
- Cardiology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Michael D Shapiro
- Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Lemos-Santos P, Blumrich L, Debia JB, Castaldelli-Maia JM, Suen PJC, Malbergier A. Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic. SAO PAULO MED J 2023; 142:e2022493. [PMID: 37703121 PMCID: PMC10495101 DOI: 10.1590/1516-3180.2022.0493.r1.150623] [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] [Received: 09/01/2022] [Revised: 05/09/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use. OBJECTIVES Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption. DESIGN AND SETTING A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020. METHODS Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. RESULTS Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns. CONCLUSION The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.
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Affiliation(s)
- Pedro Lemos-Santos
- Undergraduate Student, Faculdade de Medicina da Universidade de
São Paulo (FMUSP), São Paulo (SP), Brazil
| | - Lukas Blumrich
- Undergraduate Student, Faculdade de Medicina da Universidade de
São Paulo (FMUSP), São Paulo (SP), Brazil; Doctoral Student, Department of
Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São
Paulo (SP), Brazil
| | - Jordi Blanes Debia
- Undergraduate Student, Faculdade de Medicina da Universidade
de São Paulo (FMUSP), São Paulo (SP), Brazil
| | - João Mauricio Castaldelli-Maia
- PhD, Postgraduate Sponsor, Department of Psychiatry, Faculdade
de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil;
Assistant (Aux.) Professor, Department of Neuroscience, Centro Universitário
Faculdade de Medicina do ABC (FMABC), Santo André (SP), Brazil
| | - Paulo Jeng Chian Suen
- Undergraduate Student, Faculdade de Medicina da Universidade de
São Paulo (FMUSP), São Paulo (SP), Brazil; Doctoral Student, Department of
Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São
Paulo (SP), Brazil
| | - André Malbergier
- PhD, General Coordinator, Interdisciplinary Group of Studies on
Alcohol and Drugs (GREA), Institute of Psychiatry (IPq), Hospital das Clínicas
da Universidade de São Paulo (HCFMUSP), São Paulo (SP), Brazil; Collaborating
Professor, Department of Psychiatry, Faculdade de Medicina da Universidade de
São Paulo (FMUSP), São Paulo (SP), Brazil
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15
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Varas J, Coronel BV, Villagrán I, Escalona G, Hernandez R, Schuit G, Durán V, Lagos-Villaseca A, Jarry C, Neyem A, Achurra P. Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM). Rev Col Bras Cir 2023; 50:e20233605. [PMID: 37646729 PMCID: PMC10508667 DOI: 10.1590/0100-6991e-20233605-en] [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: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023] Open
Abstract
The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .
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Affiliation(s)
- Julian Varas
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Brandon Valencia Coronel
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Ignacio Villagrán
- - Pontificia Universidad Católica de Chile, Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina - Santiago - Región Metropolitana - Chile
| | - Gabriel Escalona
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Rocio Hernandez
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Gregory Schuit
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Valentina Durán
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Antonia Lagos-Villaseca
- - Pontificia Universidad Católica de Chile, Department of Otolaryngology - Santiago - Región Metropolitana - Chile
| | - Cristian Jarry
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Andres Neyem
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Pablo Achurra
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
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16
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Joseph B, Tseng ES, Zielinski MD, Ramirez CL, Lynde J, Galey KM, Bhogadi SK, El-Qawaqzeh K, Hosseinpour H. Feeling like an imposter: are surgeons holding themselves back? Trauma Surg Acute Care Open 2023; 8:e001021. [PMID: 37575613 PMCID: PMC10414117 DOI: 10.1136/tsaco-2022-001021] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/16/2023] [Indexed: 08/15/2023] Open
Abstract
Imposter syndrome is a psychological phenomenon where people doubt their achievements and have a persistent internalized fear of being exposed as a fraud, even when there is little evidence to support these thought processes. It typically occurs among high performers who are unable to internalize and accept their success. This phenomenon is not recognized as an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; however, mental health professionals recognize it as a form of intellectual self-doubt. It has been reported that imposter syndrome is predominant in the high-stakes and evaluative culture of medicine, where healthcare workers are frequently agonized by feelings of worthlessness and incompetence. Imposter syndrome can lead to a variety of negative effects. These can include difficulty concentrating, decreased confidence, burnout, anxiety, stress, depression, and feelings of inadequacy. This article will discuss the prevalence of imposter syndrome among surgeons, its associated contributing factors, the effects it can have, and potential strategies for managing it. The recommended strategies to address imposter syndrome are based on the authors' opinions.
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Affiliation(s)
- Bellal Joseph
- Surgery, University of Arizona, Tucson, Arizona, USA
| | - Esther S Tseng
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Martin D Zielinski
- Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Christine L Ramirez
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Jennifer Lynde
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of California Davis Health System, Sacramento, California, USA
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17
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Henrique-Sanches BC, Sabage L, Costa RRDO, Almeida RGDS, Moron RA, Mazzo A. Implications of practical activities in the Skills and Simulation Laboratory on students' motivation and feelings. Rev Lat Am Enfermagem 2023; 31:e3902. [PMID: 37194811 PMCID: PMC10202410 DOI: 10.1590/1518-8345.6397.3903] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/14/2022] [Indexed: 03/05/2024] Open
Abstract
to verify the implications of practical activities in the Skills and Simulation Laboratory on the motivation and feelings expressed by undergraduate students when returning to face-to-face activities after the social isolation caused by COVID-19 pandemic. a quasi-experimental study, with a single group and of the pre- and post-test type, carried out through an educational intervention based on skills training on medication administration and venipuncture, with medical students from a Brazilian public university. The sample was comprised by 47 students. The instruments of students' characterization and self-perceived feelings and the Situational Motivation Scale were used for data collection. in the sample, 98% mentioned the lack of practical activities during the pandemic. The most frequently described feeling was anxiety. After carrying out the activity, there was a change in the frequency of expressed feelings, although there was no significant change in motivational levels. External Regulation (5.1 - 5.6), Identified Regulation (6.1 - 6.4) and Intrinsic Motivation (5.6 - 6.0) presented high results, showing similarity to the feelings reported by the learners. motivation is essential for effective learning and the use of active methodologies reinforces skills built in an affective way in the students facing the learning process.
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Affiliation(s)
- Barbara Casarin Henrique-Sanches
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
- Becaria de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Luis Sabage
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
| | - Raphael Raniere de Oliveira Costa
- Universidade Federal do Rio Grande do Norte, Escola Multicampi de Ciências Médicas do Rio Grande do Norte, Caicó, Rio Grande do Norte, Brasil
| | | | | | - Alessandra Mazzo
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
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18
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Henrique-Sanches BC, Sabage L, Costa RRDO, Almeida RGDS, Moron RA, Mazzo A. Implications of practical activities in the Skills and Simulation Laboratory on students' motivation and feelings. Rev Lat Am Enfermagem 2023; 31:e3902. [PMID: 37194811 PMCID: PMC10202410 DOI: 10.1590/1518-8345.6397.3902] [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: 07/17/2022] [Accepted: 12/14/2022] [Indexed: 05/18/2023] Open
Abstract
to verify the implications of practical activities in the Skills and Simulation Laboratory on the motivation and feelings expressed by undergraduate students when returning to face-to-face activities after the social isolation caused by COVID-19 pandemic. a quasi-experimental study, with a single group and of the pre- and post-test type, carried out through an educational intervention based on skills training on medication administration and venipuncture, with medical students from a Brazilian public university. The sample was comprised by 47 students. The instruments of students' characterization and self-perceived feelings and the Situational Motivation Scale were used for data collection. in the sample, 98% mentioned the lack of practical activities during the pandemic. The most frequently described feeling was anxiety. After carrying out the activity, there was a change in the frequency of expressed feelings, although there was no significant change in motivational levels. External Regulation (5.1 - 5.6), Identified Regulation (6.1 - 6.4) and Intrinsic Motivation (5.6 - 6.0) presented high results, showing similarity to the feelings reported by the learners. motivation is essential for effective learning and the use of active methodologies reinforces skills built in an affective way in the students facing the learning process.
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Affiliation(s)
- Barbara Casarin Henrique-Sanches
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
- Becaria de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Luis Sabage
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
| | - Raphael Raniere de Oliveira Costa
- Universidade Federal do Rio Grande do Norte, Escola Multicampi de Ciências Médicas do Rio Grande do Norte, Caicó, Rio Grande do Norte, Brasil
| | | | | | - Alessandra Mazzo
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
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19
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Patel KP, Baumbach A. Future of transcatheter aortic valve implantation: where do we go from here? Heart 2023; 109:564-571. [PMID: 36631145 DOI: 10.1136/heartjnl-2022-321575] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Kush P Patel
- Structural Heart Intervention Department, Barts Heart Centre, London, UK.,Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- Barts Heart Centre, Barts Health NHS Trust, London, UK .,Cardiology, Queen Mary University of London, London, UK
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20
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Knowlton LM, Butler WJ, Dumas RP, Bankhead BK, Meizoso JP, Bruns B, Van Gent JM, Kaafarani HMA, Martin MJ, Namias N, Stein DM, Tadlock MD, Martin RS, Staudenmayer KL, Gurney JM. Power of mentorship for civilian and military acute care surgeons: identifying and leveraging opportunities for longitudinal professional development. Trauma Surg Acute Care Open 2023; 8:e001049. [PMID: 36866105 PMCID: PMC9972450 DOI: 10.1136/tsaco-2022-001049] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Across disciplines, mentorship has been recognized as a key to success. Acute care surgeons, focused on the care of trauma surgery, emergency general surgery and surgical critical care, practice in a wide variety of settings and have unique mentorship needs across all phases of their career. Recognizing the need for robust mentorship and professional development, the American Association for the Surgery of Trauma (AAST) convened an expert panel entitled 'The Power of Mentorship' at the 81st annual meeting in September 2022 (Chicago, Illinois). This was a collaboration between the AAST Associate Member Council (consisting of surgical resident, fellow and junior faculty members), the AAST Military Liaison Committee, and the AAST Healthcare Economics Committee. Led by two moderators, the panel consisted of five real-life mentor-mentee pairs. They addressed the following realms of mentorship: clinical, research, executive leadership and career development, mentorship through professional societies, and mentorship for military-trained surgeons. Recommendations, as well as pearls and pitfalls, are summarized below.
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Affiliation(s)
- Lisa Marie Knowlton
- Division of General Surgery, Section of Acute Care Surgery, Stanford University, Stanford, California, USA,Stanford University School of Medicine, Department of Surgery, Stanford, California, USA
| | | | | | - Brittany K Bankhead
- Division of Trauma, Burns, and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brandon Bruns
- Department of Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Jan-Michael Van Gent
- Division of Trauma and Surgical Critical Care, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Matthew J Martin
- Division of Trauma and Surgical Critical Care, LAC USC Medical Center, Los Angeles, California, USA
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah M. Stein
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, US Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - R Shayn Martin
- Department of Surgery, Division of Acute Care Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristan L Staudenmayer
- Division of General Surgery, Section of Acute Care Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer M Gurney
- Department of Trauma Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
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21
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Weir RAP. Management of hospitalised patients with heart failure admitted to non-cardiology services. Heart 2023; 109:959-965. [PMID: 36849234 DOI: 10.1136/heartjnl-2022-321720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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22
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Beach LB, Streed CG. Beyond Sex-Based Medicine in Cardiovascular Health Research and Practice. Circulation 2023; 147:529-531. [PMID: 36780385 PMCID: PMC9936622 DOI: 10.1161/circulationaha.122.063156] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Lauren B. Beach
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
- ADVOCATE SGM Health Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Carl G. Streed
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
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23
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Ticku S, Savageau JA, Riedy CA, Harvan RA, Silk H. 100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity. Ann Fam Med 2023; 21:S86-S91. [PMID: 36849476 PMCID: PMC9970669 DOI: 10.1370/afm.2930] [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] [Received: 06/16/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE More individuals access primary care compared with oral health services. Enhancing primary care training to include oral health content can therefore improve access to care for millions of individuals and improve health equity. We developed the 100 Million Mouths Campaign (100MMC), which aims to create 50 state oral health education champions (OHECs) who will work with primary care training programs to integrate oral health into their curricula. METHODS In 2020-2021, we recruited and trained OHECs from 6 pilot states (Alabama, Delaware, Iowa, Hawaii, Missouri, and Tennessee) with representation from varied disciplines and specialties. The training program consisted of 4-hour workshops over 2 days followed by monthly meetings. We conducted internal and external evaluations to assess the program's implementation through postworkshop surveys, identifying process and outcome measures for engagement of primary care programs, and through focus groups and key informant interviews with the OHECs. RESULTS The results of the postworkshop survey indicated that all 6 OHECs found the sessions helpful in planning next steps as a statewide OHEC. Each OHEC was also successful in engaging 3 primary care training programs within their state and incorporating oral health curricular content through various modalities, including lectures, clinical practice, and case presentations. During the year-end interviews, the OHECs reported that they would overwhelmingly recommend this program to future state OHECs. CONCLUSIONS The 100MMC pilot program was implemented successfully, and the newly trained OHECs have the potential to improve access to oral health within their communities. Future program expansion needs to prioritize diversity within the OHEC community and focus on program sustainability.
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Affiliation(s)
- Shenam Ticku
- Harvard School of Dental Medicine, Boston, Massachusetts
| | - Judith A Savageau
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | | | - Robin A Harvan
- Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts
| | - Hugh Silk
- Harvard School of Dental Medicine, Boston, Massachusetts.,University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Martins SR, de Araújo AJ, Wehrmeister FC, Freitas BM, Basso RG, Santana ANC, Santos UDP. Prevalence and associated factors of experimentation with and current use of water pipes and electronic cigarettes among medical students: a multicentric study in Brazil. J Bras Pneumol 2023; 49:e20210467. [PMID: 36700569 PMCID: PMC9970372 DOI: 10.36416/1806-3756/e20210467] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/16/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence of and factors associated with experimentation with and current use of water pipes and e-cigarettes among medical students. METHODS This was a cross-sectional multicentric study involving a convenience sample of students from medical schools in most Brazilian geographic regions. Information about experimentation with and current use of conventional cigarettes, water pipes, and e-cigarettes; beliefs and attitudes toward tobacco products; religiosity; and demographics were collected by means of an online structured questionnaire. We used descriptive statistics and logistic regression to analyze the association of those factors. RESULTS Our sample comprised 700 individuals from four Brazilian regions. Prevalence of experimentation with and current use of cigarettes, water pipes, and e-cigarettes were, respectively, 39.1% and 7.9%; 42.6% and 11.4%; and 13.1% and 2.3%. Water pipe experimentation was higher among those who had a sibling (adjusted OR = 2.64; 95% CI, 1.24-5.61) or friends (adjusted OR = 2.33; 95% CI, 1.63-3.31) who smoke. The same occurred regarding e-cigarette experimentation: siblings (adjusted OR = 2.76; 95% CI, 1.17-6.50) and friends (adjusted OR = 2.47; 95% CI, 1:45-4.22). Curiosity and scent/taste were the major reasons for water pipe use and e-cigarette experimentation. Although 93% of the responders learned about health damages of smoking during medical school classes, 51.4% reported having experimented with at least one of these tobacco products. Most responders who reported feeling the presence of God/the Holy Spirit in their lives were never experimenters of water pipes (59.2%) or e-cigarettes (55.3%). CONCLUSIONS There is a high prevalence of experimentation with tobacco products among medical students whose siblings or friends smoke, despite their knowledge about smoking harms.
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Affiliation(s)
- Stella Regina Martins
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Fernando C Wehrmeister
- . Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS) Brasil
| | - Beatriz Martins Freitas
- . Curso de Medicina, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo (SP) Brasil
| | | | - Alfredo Nicodemos Cruz Santana
- . Hospital Regional da Asa Norte, Escola Superior de Ciências da Saúde, Brasília, Brasília (DF) Brasil.,. Núcleo Avançado de Tórax, Hospital Sírio-Libanês, Brasília (DF) Brasil
| | - Ubiratan de Paula Santos
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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25
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Pegoraro MG, Troster EJ. Validation of tool to assess pediatric residents' knowledge of development and behavior. Rev Paul Pediatr 2023; 41:e2021372. [PMID: 36700566 PMCID: PMC9869736 DOI: 10.1590/1984-0462/2023/41/2021372] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/06/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to create and validate an instrument to measure pediatric residents' knowledge about development and behavior. METHODS This was a longitudinal study with the consecutive application of questionnaires to validate an instrument of analysis. The modified Delphi technique was used for validation, which involved judges who were selected based on their expertise. Judges, who were renowned for their knowledge of the subject and willing to participate, were chosen from different states of Brazil. A convenience sample was obtained. The original questionnaire included 45 open questions divided into 13 relevant thematic axes on development and behavior. RESULTS After the third round using the Delphi technique, the whole questionnaire had a validity index of more than 80% on scope and relevance as well as all thematic axes, and the 44 final questions. CONCLUSIONS The whole questionnaire was considered validated by the 14 expert judges who participated in the study.
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Affiliation(s)
- Mariana Grando Pegoraro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Corresponding author: E-mail: (M. G. Pegoraro)
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26
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Croce M. Overview of leadership and research: Timothy C Fabian, MD. Trauma Surg Acute Care Open 2023; 8:e001142. [PMID: 37082314 PMCID: PMC10111895 DOI: 10.1136/tsaco-2023-001142] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/22/2023] Open
Abstract
There are a number of leadership styles. A leader can be loud and boisterous, quiet and unassuming, or anywhere in between. Some are like a chameleon and change their style depending on the circumstances. Regardless of style, there are certain traits that must be present for surgeon-leaders to be effective. Some such traits include strategic thinking, team building, effective communication, accountability, setting clear goals, technical expertise, faculty development, and selflessness. These seven traits can be summed up in two words: Tim Fabian. The following sections will hopefully illustrate Dr Fabian's attributes as they relate to these leadership traits. Some actions will fall under more than one trait.
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Affiliation(s)
- Martin Croce
- Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Santarelli IM. [The medical curriculum, students and teachers. Which should be their role?]. Rev Fac Cien Med Univ Nac Cordoba 2022; 79:408-9. [PMID: 36542582 DOI: 10.31053/1853.0605.v79.n4.36786] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
A century after the Flexner report in 1910, the book entitled "Educating Physicians: A Call for Reform of Medical School and Residency" was published, which called for strengthening the formation of professional identity, integrating basic sciences with clinical learning and implementing competency assessment. Traditional education is not compatible with these recommendations. One learns to do by doing it, and the way to achieve this is to “play the whole game”.
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Lauck S, Lewis K. Shared decision-making in cardiac care: can we close the gap between good intentions and improved outcomes? Heart 2022; 109:4-5. [PMID: 36104221 DOI: 10.1136/heartjnl-2022-321482] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sandra Lauck
- Heart Centre, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystina Lewis
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Milani MFL, Silvestre D, Marim J. Experience of a resident physician in general surgery basic area on board of an expedition in the amazon river. Rev Col Bras Cir 2022; 49:e20223369. [PMID: 36449943 PMCID: PMC10578782 DOI: 10.1590/0100-6991e-20223369-en] [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: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Located in areas of difficult access, the riverside population of the upper Amazon River has a great demand for health care, whether in the scope of basic health promotion or in general or specialized medical care, surgical procedures, dental and pharmaceutical care. Taking this to consideration, the Barco Hospital Papa Francisco project was conceived and implemented, which aims to provide health care to riverside communities through expeditions that safely transfer health resources to populations located on the banks of the river. Having participated in one of the expeditions, it was possible to carry out a survey of data regarding the attendance and writing of a personal report on the impact on the professional activity. The expedition allowed the performance of a large number of surgical procedures in a condensed period, covering a wide variety of technical approaches essential to the performance of the general surgeon, among them, we can mention inguinal and incisional hernioplasties, umbilical and inguinal herniorrhaphy, postectomy and tubal ligation, lipoma excision, sebaceous cyst excision, nevi excision, among others (data available in the vessels Wareline® system).
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Affiliation(s)
| | - Daniela Silvestre
- - Hospital Universitario São Francisco de Assis, Cirurgia Pediátrica - Bragança Paulista - SP - Brasil
| | - Juliana Marim
- - Hospital Universitario São Francisco de Assis, Psiquiatria - Bragança Paulista - SP - Brasil
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Santos EGD, Peterle VCU, Sanches MM, Neser A, Bonifacio MDI, Bahten LCVON, Tallo F, Ribeiro M, Melo RLDE, Corsi PRGD. Overview of general surgery medical residency programs and prerequisite program in basic surgical area in Brazil: Historical review and update. Rev Col Bras Cir 2022; 49:e20223410. [PMID: 36449946 PMCID: PMC10578780 DOI: 10.1590/0100-6991e-20223410_en] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). METHOD descriptive, quali-quantitative, cross sectional study conducted from document analysis from National Commission of Medical Residency (CNRM). RESULTS in 2018, after evaluation of the General Surgery Services for adequacy of the number of vacancies (DS), the PRACB was instituted as a modality of access to surgical specialties until definitive change in the time of the formation of the general surgeon for three years, in 2022. In the first addition of vacancies in 2018, 127 PRMCG were authorized with 736 vacancies of R1 and 290 PRACB (2 years) with 1.286 vacancies offered for R1. In the second addition in 2021, 423 PRM were authorized with 1.564 R1 vacancies in PRMCG. DISCUSSION the regulation of the offer of vacancies for the formation of specialties in Brazil should align the evaluation of practice scenarios with the profile of skills. The PRACB modality was instituted for a certain time for budgetary preparation and practice scenarios until the complete transition to training in 3 years. CONCLUSION Brazil by 2018 was the only country to grant the Board Certification to General Surgeon with only 2 years of training. After a transitional period the same analysis methodology for adding and regulating vacancies was applied to services.
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Affiliation(s)
| | | | | | - Adnan Neser
- - Comissão Nacional de Residência Médica - São Paulo - SP - Brasil
| | | | | | - Fernando Tallo
- - Associação Médica Brasileira - São Paulo - SP - Brasil
| | - Mauro Ribeiro
- - Conselho Federal de Medicina - São Paulo - SP - Brasil
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Purim KSM, Andrade FADE, Lehmkuhl F, Bernardes ABS. Medical advertising in social networks: awareness and medical school education. Rev Col Bras Cir 2022; 49:e20223386. [PMID: 36350882 PMCID: PMC10578823 DOI: 10.1590/0100-6991e-20223386_en] [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: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE this study analyzed medicine students' knowledge regarding medical advertising on social media. METHOD this is a cross-sectional study carried out between January and May 2022 with 179 medical students from public and private institutions from Curitiba - PR, using a structured questionnaire with nine problem situations on medical advertising. It was established as "sufficient" knowledge ≥70% of the problem-situations based on current professional codes and resolutions. RESULTS five questions had the highest percentage of correct answers resulting from the acquisition of knowledge from different sources. Most students did not learn about medical marketing in their undergraduate course (84.9%), having already shared patients' pictures on social media (89.9%), and fell the lack of discussions about medical advertising (96.6%). CONCLUSION there is a need to direct undergraduate education towards the ethical use of advertising in order to better prepare them for professional practice.
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Affiliation(s)
| | | | - Fernanda Lehmkuhl
- - Universidade Positivo, Escola de Ciências da Saúde - Curso de Medicina - Curitiba - PR - Brasil
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Kreshover JE, Vanni AJ, Sternberg KM, Bhojani N, Kobashi KC. Urological Education in United States Medical Schools: Where Are We Now and How Can We Do Better? Urol Pract 2022; 9:581-586. [PMID: 37145808 DOI: 10.1097/upj.0000000000000336] [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: 03/21/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION While urological complaints increase in aging populations and conditions commonly require management by multiple physician specialty types, exposure to formal urological education in United States medical schools is limited and has been decreasing over time. We aim to update the current status of urological education in the United States curriculum and delve further into the subject matter being taught and the type and timing of this education. METHODS An 11-question survey was developed to describe the current status of urological education. The survey was distributed using Survey Monkey to the American Urological Association's medical student listserv in November 2021. Descriptive statistics were used to summarize survey findings. RESULTS Of 879 invitations sent, 173 responded (20%). Most (112/173, 65%) of respondents were in their fourth year. Only 4 (2%) reported that their school had a required clinical urology rotation. Kidney stones (98%) and urinary tract infections (100%) were the most frequent topics taught. The least exposure included infertility (20%), urological emergencies (19%), bladder drainage (17%), and erectile dysfunction (13%). Videos and case vignettes were the preferred learning modalities and the majority (84%) of respondents were familiar with the American Urological Association's medical student curriculum material. CONCLUSIONS The majority of United States medical schools do not have a required clinical urology rotation and some core urological topics are not taught at all. Future incorporation of urological educational material through video and case vignette learning may be the best opportunity to provide exposure to clinical topics that will commonly be encountered regardless of chosen medical discipline.
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Affiliation(s)
| | - Alex J Vanni
- Lahey Hospital and Medical Center, Burlington, Vermont
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Bellaire CP, Ditzel RM, Meade ZS, Love ZD, Appel JM. Edith Nourse Rogers: A Pioneer for Women, Military Veterans, and US Medical Education. J Spec Oper Med 2022; 22:62-64. [PMID: 35661983 DOI: 10.55460/te5i-gjwb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
This year is the 80th anniversary of the Women's Army Auxiliary Corps. The passage of this seminal legislation - sponsored by Edith Nourse Rogers - formalized the role of women in the US military and compensated them for their service and in the event of injury or illness. Rogers was a pioneer in her own right. A trailblazer for women and a staunch advocate for military veterans' healthcare, Rogers was forged by her wartime experiences. The authors describe Rogers' contributions as a congresswoman during World War II and during her 35 years of public service in the House of Representatives. Congresswoman Rogers was foundational to the modern US healthcare system.
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Houser RS. Democratization of terrorism: an analysis of vehicle-based terrorist events. Trauma Surg Acute Care Open 2022; 7:e000964. [PMID: 36111141 PMCID: PMC9462130 DOI: 10.1136/tsaco-2022-000964] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives The COVID-19 pandemic inspired social changes that promote outdoor activities including eating at restaurants, which may linger in a world hyperfocused on disease transmission prevention, increasing the vulnerabilities to vehicle-based terrorism. Vehicle ramming attacks started to transition from a relatively rare method of attack to one of the most lethal forms of terrorism in Western countries just prior to the emergence of SARS-CoV-2. This study aims to provide a historical analysis of the terrorism-based attacks using vehicles between 1970 and 2019. Methods This study uses the methodology suggested by Tin et al in which the Global Terrorism Database hosted by the National Consortium for the Study of Terrorism and Responses to Terrorism was searched retrospectively for data. Data was collected from the database using the internal search function for terror events between January 1, 1970 and December 31, 2019 which used a vehicle as a means of attack. Results There were 257 recorded terror attacks that involved some type of vehicle between 1970 and 2019. The attacks resulted in 808 fatalities and 1715 injuries when excluding the September 11 attacks. 76 events occurred at the West Bank and Gaza Strip, 25 in the USA, 16 in Israel, and 14 in the UK. Of the 257 terror incidents, 71% (183) occurred within the last 6-year span of inquiry. Conclusion By 2016, vehicle attacks were the most lethal form of attack comprising just over half of all terrorism-related deaths in that year. Large gatherings such as festivals, sporting events, and now outdoor seating at restaurants, leave a number of people highly vulnerable to a vehicle ramming attacks depending on established countermeasures. The increased prevalence of outdoor activities and gatherings in a post-COVID-19 world will further expose large numbers of people to the potential vulnerabilities of vehicle-based terrorism. The scale of the casualties from a vehicle-based terror attack can overwhelm traditional resources and strain the abilities of the healthcare sector. Counterterrorism and disaster medicine specialists are crucial players in educating first responders and emergency medicine providers, allowing them to adequately prepare for an evolving threat in a world devastated by COVID-19. Level of evidence VI.
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Affiliation(s)
- Ryan Scott Houser
- Schar School of Policy and Government, George Mason University, Arlington, Virginia, USA.,Department of War Studies, King's College London, London, UK.,Emergency Department, Morristown Medical Center - Atlantic Health System, Morristown, NJ, USA
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Al-Bedaery R, Chaudhry UAR, Jones M, Noble L, Ibison J. Undergraduate medical teaching with remote consultations in general practice: a realist evaluation. BJGP Open 2022; 6:BJGPO. [PMID: 35210228 DOI: 10.3399/BJGPO.2021.0185] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. DESIGN & SETTING A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. METHOD An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. CONCLUSION Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.
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Grandi GT, Baldaçara RPDC, Coutinho IHILS, Baldaçara L. Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil. SAO PAULO MED J 2022; 140:642-650. [PMID: 36043667 PMCID: PMC9514867 DOI: 10.1590/1516-3180.2021.0731.r1.14122021] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
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Affiliation(s)
| | | | | | - Leonardo Baldaçara
- MD, PhD. Assistant Professor, Health Department of the State of Tocantins, Universidade Federal do Tocantins (UFT), Palmas (TO), Brazil
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Ma R, Lee RS, Nguyen JH, Cowan A, Haque TF, You J, Roberts SI, Cen S, Jarc A, Gill IS, Hung AJ. Tailored Feedback Based on Clinically Relevant Performance Metrics Expedites the Acquisition of Robotic Suturing Skills-An Unblinded Pilot Randomized Controlled Trial. J Urol 2022; 208:414-24. [PMID: 35394359 DOI: 10.1097/JU.0000000000002691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Previously, we identified 8 objective suturing performance metrics highly predictive of urinary continence recovery after robotic-assisted radical prostatectomy. Here, we aimed to test the feasibility of providing tailored feedback based upon these clinically relevant metrics and explore the impact on the acquisition of robotic suturing skills. MATERIALS AND METHODS Training surgeons were recruited and randomized to a feedback group or a control group. Both groups completed a baseline, midterm and final dry laboratory vesicourethral anastomosis (VUA) and underwent 4 intervening training sessions each, consisting of 3 suturing exercises. Eight performance metrics were recorded during each exercise: 4 automated performance metrics (derived from kinematic and system events data of the da Vinci® Robotic System) representing efficiency and console manipulation competency, and 4 suturing technical skill scores. The feedback group received tailored feedback (a visual diagram+verbal instructions+video examples) based on these metrics after each session. Generalized linear mixed model was used to compare metric improvement (Δ) from baseline to the midterm and final VUA. RESULTS Twenty-three participants were randomized to the feedback group (11) or the control group (12). Demographic data and baseline VUA metrics were comparable between groups. The feedback group showed greater improvement than the control group in aggregate suturing scores at midterm (mean Δ feedback group 4.5 vs Δ control group 1.1) and final VUA (Δ feedback group 5.3 vs Δ control group 4.9). The feedback group also showed greater improvement in the majority of the included metrics at midterm and final VUA. CONCLUSIONS Tailored feedback based on specific, clinically relevant performance metrics is feasible and may expedite the acquisition of robotic suturing skills.
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Gelmini AYP, Duarte ML, da Silva MO, Guimarães JB, dos Santos LR. Augmented reality in interventional radiology education: a systematic review of randomized controlled trials. SAO PAULO MED J 2022; 140:604-614. [PMID: 35946678 PMCID: PMC9491476 DOI: 10.1590/1516-3180.2021.0606.r2.27122021] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING Systematic review of comparative studies on teaching techniques. METHODS We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.
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Affiliation(s)
| | - Márcio Luís Duarte
- MSc. Musculoskeletal Radiologist, Centro Radiológico e Especialidades Médicas São Gabriel, Praia Grande (SP), Brazil; and Doctoral Student in Evidence-based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | | | | | - Lucas Ribeiro dos Santos
- MSc. Endocrinologist, Department of Physiology and Medical Clinic, and Professor of Physiology and Medical Clinic, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil; and Doctoral Student in Evidence-based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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Luz FM, Yacoub VRD, Silveira KAA, Reis F, Dertkigi SSJ. A model for training ultrasound-guided fine-needle punctures. Rev Assoc Med Bras (1992) 2022; 68:948-952. [PMID: 35946773 PMCID: PMC9574963 DOI: 10.1590/1806-9282.20220150] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model. METHODS We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure. RESULTS The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure. CONCLUSIONS An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.
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Affiliation(s)
| | | | | | - Fabiano Reis
- Universidade Estadual de Campinas, Department of Radiology – Campinas (SP), Brazil
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Silveira BWM, Santos ALD, Holanda VA, Farias WG, Freitas IMJDE, Góes ACADEM, Veras LB. Construction and application of a low-cost laparoscopy training simulator as a teaching tool through motor coordination and two-dimensional vision practices. Rev Col Bras Cir 2022; 49:e20223095. [PMID: 35239852 PMCID: PMC10578779 DOI: 10.1590/0100-6991e-20223095] [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: 06/08/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to describe the construction of a low-cost laparoscopy training simulator and evaluate its level of acceptance, impact on learning, and skill development in medical students. METHODS we built a video training simulator using low-cost materials. We then carried out a cross-sectional study, with the use of an applied questionnaire to medical students. RESULTS 51 medical students participated in the research, of whom 76.47% gained confidence in relation to laparoscopic surgery, 100% stated that the model successfully trained the skills of motor coordination and two-dimensional visual-spatial field, in addition to enabling a greater understanding of laparoscopy. All agreed that the simulator should be used before a real laparoscopic surgery scenario. CONCLUSION the construction of the described laparoscopic surgery training simulator proved to be feasible and effective as an educational resource. It was well accepted by medical students, with easy handling, and promoted the development of motor and visual skills in video surgery.
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Affiliation(s)
| | | | | | | | | | - Annya Costa Araújo DE Macedo Góes
- - Universidade Federal do Ceará, Departamento de Cirurgia - Fortaleza - CE - Brasil
- - Hospital Universitário Walter Cantídio, Departamento de Cirurgia - Fortaleza - CE - Brasil
| | - Lara Burlamaqui Veras
- - Universidade Federal do Ceará, Departamento de Cirurgia - Fortaleza - CE - Brasil
- - Hospital Universitário Walter Cantídio, Departamento de Cirurgia - Fortaleza - CE - Brasil
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Campos MEC, Monteiro MVDEC, Kakehasi FM. Residency training for minimally invasive surgery. Rev Col Bras Cir 2022; 49:e20213040. [PMID: 35239846 PMCID: PMC10578808 DOI: 10.1590/0100-6991e-20213040] [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: 04/16/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to develop a training program in minimally invasive surgery, based on simulation and with an emphasis on the acquisition of laparoscopic competences. METHODS this was a prospective, observational study carried out at a university hospital in Belo Horizonte, Brazil, between April 2020 and January 2021. We recruited residents of surgical specialties for structured, progressive training according to instructional principles to promote learning, such as motivation, activation, demonstration, application, and integration. We filmed the skill tests at the program's beginning, middle, and end, which were then anonymously evaluated by a surgical education expert. Individual performances were scored using the global assessment tools "GOALS" and "specific checklist for suture". At the end, all participants received individual feedback and completed a questionnaire to assess the impact of training on the Kirkpatrick model. RESULTS 43 residents completed the program. The evolution of performances was evident and grew between tests. The average achievements were 29% in the initial test, 43% in the intermediate test, and 88% in the final test, with significant differences between all mean scores, with H=97.59, GL=2, p<0.0001. The program evaluation and learning perceptions were excellent, but only 10.7% of residents felt fully capable of performing unsupervised, low-complexity laparoscopic surgery at the end of training. CONCLUSIONS the training program developed in this study proved to be feasible and promising as a strategy for teaching laparoscopic surgery.
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Affiliation(s)
- Marcelo Esteves Chaves Campos
- - Hospital das Clínicas da Universidade Federal de Minas Gerais, Centro de Treinamento e Educação Cirúrgica - Belo Horizonte - MG - Brasil
| | - Marilene Vale DE Castro Monteiro
- - Hospital das Clínicas da Universidade Federal de Minas Gerais, Centro de Treinamento e Educação Cirúrgica - Belo Horizonte - MG - Brasil
| | - Fabiana Maria Kakehasi
- - Hospital das Clínicas da Universidade Federal de Minas Gerais, Centro de Treinamento e Educação Cirúrgica - Belo Horizonte - MG - Brasil
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Abstract
This is the second of three articles which explore trends in health science libraries. It is based on a series of articles called New Directions in Health Science Libraries published in a HILJ regular feature (International Perspectives and Initiatives) between June 2017 and March 2020. The series covered 12 countries: The United States, Canada, Australia, China, England, two countries in Africa (Uganda and Tanzania) and five in Europe (Sweden, Romania, Belgium, Germany, and Switzerland). The commissioning editor identified potential authors and invited them to write a short piece. They were given a briefing sheet which said: 'Your article should serve as a road map, describing the key changes in the field and explain the factors driving the changes'. A review of the 12 articles identified 11 trends. This is the article which explores the trends four trends, using examples provided by the authors. The trends covered are: Involvement in systematic reviews and data synthesis; Professional development for health science librarians; Providing education and training to students, researchers, and clinicians; Supporting the delivery of health literacy.
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Affiliation(s)
- Jeannette Murphy
- The Farr Institute of Health Informatics Research, University College London, CHIME, London, UK
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Kötter T, Steinhäuser J. [Experiences with Video-Based Assessment under Pandemic-Related Contact Restrictions]. ZFA (Stuttgart) 2022; 98:386-389. [PMID: 37123508 PMCID: PMC10125252 DOI: 10.53180/zfa.2022.0386-0389] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/23/2022] [Indexed: 05/02/2023]
Abstract
Background Due to the COVID-19 pandemic, the Objective Structured Clinical Examination (OSCE) examinations were cancelled in the short term. This project described how to offer medical students an alternative assessment at Miller's competence level of "shows how". Methods Students produced videos in which they can be seen performing various physical examinations related to family medicine consultations. Trained assessors rated the videos uploaded to the learning platform and gave verbal feedback if requested. Results The grading (65 "very good" and 38 "good") was very mild. Twelve per cent of the students requested verbal feedback. Their evaluation of the procedure was mixed. The evaluators consistently assessed their task and the process as positive. Technically, the video-based assessment could be implemented without any problems. Conclusions The short-term implementation of a video-based assessment in the context of medical education proved to be feasible. It could serve not only as an emergency solution under a pandemic, but also as an additional opportunity for formative feedback in the future.
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Affiliation(s)
- Thomas Kötter
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
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Feijó LP, Pereira GA, Ruffini VMT, Valente FS, dos Santos RA, Fakhouri SA, Nunes MDPT, Augusto KL. Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study. SAO PAULO MED J 2022; 141:e20211028. [PMID: 36197349 PMCID: PMC10065108 DOI: 10.1590/1516-3180.2021.1028.r1.13072022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.
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Affiliation(s)
- Lorena Pinho Feijó
- MSc. Physician and Assistant Professor, Department of Social
Department, Centro Universitário Unichristus, Fortaleza (CE), Brazil
| | - Guilherme Abreu Pereira
- MD. Attending Physician, Department of Internal Medicine,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Vitor Maia Teles Ruffini
- MD. Physician and Associate Professor, Department of Internal
Medicine, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil; and Fellow
of Hospital Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Fernando Salvetti Valente
- MD. Physician and Assistant Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Renato Antunes dos Santos
- PhD. Physician and Assistant Professor, Department of
Psychiatry, University of Toronto, Toronto, Canada. And Adjunct Professor,
Department of Psychiatry, McMaster University, Ontario, Canada
| | - Saadallah Azor Fakhouri
- PhD. Physician and Professor, Department of Internal Medicine,
Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Maria do Patrocínio Tenório Nunes
- PhD. Physician and Associate Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Kristopherson Lustosa Augusto
- PhD. Physician and Assistant Professor, Department of
Internal Medicine, Faculdade de Medicina, Universidade de Fortaleza (UNIFOR),
Fortaleza (CE), Brazil; Postgraduate Professor at master's level, Centro
Universitário Christus-Unichristus Fortaleza (CE), Brazil; and Assistant
Professor, Department of Internal Medicine, Faculdade de Medicina da
Universidade Federal do Ceará (UFC), Fortaleza (CE), Brazil
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Iyeyasu JN, Cecilio-Fernandes D, de Carvalho KM. Longitudinal evaluation of the Ophthalmology residents in Brazil: an observational prospective study. SAO PAULO MED J 2022; 141:e202292. [PMID: 36197351 PMCID: PMC10065116 DOI: 10.1590/1516-3180.2022.0092.r1.01072022] [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] [Received: 03/03/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The longitudinal evaluation of students seems to be a better way to assess their knowledge compared with that of the traditional methods of evaluation, such as modular and final tests. Currently, progress testing is the most consolidated type of longitudinal testing method. However, despite being well consolidated as an assessment tool in medical education, the use of this type of test in residency programs is scarce. OBJECTIVES This study aimed to investigate residents' knowledge growth regarding residency training and to describe the implementation of a longitudinal evaluation test in ophthalmological residency training across several medical schools in Brazil. Finally, the study aimed to check whether performance in the tests can be used as a predictor of the results of the specialist title test. DESIGN AND SETTING This was a prospective observational study. This study was conducted using an online platform. METHODS Online tests were developed following the same pattern as the Brazilian Ophthalmology Council specialist tests. All the residents performed the test simultaneously. The tests were conducted once a year at the end of the school year. RESULTS A progress test was conducted across 13 services with 259 residents. Our results demonstrated that resident scores improved over the years (P < 0.0001) and had a moderate correlation with the Brazilian Opthalmology Council specialist test (P = 0.0156). CONCLUSION The progress test can be considered a valuable tool to assess knowledge, meaning their knowledge increased over residency training. In addition, it can be used as a predictor of the result in the specialist title test.
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Affiliation(s)
- Josie Naomi Iyeyasu
- MD. Ophthalmologist and Assistant Doctor, Low Vision and
Strabismus Sector, Hospital de Clínicas, Faculdade de Ciências Médicas da
Universidade Estadual de Campinas (HC/FCM/UNICAMP), Campinas (SP), Brazil
| | - Dario Cecilio-Fernandes
- Psy, MSc, PhD. Psycologist and Researcher, Department of
Psychology and Psychiatry, Faculdade de Ciências Médicas da Universidade
Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil
| | - Keila Monteiro de Carvalho
- MD. Ophthalomologist and Full Professor, Faculty of Medical
Sciences, Universidade Estadual de Campinas (UNICAMP); and Chief Department of
Ophthalmo-Otorrynolaringology, Faculdade de Ciências Médicas da Universidade
Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil
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Kearsley R, Lyons C, Daly Guris R. Case reports: invaluable learning from mistakes. Anaesth Rep 2021; 9:e12140. [PMID: 34881363 DOI: 10.1002/anr3.12140] [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] [Accepted: 11/11/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- R Kearsley
- Imperial College Healthcare NHS Trust London UK
| | - C Lyons
- University Hospital Galway Galway Ireland
| | - R Daly Guris
- Department of Anaesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Philadelphia PA USA.,Anaesthesiology and Critical Care University of Pennsylvania Philadelphia PA USA
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Kampa P, Balzer F. Algorithmic literacy in medical students - results of a knowledge test conducted in Germany. Health Info Libr J 2021; 38:224-230. [PMID: 34549514 DOI: 10.1111/hir.12392] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022]
Abstract
The impact of algorithms on everyday life is ever increasing. Medicine and public health are not excluded from this development - algorithms in medicine do not only challenge, change and inform research (methods) but also clinical situations. Given this development, questions arise concerning the competency level of prospective physicians, thus medical students, on algorithm related topics. This paper, based on a master's thesis in library and information science written at Humboldt-Universität zu Berlin, gives an insight into this topic by presenting and analysing the results of a knowledge test conducted among medical students in Germany. F. J.
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Affiliation(s)
- Philipp Kampa
- Universitäts- und Landesbibliothek Sachsen-Anhalt, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Affiliation(s)
- Samrat Das
- Pediatrics, Duke University School of Medicine, Durham, NC STE 903, USA
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Richards R, Kinnersley P, Brain K, Wood F. Cancer Clinicians' Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study. JMIR Cancer 2021; 7:e23671. [PMID: 33955836 PMCID: PMC8138703 DOI: 10.2196/23671] [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: 09/17/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients' needs and can provide further insight into the type of app and features that might be most beneficial. OBJECTIVE This study aims to explore cancer clinicians' views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored. METHODS A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis. RESULTS Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians' workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients' age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. CONCLUSIONS This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process.
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Affiliation(s)
- Rebecca Richards
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Paul Kinnersley
- Centre for Medical Education, Cardiff University, Cardiff, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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Mattar TGDM, dos Santos GB, Telles JPM, de Rezende MR, Wei TH, Mattar R. Structured evaluation of a comprehensive microsurgical training program. Clinics (Sao Paulo) 2021; 76:e3194. [PMID: 34669876 PMCID: PMC8491592 DOI: 10.6061/clinics/2021/e3194] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons. METHODS The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs. The other sessions were performed on the femoral vessels of rats: 5 sessions for end-to-end arterial anastomosis, 5 for end-to-end venous anastomosis, 1 for arterial grafting, and 1 for end-to-side anastomosis. We conducted a structured assessment of the microsurgical skills in each training session. RESULTS In this study, 89 surgeons were evaluated. The mean scores for the different procedures were as follows: glove suturing, 33.3±0.59; chicken nerve end-to-end anastomosis, 40.3±0.49; chicken artery suturing, 40.9±0.36; chicken vein suturing, 42.3±0.36; graft interposition, 44.8±0.7; and end-to-side anastomosis, 43.7±0.63 (p<0.05 for all). The chicken thigh suturing scores were significantly higher than the rubber gloves suturing scores (p<0.01). There were no differences between scores of the rat artery and chicken thigh suturing procedures (p=0.24). The rat venous anastomosis scores were higher than the rat arterial anastomosis scores (p=0.02), as were graft interposition scores when compared with end-to-end venous anastomosis scores. The end-to-side anastomosis scores did not differ significantly from the grafting scores (p=0.85). The most common errors were inadequate knotting technique and suture rupture due to inadequate technique (both n=88 [98.9%]). CONCLUSION We propose a 16-step, progressive microsurgical training program to learn the basic microsurgical techniques comprehensively and reliably. The program was evaluated in a large sample of trainees, and it demonstrated the adequacy of the training sequence and results.
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Affiliation(s)
- Tiago Guedes da Motta Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo Bispo dos Santos
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | | | - Marcelo Rosa de Rezende
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Teng Hsiang Wei
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Rames Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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