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Basics of Infant Conventional Mechanical Ventilation: An Interactive Animated Teaching Module

Original Publication | Published: December 14, 2017
Views: 4 | Downloads: 0 |

Abstract

Introduction: While conventional mechanical ventilation is a common therapy in the neonatal intensive care unit (NICU), pediatric residents receive insufficient instruction. This stand-alone computer module provides an interactive method of learning basic infant pulmonary physiology and principles of mechanical ventilation. Methods: This module runs offline and is compatible with a variety of operating systems. Participants complete a six-question, case-based pretest. The seven-section instructional module is self-paced, narrated, animated, and interactive. Learners can repeat each section as needed. At the conclusion of the module, participants complete the same six-question test and receive feedback. In total, the module requires 15-20 minutes to complete. Results: The curriculum has been implemented at the beginning of the NICU rotation over a 2-year period within our pediatric residency program. Participants preferred this interactive module and had higher posttest scores when compared to a PowerPoint presentation. After 4 months, there was evidence of knowledge decay. Discussion: The interactive module is enjoyable, effective, and convenient. It engages participants in active learning and allows them to control the time and pace of their instruction. We have implemented the curriculum within our residency program and believe it would be useful for a variety of NICU health care providers.

Keywords: Infant, Lung, Neonate, Pulmonary, Neonatal, Ventilation, Respiration, Ventilator, Neonatal Intensive Care Unit
score: None / boost: 2.5 / featured: 0 / priority: 3

Helping Trainees Develop Scholarship in Academic Medicine From Community Service

Original Publication | Published: December 14, 2017
Views: 7 | Downloads: 1 |

Abstract

Introduction: Service in the community and academic medicine are often seen by trainees as unrelated. This may be one reason for the lack of faculty diversity and the declining interest in academic medicine among new trainees. Methods: We developed an educational workshop through the application of the Kern model to help medical students and residents understand the relationship between community service work and scholarship as it pertains to a career in academic medicine. Specifically, the workshop helped trainees (1) understand the terms service and scholarship, (2) understand the benefits of achieving community service scholarship, and (3) identify steps to achieve community service scholarship through mock cases and personal stories. Results: The workshop was implemented at five conferences with a total of 139 trainees. Results of a paired-samples t test of learners’ responses pre- and postworkshop showed statistically significant growth in their confidence to publish service-related work, as well as more positive agreement with the notion that community service work aligns with an academic medicine career. Discussion: This effective module can help trainees understand how community service and academic medicine are aligned, and raise their confidence in building a foundation for an academic medicine career through conducting community service scholarship.

Keywords: Scholarship, Academic Medicine, Community Service
score: None / boost: 2.5 / featured: 0 / priority: 3

On-the-Go Training: Downloadable Modules to Train Medical Students to Care for Adult Female Sexual Assault Survivors

Abstract

Introduction: Every medical provider encounters patients who have experienced sexual assault, and a patient’s interaction with the medical system can impact long-term outcomes. Training to provide appropriate, compassionate care for this population is lacking in most medical school curricula. This educational resource contains three downloadable modules to train medical students in providing improved care for adult female survivors of sexual assault so students can feel more confident and empowered in caring for this population. Methods: The modules are composed of an informational video on initial medical management, a patient interview simulation video, and a set of audio interviews on suggestions for practice. Interdisciplinary experts assisted in the modules’ development. Associated materials include a 10 question pre- and posttest of medical knowledge, with additional survey questions to assess student attitudes and satisfaction outcomes. Results: A cohort of 32 medical student volunteers from all class years tested the modules. Overall, student scores improved 20% (95% confidence interval, 16%-23%) from pre- to posttest. Students reported that their comfort in caring for an adult female sexual assault survivor increased after completion of the modules (p = .025). On the whole, students reported on the postsurvey that the modules enhanced their education, improved their comfort, and were appropriate for their level of education. Discussion: These modules can enrich an undergraduate medical curriculum in a currently underaddressed topic, the care of female survivors of sexual assault. Empowering and educating students to care for this patient population can result in improved health outcomes.

Keywords: Communication, Sex Offenses, Self-Directed Learning, Sexual Assault, Sexual Trauma, Sexual Violence, Sexual Offenses, Trauma-Informed Care
score: None / boost: 2.5 / featured: 0 / priority: 3

Newborn Care Curriculum: The Late Preterm Infant in the Level II Neonatal Intensive Care Unit

Original Publication | Published: December 11, 2017
Views: 21 | Downloads: 5 |

Abstract

Introduction: Late preterm births represent the largest category of preterm deliveries. Although these infants are frequently managed in normal newborn nurseries, they have an increased risk of readmissions and mortality. Thus, we designed this PowerPoint-based learning module to provide learners with a computer-based educational resource on late preterm infants in the level II neonatal intensive care unit. Methods: This module can be completed using the included pretest and posttest to assess for change in knowledge. The module should take approximately 20 to 30 minutes to complete. Results: Between May and June of 2016, members of the pediatric hospitalist division at Children’s National Health System in Washington, DC participated in a study of the module as a self-directed learning tool and completed the pretest, posttest, and postmodule evaluation forms. There was an overall increase in knowledge, with an increase in posttest score from 64% to 94%. Furthermore, this module was well-received by learners, as 55% of learners agreed or strongly agreed that the material presented in the module would change their clinical practice, and 100% agreed or strongly agreed that the module increased their comfort with teaching on this topic. Discussion: Initial implementation of the module indicates it could be a valuable tool to address a perceived educational need in the area of late preterm infant care in the level II neonatal intensive care unit

Keywords: Nursery, Pediatrics, Hospital Medicine, Newborn Care, Preterm Infant
score: None / boost: 2.5 / featured: 0 / priority: 3

Teaching Health Care Policy: Using Panel Debate to Teach Residents About the Patient Protection and Affordable Care Act

Original Publication | Published: November 21, 2017
Views: 93 | Downloads: 14 |

Abstract

Introduction: The debate format has been infrequently used in resident education. We used the panel debate format as a tool to improve health care professionals’ knowledge of the Patient Protection and Affordable Care Act (PPACA). Methods: Six physical medicine and rehabilitation resident physician debaters led a 60-minute panel debate about the PPACA. Outcome measures included a survey of the spectators with validated questions on physician attitudes towards health care reform in the US and open-ended questions regarding Americans’ views on the US health care system. Results: Twenty-nine physician and nonphysician faculty and staff participated as spectators. Responses to the questions on attitudes toward reform of the health care system indicated that zero spectators rated the current US health care system (i.e., the PPACA) as “Excellent,” 25% rated it as “Good,” 42% “Average,” 25% “Poor,” and 8% “Failing.” Half of the respondents indicated they support a US president who advocates making the US health care system more like those of other countries. The majority of respondents (89%) expressed the idea that the US does not have the best health care system in the world. Discussion: Approaching a topic as broad as health care reform with the debate format promoted knowledge, reflection, and interaction with both the opposing debaters and audience.

Keywords: Rehabilitation, Debate, Health Care Policy, Health Care Professional, Hospital Physician, Patient Protection and Affordable Care Act
score: None / boost: 2.5 / featured: 0 / priority: 3

Explaining Breast Density Recommendations: An Introductory Workshop for Breast Health Providers

Original Publication | Published: November 21, 2017
Views: 24 | Downloads: 3 |

Abstract

Introduction: High breast density is an independent risk factor for breast cancer and can decrease the sensitivity of mammography. However, evidence surrounding recommendations for patient risk stratification and supplemental screening is evolving, and providers receive limited training on breast density counseling. Methods: We implemented an introductory, interactive workshop about breast density including current evidence behind supplemental screening and risk stratification. Designed for providers who counsel women on breast health, this workshop was evaluated with internal medicine providers, primary care residents, and radiology residents. We surveyed participants about knowledge and attitudes at baseline, postintervention (residents and providers), and 3-month follow-up (providers only). We compared baseline and postintervention scores and postintervention and 3-month follow-up scores using paired t tests and McNemar’s tests. Results: Internal medicine providers had significant gains in knowledge when comparing baseline to postintervention surveys (6.5-8.5 on a 10-point scale, p < .0001), with knowledge gains maintained when comparing postintervention to 3-month follow-up surveys (p = .06). Primary care and radiology residents also had significant gains in knowledge when comparing baseline to postintervention surveys (p < .004 for both). All learner groups reported increases in their confidence regarding counseling women about breast density and referring for supplemental screening. Discussion: Through this breast density session, we showed trends for increased knowledge and change in attitudes for multiple learner groups. Because we aim to prepare providers with the best currently available recommendations, these materials will require frequent updating as breast density evidence and national consensus evolve.

Keywords: Faculty Development, Women’s Health, Breast Density
score: None / boost: 2.5 / featured: 0 / priority: 3

Introducing Trainees to Academic Medicine Career Roles and Responsibilities

Original Publication | Published: November 15, 2017
Views: 323 | Downloads: 22 |

Abstract

Introduction: The future of academic medicine depends on attracting motivated trainees to the academic career path, but challenges to recruitment include unfamiliarity with academic career options. Methods: This workshop comprises a didactic session with small-group case discussion to enable trainees to learn how to: (1) define academic medical center roles and responsibilities, (2) assess the alignment of academic medical center roles with personal goals and interests, and (3) identify factors that support an academic medicine career trajectory. Workshop evaluations were collected at five academic medicine conferences for medical students and residents held across the U.S. Results: Among the 139 conference participants who completed an evaluation form, the majority had a statistically significant increase in confidence regarding their building a foundation for a career in academic medicine, and in identifying an academic medicine career role aligning with their own personal and professional interests. The majority strongly agreed or agreed that the workshop objectives were met. Trainees reported that the workshop was “illuminating,” “informative,” and “educational.” Discussion: Improved understanding of academic medicine career roles and responsibilities can increase trainees’ awareness of the opportunities in academic medicine and may support development of the next generation of academic physicians.

Keywords: Academic Medicine, Career Development, Academic Track, Career Path
score: None / boost: 2.5 / featured: 0 / priority: 3

Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students

Abstract

Introduction: The operating room is a complex environment in which individual team members perform specific tasks according to their role. A simulation activity was created to introduce medical students on the surgery clerkship to issues relating to patient safety, infection control, and regulatory requirements. Methods: This activity takes place prior to general surgery rotation operative experiences, and addresses the need for students to practice roles they will perform while participating in patient care. The activity includes a simulated operation, an assessment, and a scripted debriefing. Among other tasks, students practice safe patient transfer and monitoring, donning sterile garb, preparing the surgical site, and being active participants in a sign-in and time-out. Students are assessed on assigned tasks, their ability to maintain sterility, and the degree to which they engage with their team. Results: Students reported the simulation helped them better understand how they could become involved on their first day in the operating room. Students also reported they were more confident when in the operating room. This finding also extended to students who had previously been in the operating room during a prior OB/GYN rotation. Discussion: Patient safety is paramount when in the operating room, and this simulation activity fills a current gap in student’s practical knowledge as they prepare to enter their surgery clerkship. Giving medical students the information and skills needed to be safe and effective members of the operating team prior to entering the operating room is of benefit to the surgical team, students, and patients.

Keywords: Simulation, General Surgery, Surgery, Safety, Operating Rooms
score: None / boost: 2.5 / featured: 0 / priority: 3

Diagnosing and Remediating Clinical Reasoning Difficulties: A Faculty Development Workshop

Abstract

Introduction: Clinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners. Published resources on faculty development to diagnose and remediate clinical reasoning difficulties are limited. We created and implemented a workshop to assist faculty in developing these skills based on the five-domain framework described by Audétat, Laurin, and Sanche. This workshop provides all the materials needed to replicate this training with faculty at other institutions. Methods: The workshop consists of a didactic component and case-based active learning in small groups. Each case focuses on different domains of clinical reasoning difficulties and targets different learner levels (preclinical medical students through residents). The workshop was given in multiple venues in 2016 and 2017. Results: Participants reported the session was valuable (4.71/5.0), the facilitators were effective (4.5/5.0), and the objectives were met (4.28/5.0). They highlighted the strengths of the interactive format, the framework to diagnose and remediate clinical reasoning difficulties, and the excellent take-home resources. They suggested more time for the workshop, revision of cases to better highlight difficulties, and refinement of instructions to approach the cases. These suggestions were incorporated into the current iteration of the workshop. Discussion: We successfully implemented a workshop for diagnosing and remediating clinical reasoning difficulties in multiple venues. The sessions were diverse in terms of faculty participants and learner groups addressed.

Keywords: Faculty Development, Clinical Reasoning, Illness Script, Problem Representation, Semantic Qualifiers
score: None / boost: 2.5 / featured: 0 / priority: 3

Resident Wellness: An Intervention to Decrease Burnout and Increase Resiliency and Happiness

Original Publication | Published: November 6, 2017
Views: 300 | Downloads: 23 |

Abstract

Introduction: Despite the national focus on trainee burnout, effective wellness programs that can easily be incorporated into training curriculums are lacking. Strategies such as mindfulness and positive psychology, linked with deep breathing, have been shown to increase resiliency. We hypothesized that education about the neuroscience literature, coupled with teaching about well-being using short, easy-to-practice evidence-based exercises, would increase acceptance of this curriculum among residents and that providing protected time to practice these exercises would help trainees incorporate them into their daily lives. Methods: Residents were asked to attend a 60-minute didactic featuring both the concepts and science behind well-being. Residents then attended 15-minute booster sessions during protected didactic time each week for a 12-week curriculum. The booster sessions were peer-led by wellness champions. Additionally, there were monthly competitions using free phone apps to promote physical fitness through steps and flights challenges. Results: The 12-week curriculum was offered to 272 residents across five subspecialties of internal medicine, general surgery, anesthesiology, psychiatry, and physical medicine and rehabilitation. A total of 188 residents (69%) participated in the initial didactic component. The curriculum was positively received, with four of the five residency programs participating in weekly sessions. Residents in four participating departments then chose to continue the weekly sessions on a voluntary basis after the initial 12-week curriculum. Discussion: It is feasible to implement a low-cost, peer-led wellness curriculum to educate residents and foster an environment during residency training where mindfulness, optimism, gratitude, and social connectedness are the norm.

Keywords: Curriculum, Self Care, Stress, Psychological Stress, Physician Well-Being, Workplace, Job Satisfaction
score: None / boost: 2.5 / featured: 0 / priority: 3

Alcohol Withdrawal and Lithium Toxicity: A Novel Psychiatric Mannequin-Based Simulation Case for Medical Students

Original Publication | Published: November 1, 2017
Views: 249 | Downloads: 10 |

Abstract

Introduction: High-fidelity mannequin-based simulation is frequently used to compliment medical student education during clinical clerkships. However, psychiatric educators have not broadly adopted this modality, focusing rather on standardized patient actors. We developed and delivered a simulation case involving a patient with alcohol withdrawal and lithium toxicity followed by a debriefing session to medical students at the end of their psychiatric clerkship. Methods: The case involves a 40-year-old male truck driver with a history of bipolar disorder who presents to the emergency room after a truck accident. The patient is in alcohol withdrawal, which responds to benzodiazepines. A workup reveals that the patient also has lithium toxicity related to the co-ingestion of lithium and naproxen for pain. Participants learn to evaluate and treat alcohol withdrawal, consider medical comorbidities and legal consequences, and complete a brief intervention for substance use. This case requires a simulation mannequin. Results: To date, 150 second-, third-, and fourth-year medical students have participated in this case and 76 have been surveyed. Participants have provided a postsession rating of 4.49 on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree) on a question about enjoyment, and 3.93 on a question about confidence with evaluation and treatment of patients in alcohol withdrawal. Discussion: Psychiatric education currently underutilizes mannequin-based simulation compared to other medical disciplines. Mannequin simulation is feasible and effective in psychiatric education, especially in cases involving medical complexity, as shown in this novel case involving a patient with alcohol withdrawal and lithium toxicity.

Keywords: Psychiatry, Alcohol Use Disorder, Mannequin Simulation, Lithium Toxicity
score: None / boost: 2.5 / featured: 0 / priority: 3

Longitudinal Faculty Development Program to Promote Effective Observation and Feedback Skills in Direct Clinical Observation

Original Publication | Published: October 30, 2017
Views: 181 | Downloads: 28 |

Abstract

Introduction: We developed a longitudinal faculty development program to maximize faculty training in direct clinical observation (DCO) and feedback, as there was a perceived need for higher quality of DCO and feedback. To achieve this, we created a behaviorally anchored DCO instrument and worked to improve faculty skills in this area. Methods: We describe an innovative model of faculty training that is learner centered and reinforces evidence-based principles of effective feedback that are introduced and then repeated in all sessions. The training centers on both peer-led observation of and feedback on faculty learners’ recorded DCO feedback encounters, and is guided by our DCO instrument. Residents and faculty completed surveys to assess program impact. Qualitative responses were analyzed for themes. The Wilcoxon signed rank test was used to examine significance of difference in feedback quality before and after DCO faculty development education sessions. Results: Our faculty development program has been well received and had a significant impact on quality of faculty feedback, as rated by resident learners. Discussion: Our faculty development model is effective at growing faculty learners’ DCO and feedback skills. Potential strengths of this program include the use of a behaviorally anchored DCO instrument, longitudinal and experiential faculty development, and use of small-group peer review of recorded faculty feedback encounters. We have found that when their learning needs are attended to, faculty learners cultivate a deep appreciation for principles of effective feedback. In fact, faculty feedback skills can be enhanced in the eyes of resident learners.

Keywords: Feedback, Faculty Development, Role Playing, Role-Play, Direct Clinical Observation, Videotape Review
score: None / boost: 2.5 / featured: 0 / priority: 3

An Experiential Resident Module for Understanding Social Determinants of Health at an Academic Safety-Net Hospital

Original Publication | Published: October 26, 2017
Views: 244 | Downloads: 30 |

Abstract

Introduction: Half of the U.S. population has chronic illness. Many disparities exist in health care for management of chronic disease among poorer individuals, including decreased access to healthy foods, homelessness, and difficulty navigating large hospital systems due to low health literacy. A survey of resident physicians found significant gaps in preparedness to provide cross-cultural care. Education is needed to promote consideration of patients’ social and cultural barriers in managing disease and navigating the health care system. This module was created as an introduction to social determinants of health, and highlights disparities in access to healthy food, water, shelter, and medical care in a sample of the residents’ own continuity clinic patient panel. Methods: We designed this experiential module to help internal medicine residents at an urban institution better understand how social constructs might hinder patient health. Activities were chosen by learners from a list of options, and carried out in small groups during a half day of protected time. We used reflective writing exercises to elicit resident thoughts about the module. Results: Thirty-nine second-year residents participated in the module. Following the course, 41% of residents submitted reflective statements about their experience. Reflective responses suggest an enhanced appreciation for social determinants of health, a sense of empowerment to advocate for better patient resources, and an appreciation for systems-level factors that play a role in social determinants of health. Discussion: Our results demonstrate that a short, experience-based module can impact resident attitudes about social determinants and improve advocacy around identifying community resources.

Keywords: Curriculum, Experiential, Social Determinants, Editor’s Choice, Safety-Net
score: None / boost: 2.5 / featured: 0 / priority: 3

Simulation Clinical Scenario Design Workshop for Practicing Clinicians

Original Publication | Published: October 23, 2017
Views: 518 | Downloads: 111 |

Abstract

Introduction: Faculty development is important to developing skilled faculty members who are able to effectively design and deliver educational content. There has been an increase in courses designed to help faculty better teach at the bedside, but fewer options for those interested in developing their skills as simulation-based educators. Our goal was to create a workshop to train prospective simulation educators on the skills and knowledge necessary to design a clinical scenario. Methods: Learners participate in a 90-minute workshop utilizing short, didactic teaching and practical hands-on practice. Faculty guide learners through the process of developing targeted goals and learning outcomes, setting the scene for a clinical scenario, and storyboarding the main action. Learners work individually, but engage in peer-to-peer feedback, as well as instructor feedback, throughout the session. Results: We have run four iterations of this workshop at our institution in the past year, and developed a modified version for an international meeting. A total of 51 learners from our hospital have completed the workshop. Overall, learners agree that the workshop is informative and increases their knowledge. For each educational objective, more than 70% of participants indicated the workshop increased their competence in the area either “extremely” or “quite a bit.” Discussion: This workshop provides learners hand-on practice in developing a scenario for simulation-based education. Learners leave with the tools and knowledge necessary to take the work developed in the session and create a complete scenario that can be used at our simulation center or at another facility.

Keywords: Simulation, Faculty Development, Clinical Scenario
score: None / boost: 2.5 / featured: 0 / priority: 3

Cognitive Debiasing Strategies: A Faculty Development Workshop for Clinical Teachers in Emergency Medicine

Abstract

Introduction: Medical decision-making is a cornerstone of clinical care and a key contributor to diagnostic accuracy. Medical decision-making occurs via two primary pathways: System 1, pattern recognition, is fast, intuitive, and heuristically driven and occurs largely unconsciously. System 2, analytic thinking, is slow, deliberate, and under conscious control. Biases are systematic errors that can impact reasoning via either pathway but predominantly affect decisions made by pattern recognition. Debiasing strategies involve the deliberate switching from pattern recognition to analytic thinking triggered by a stimulus. This resource describes a faculty development workshop designed to train emergency medicine educators about common biases and debiasing strategies, to improve teaching of diagnostic reasoning to trainees. Methods: This workshop was implemented at the 2017 Society for Academic Emergency Medicine Annual Meeting. The workshop consisted of a brief didactic, followed by small-group case-based learning. A retrospective survey and qualitative evaluation were administered to attendees. Results: The participants’ self-assessment showed significant improvements (p < .001) in their abilities to recognize how pattern recognition can lead to bias, identify common types of bias in the emergency department, teach trainees about common types of bias, and apply cognitive debiasing strategies to improve diagnostic reasoning. Strengths of the workshop included the interactive case-based format, discussions of bias-mitigation strategies, and take-home resources. Suggestions for improvement included lengthening the discussion time and providing more cases. Discussion: Cognitive biases can negatively impact patient care. Faculty development is needed to improve instruction about bias and debiasing strategies for all levels of trainees.

Keywords: Faculty Development, Clinical Reasoning, Dual Processing Theory, Cognitive Debiasing
score: None / boost: 2.5 / featured: 0 / priority: 3

Advance Care Planning and Shared Decision-Making: An Interprofessional Role-Playing Workshop for Medical and Nursing Students

Original Publication | Published: October 18, 2017
Views: 338 | Downloads: 73 |

Abstract

Introduction: Advance care planning (ACP) is an essential discussion between a health care provider and a patient about their future care during serious illness. In clinical practice, high-quality ACP may be addressed with an interprofessional approach. Role-playing is an ideal method to practice both ACP and shared decision-making before having these conversations with patients. Methods: This asynchronous role-playing workshop is prefaced with two prerecorded 25-minute videos for faculty and student preparation with one introducing ACP concepts, and one depicting a patient-physician ACP discussion. During the 2-hour workshop, students complete four role-play ACP scenarios with the following roles: patient, family member, nurse, nurse practitioner, and physician. Students rotate through different roles guided by scripts, and have a fact sheet for each scenario detailing prognostic information for disease processes. The role-play works optimally with three nursing students, three medical students, and one faculty facilitator per group. Facilitators are provided with a timeline, a guide for debriefing, and an evaluation rubric. Results: The survey data from 85 students spread over four course offerings were summarized. When asked both if learning objectives were met, and to reflect on the clinical relevance, teaching effectiveness, and the overall workshop experience, most participants reported a good to excellent rating. Discussion: This role-play activity allows students to practice ACP and shared decision-making, both with patient and family presence, and in premeeting rounds with the health care team. ACP exposure during student training helps trainees recognize the impact of high-quality interprofessional conversations on the care patients want and ultimately receive.

Keywords: Workshop, Interprofessional, Prognosis, Shared Decision-making, Advance Care Planning, Ask-Tell-Ask, Role-play
score: None / boost: 2.5 / featured: 0 / priority: 3

Pediatric Emergency Medicine Simulation Curriculum: Submersion Injury With Hypothermia and Ventricular Fibrillation

Abstract

Introduction: Submersion injury or drowning is a leading preventable cause of pediatric mortality and morbidity. Submersion injuries are often accompanied by hypothermia and asphyxia that can lead to inadequate oxygen delivery to tissues and subsequent cardiac arrhythmias. Methods: This simulation-based curriculum involves the identification and management of a submersion injury in a 4-year-old boy who was rescued from a cold-water submersion. The simulated patient is apneic, pulseless, bradycardic, and hypothermic; he is being bag-mask ventilated on arrival without intravenous access. He ultimately develops ventricular fibrillation. Providers must recognize the degree of submersion injury, initiate early airway protection, adequately address circulation, and be alert to developing hypothermia and cardiac arrhythmias to prevent further decompensation. This scenario can be modified based on trainee level (pediatric residents vs. pediatric emergency medicine fellows). Results: A total of 22 trainees (PGY 1-PGY 6 pediatric residents and pediatric emergency medicine fellows) participated in this simulation curriculum on separate occasions and rated it as an overall positive learning experience. The curriculum’s goal is to provide learners with an opportunity to manage life-threatening pediatric submersion injuries, where the correct steps need to be taken in a limited period of time. Discussion: We have provided preparatory materials to help instructors set up, run, and debrief the scenario in a standardized fashion. The debriefing tools allow for adaptation depending on learners’ needs and individual experiences during the simulated scenario. Also included are supporting educational materials and a learner feedback form that can be used to evaluate the session.

Keywords: Simulation, Ventricular Fibrillation, Hypothermia, Drowning, Pediatric Emergency Medicine, Submersion, Immersion
score: None / boost: 2.5 / featured: 0 / priority: 3

A Quality Improvement Educational Intervention to Increase Knowledge of Cardiogastroenterology Amongst Medical Trainees and Nursing Staff

Original Publication | Published: October 16, 2017
Views: 82 | Downloads: 10 |

Abstract

Introduction: The American Society of Gastrointestinal Endoscopy recommends continuing aspirin prior to routine endoscopy. National data show that few endoscopists follow the current guidelines due to concern about bleeding and perceived minimal downside to stopping aspirin. Utilizing the Kern model, we implemented an educational quality improvement initiative aimed at increasing knowledge of antithrombotic management periendoscopy and during acute gastrointestinal (GI) bleeding. Methods: We implemented an interactive lecture incorporating a large-group discussion to help residents learn to define low- versus high-risk procedures, distinguish thrombotic risk in medical conditions, present the procedural risks associated with use of antiplatelets, and list current practice guidelines. Nursing staff received a tailored lecture with the goal of learning proper management of current antiplatelets and holding parameters for anticoagulants prior to endoscopy. Both groups received pre-and posttest questionnaires evaluating their knowledge. Results: Eighteen nurses and 75 medical trainees received this intervention. Significant score improvement was noted in both groups. The greatest change was seen in aspirin management (30.5% vs. 95.0% for group 1, 43.7% vs. 91.9% for group 2; p < .0001). For management of antiplatelets after aspirin-induced GI bleed, the medical trainees improved from 50.7% to 93.3%. Chi-square analysis showed a statistically significant difference in knowledge across all areas among medical trainees pre-and posttest (p < .001). Discussion: This quality-based educational intervention significantly increased the knowledge of nurses and medical trainees in management guidelines that directly impact patient care. Similar educational programs may be very effective in improving quality and safety.

Keywords: Education, Aspirin, Hemorrhage, Quality Improvement, Gastroenterology, Guidelines, Bleeding, Endoscopy, Antithrombotic, Fibrinolytic Agents, Clopidogrel
score: None / boost: 2.5 / featured: 0 / priority: 3

An Integrated, Multimodal Resident Curriculum in Patient Safety and Quality Improvement

Original Publication | Published: October 13, 2017
Views: 273 | Downloads: 29 |

Abstract

Introduction: Patient safety and quality improvement are essential components of modern medicine. The traditional model of graduate medical education does not lend itself well to learning these disciplines. This curriculum encompasses these disciplines across multiple modalities and extends throughout residency. Methods: The curriculum includes introductory presentations suitable for naive audiences. Following these is a structured rotation that provides the opportunity both to experience in-depth self-directed learning and to practice skills involved in quality and safety. This rotation includes existing online courses published elsewhere, reflective writing exercises based on self-directed learning, and practice cases. Finally, residents lead a morbidity, mortality, and improvement conference where adverse events are identified and reviewed, specific interventions and outcome objectives are selected, and action teams are identified. Results: After two presentations on system issues and individual issues, responses to the prompt “This talk will aid in my professional development” were 4.75 and 4.59 out of 5, respectively. Eighty-three percent of residents agreed they had a better understanding of the concepts of patient safety and/or quality improvement than they did before the rotation. Audience members for the resident-led morbidity, mortality, and improvement conference agreed it would lead to a change in their own practice. Discussion: The contents of this longitudinal curriculum have been incorporated into the core requirements of our general pediatrics residency program and could reasonably be imported into any residency requiring a robust longitudinal experience in quality improvement and patient safety.

Keywords: Safety, Morbidity, Quality Improvement, Quality, Morbidity and Mortality, Reflective Learning
score: None / boost: 2.5 / featured: 0 / priority: 3

Difficult Interpersonal Encounters with Medical Students and Residents: Two Objective Standardized Teaching Encounters

Original Publication | Published: October 11, 2017
Views: 263 | Downloads: 26 |

Abstract

Introduction: Objective standardized teaching exercises (OSTEs) are widely used to develop professional competencies, especially in the health care professions. An OSTE involves exposing different providers to the same, time-limited scenario that is concurrently observed and/or recorded for either formative or summative evaluation. As there are limited resources available for creating a resident-specific OSTE, especially those applicable to family and community medicine residents, we created and evaluated a resident OSTE (R-OSTE) for second- and third-year family and community medicine residents. Methods: This R-OSTE involved two cases. The first featured Taylor, a third-year medical student resistant to feedback. The second featured Kris, a first-year resident nervous about approaching the attending on duty. Our R-OSTE had residents teaching interpersonal skills to trained actors in a standardized learner role. Results: Residents in the teaching role were formatively evaluated by peer observers (fellow residents) and standardized learners on interpersonal domains such as communication and professionalism. Learners gave residents an average performance rating of 4.9 on a 1 to 6 scale with 1 = Very Poor and 6 = Excellent. Residents also evaluated the OSTE itself, rating their experience on multiple teaching-related statements. Eighty-six percent of residents agreed this exercise was an appropriate development activity for family medicine residents. Overall, our R-OSTE was rated highly for relevance to teaching by the residents. Discussion: The residents were rated highly by both peer observers and standardized learners. However, there was little variability in peer observer scores, indicating the need for an alternative method of measurement.

Keywords: Objective Structured Teaching Exercise, Teaching, Resident, Interpersonal Communication, Objective Structured Clinical Exam
score: None / boost: 2.5 / featured: 0 / priority: 3