scholarly journals MP21: An interprofessional delirium assessment tool for healthcare professionals and trainees working in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S72
Author(s):  
B. Balasubramanaiam ◽  
J. Chenkin ◽  
T.G. Snider ◽  
D. Melady ◽  
J.S. Lee
Keyword(s):  
Medical Students ◽  
Prospective Observational Study ◽  
Survey Methodology ◽  
Assessment Tool ◽  
Medical Training ◽  
Delirium Assessment ◽  
Future Studies ◽  
Clinical Vignettes ◽  
Geriatric Emergency Medicine ◽  
Different Levels

Introduction: Multiple studies since the ‘90’s demonstrate that ED staff fail to identify delirium in up to 75% of older patients. Those patients who are discharged have a 3-fold increased mortality. Methods: We iteratively developed a 14-item interprofessional tool with 4 clinical vignettes to assess comfort, knowledge and ability to identify delirium among medical students, EM residents, staff MDs and RNs. We conducted a prospective observational study using modified Dillman survey methodology. Surveys were sent on paper to residents and nurses and online to medical students and staff MDs. Results: Our response rate was 68% (38/56) for residents, 80%(16/20) for RNs; but only 37%(13/35) for staff MDs and 13%(139/1036) for medical students. Comfort with identifying delirium increased with level of medical training; 38/139(27%) 1st-4th year medical students (MS1-MS4); 25/38(66%) 1st-5th year residents (R1-R5); and 12/13(92%) staff physicians reported being comfortable (χ2=34.7, df=2, p<0.001). MS1-MS2 were the least comfortable, with only 5/82(6%) reporting comfort, increasing to 33/57(58%) among MS3-MS4 (χ2=44.9, df=1, p<0.001). A greater proportion of R4-R5 who completed a geriatric emergency medicine (Geri-EM) curriculum reported comfort, 11/12(92%) compared to 14/26(54%) of R1-R3 (χ2=19.2, df=1, p<0.05). Only 5/16(31%) nurses reported being comfortable with identifying delirium. Ability to identify all 4 clinical vignettes correctly was higher among MS3-MS4 than MS1-MS2 (32/57(56%) vs. 30/82(37%), χ2=5.2, df=1, p<0.05). There was no difference between respondents from different levels of medical training (62/139(45%) MS1-MS4, 21/38(55%) R1-R5 and 6/13(46%) staff MDs, χ2=1.4, df=2 p=0.52). There was no effect of Geri-EM completion on perfect vignette scores (6/12(50%) R4-R5 vs. 15/26(58%) R1-R3, χ2=0.20, df=1, p=0.66). There was a trend towards a lower proportion of nurses who identified all 4 clinical vignettes correctly compared to physicians (4/16(25%) vs. 27/51(53%), χ2=3.82, df=1, p=0.051). Conclusion: Our tool may be useful for assessing comfort and knowledge of delirium among ED physicians and nurses. Completion of the Geri-EM curriculum was associated with increased comfort with detecting delirium but not knowledge. Future studies should assess current ED delirium comfort and knowledge at different levels of training; between professions and examine differences nationwide.

scholarly journals Commentary and Opinions: The Utilization of Social Media by Medical Residency Programs During COVID-19 Pandemic and Beyond

2022 ◽  
Vol 10 (2) ◽  
pp. 13
Author(s):  
Leilynaz Malekafzali ◽  
Chaocheng Liu
Keyword(s):  
Social Media ◽  
Medical Students ◽  
Residency Program ◽  
Medical Training ◽  
Faculty Members ◽  
Medical Residency ◽  
Educational Materials ◽  
Residency Programs ◽  
Future Studies ◽  
Social Media Platforms

As a result of COVID-19 pandemic, medical training has been greatly impacted globally. In Canada, out-of-province visiting clinical electives were cancelled. In addition, the Canadian Resident Matching Service (CaRMS) interviews were transitioned to being virtual since 2020. As residency programs are exploring new ways to overcome the challenges of elective cancellation, there has been a surge of residency program social media accounts on Instagram, Twitter, and Facebook. Social media serves as a platform for residency programs to promote themselves in addition to posting interactive educational materials. Moreover, social media residency accounts provide a platform for medical students to learn about the programs and network virtually with fellow applicants, residents, program directors, and faculty members. Overall, social media is becoming a popular and valuable tool for residency programs to connect with the applicants during COVID-19 pandemic and beyond. Among the different social media platforms, Instagram seems to be more appealing to both residency programs and the graduating medical students. We report our observations regarding selected Canadian residency program Instagram accounts. To maximize the success of using social media, it is important for the residency programs to consider the attitudes of applicants towards the residency social media accounts. Future studies are needed to assess the effectiveness of the Canadian residency program social media accounts for the final year students applying for these programs.

Development and Validation of an Assessment Tool for Technical Skills in Handheld Otoscopy

2020 ◽  
Vol 129 (7) ◽  
pp. 715-721
Author(s):  
Mads J. Guldager ◽  
Jacob Melchiors ◽  
Steven Arild Wuyts Andersen
Keyword(s):  
Medical Students ◽  
Assessment Tool ◽  
Medical Training ◽  
Technical Skills ◽  
University Teaching ◽  
Validity Evidence ◽  
Level Of Evidence ◽  
Training Interventions ◽  
Diagnostic Skills ◽  
Novices And Experts

Objective: Handheld otoscopy requires both technical and diagnostic skills, and is often reported to be insufficient after medical training. We aimed to develop and gather validity evidence for an assessment tool for handheld otoscopy using contemporary medical educational standards. Study Design: Educational study. Setting: University/teaching hospital. Subjects and Methods: A structured Delphi methodology was used to develop the assessment tool: nine key opinion leaders (otologists) in undergraduate training of otoscopy iteratively achieved consensus on the content. Next, validity evidence was gathered by the videotaped assessment of two handheld otoscopy performances of 15 medical students (novices) and 11 specialists in otorhinolaryngology using two raters. Standard setting (pass/fail criteria) was explored using the contrasting groups and Angoff methods. Results: The developed Copenhagen Assessment Tool of Handheld Otoscopy Skills (CATHOS) consists 10 items rated using a 5-point Likert scale with descriptive anchors. Validity evidence was collected and structured according to Messick’s framework: for example the CATHOS had excellent discriminative validity (mean difference in performance between novices and experts 20.4 out of 50 points, P < .001); and high internal consistency (Cronbach’s alpha = 0.94). Finally, a pass/fail score was established at 30 points for medical students and 42 points for specialists in ORL. Conclusion: We have developed and gathered validity evidence for an assessment tool of technical skills of handheld otoscopy and set standards of performance. Standardized assessment allows for individualized learning to the level of proficiency and could be implemented in under- and postgraduate handheld otoscopy training curricula, and is also useful in evaluating training interventions. Level of evidence: NA

scholarly journals Self-Assessment of Final Year Medical Students’ Proficiency at Basic Procedures

2014 ◽  
Vol 2 (3) ◽  
pp. 532-535 ◽  
Author(s):  
Thomas Olajide ◽  
Justina Seyi-Olajide ◽  
Andrew Ugburo ◽  
Ezekiel Oridota
Keyword(s):  
Medical Students ◽  
Medical Training ◽  
Significant Proportion ◽  
Self Assessment ◽  
Urethral Catheterization ◽  
Line Placement ◽  
Urethral Catheterisation ◽  
High Level ◽  
Degree Of Participation ◽  
Different Levels

BACKGROUND: Procedural tasks are important in patient management, with varying degrees of proficiency expected at different levels of medical training. Little has been done in this region to assess the medical students’ proficiency at performing basic procedures.AIM: The aim of this study is to determine their self-assessed proficiency, degree of participation in performing these procedures and the use of skill-lab training.MATERIALS AND METHODS: The study is questionnaire-based, amongst final year medical students of University of Lagos, Nigeria.RESULTS: One hundred and forty students participated in the study.  A significant number (82{58.6%}) self-reported level of proficiency for venepuncture was above average or excellent; for IV line placement it was  a little less than half (65{46.4%}) and for urethral catheterisation 44 (31.7%); however it was quite low for the other procedures. Many students self-reported high level of participation for venepuncture (83{59.2%}); sixty one (43.6%) for IV line placement and 30 (21.7%) for urethral catheterization. The correlations between self-assessed levels of proficiency and participation were significant for all procedures. There was no exposure to the use of mannequins.CONCLUSION: Self-reported proficiency is lacking for basic procedures in a significant proportion of students with a low level of participation.

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

scholarly journals Efficacy and safety of urate-lowering therapy in people with kidney impairment: a GCAN-initiated literature review

2021 ◽  
Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Case Reports ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Studies ◽  
Kidney Impairment ◽  
The Cochrane Library ◽  
Study Designs ◽  
Different Levels

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate &lt;6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of &lt; 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of &lt; 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.

scholarly journals Integration of various scales for measurement of insomnia

2021 ◽  
pp. 263208432110100
Author(s):  
Satyendra Nath Chakrabartty
Keyword(s):  
Test Scores ◽  
Data Driven ◽  
Weighted Sum ◽  
Future Studies ◽  
Normal Probability ◽  
Equivalent Test ◽  
Item Scores ◽  
Using Data ◽  
Set Up ◽  
Different Levels

Background Scales for evaluating insomnia differ in number of items, response format, and result in different scores distributions and score ranges and may not facilitate meaningful comparisons. Objectives Transform ordinal item-scores of three scales of insomnia to continuous, equidistant, monotonic, normally distributed scores, avoiding limitations of summative scoring of Likert scales. Methods Equidistant item-scores by weighted sum using data-driven weights to different levels of different items, considering cell frequencies of Item-Levels matrix, followed by normalization and conversion to [1, 10]. Equivalent test-scores (as sum of transformed item- scores) for a pair of scales were found by Normal Probability curves. Empirical illustration given. Results Transformed test-scores are continuous, monotonic and followed Normal distribution with no outliers and tied scores. Such test-scores facilitate ranking, better classification and meaningful comparison of scales of different lengths and formats and finding equivalent score combinations of two scales. For a given value of transformed test-score of a scale, easy alternate method avoiding integration proposed to find equivalent scores of another scales. Equivalent scores of scales help to relate various cut-off scores of different scales and uniformity in interpretations. Integration of various scales of insomnia is achieved by finding one-to-one correspondence among the equivalent score of various scales with correlation over 0.99 Conclusion Resultant test-scores facilitated undertaking analysis in parametric set up. Considering the theoretical advantages including meaningfulness of operations, better comparison, use of such method of transforming scores of Likert items/test is recommended test and items, Future studies were suggested.

scholarly journals The effect of prior experience on diagnostic reasoning: exploration of availability bias

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 265-272
Author(s):  
Sandra Monteiro ◽  
Jonathan Sherbino ◽  
Jonathan S. Ilgen ◽  
Emily M. Hayden ◽  
Elizabeth Howey ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Features ◽  
Patient Characteristics ◽  
Diagnostic Error ◽  
Diagnostic Reasoning ◽  
Error Rates ◽  
Prior Exposure ◽  
Clinical Vignettes ◽  
Experience Levels ◽  
Similar Patient

AbstractObjectivesDiagnostic reasoning has been shown to be influenced by a prior similar patient case. However, it is unclear whether this process influences diagnostic error rates or whether clinicians at all experience levels are equally susceptible. The present study measured the influence of specific prior exposure and experience level on diagnostic accuracy.MethodsTo create the experience of prior exposure, participants (pre-clerkship medical students, emergency medicine residents, and faculty) first verified diagnoses of clinical vignettes. The influence of prior exposures was measured using equiprobable clinical vignettes; indicating two diagnoses. Participants diagnosed equiprobable cases that were: 1) matched to exposure cases (in one of three conditions: a) similar patient features, similar clinical features; b) dissimilar patient features, similar clinical features; c) similar patient features, dissimilar clinical features), or 2) not matched to any prior case (d) no exposure). A diagnosis consistent with a matched exposure case was scored correct. Cases with no prior exposure had no matched cases, hence validated the equiprobable design.ResultsDiagnosis A represented 47% of responses in condition d, but there was no influence of specific similarity of patient characteristics for Diagnosis A, F(3,712)=7.28, p=0.28 or Diagnosis B, F(3,712)=4.87, p=0.19. When re-scored based on matching both equiprobable diagnoses, accuracy was high, but favored faculty (n=40) 98%, and residents (n=39) 98% over medical students (n=32) 85%, F(2,712)=35.6, p<0.0001. Accuracy for medical students was 84, 87, 94, and 73% for conditions a–d, respectively, interaction F(2,712)=3.55, p<0.002.ConclusionsThe differential diagnosis of pre-clerkship medical students improved with prior exposure, but this was unrelated to specific case or patient features. The accuracy of medical residents and staff was not influenced by prior exposure.

scholarly journals Face, Content, and Construct Validity of a Virtual Reality Otoscopy Simulator and Applicability to Medical Training

2021 ◽  
pp. 019459982110328
Author(s):  
Tobias Albrecht ◽  
Christoph Nikendei ◽  
Mark Praetorius
Keyword(s):  
Virtual Reality ◽  
Medical Students ◽  
Construct Validity ◽  
Content Validity ◽  
Medical Training ◽  
Controlled Trial ◽  
Correct Diagnosis ◽  
Age Groups ◽  
Tertiary Referral Center ◽  
The Face

Objective Otologic diseases are common in all age groups and can significantly impair the function of this important sensory organ. To make a correct diagnosis, the correct handling of the otoscope and a correctly performed examination are essential. A virtual reality simulator could make it easier to teach this difficult-to-teach skill. The aim of this study was to assess the face, content, and construct validity of the novel virtual reality otoscopy simulator and the applicability to otologic training. Study Design Face and content validity was assessed with a questionnaire. Construct validity was assessed in a prospectively designed controlled trial. Setting Training for medical students at a tertiary referral center. Method The questionnaire used a 6-point Likert scale. The otoscopy was rated with a modified Objective Structured Assessment of Technical Skills. Time to complete the task and the percentage of the assessed eardrum surface were recorded. Results The realism of the simulator and the applicability to medical training were assessed across several items. The ratings suggested good face and content validity as well as usefulness and functionality of the simulator. The otolaryngologists significantly outperformed the student group in all categories measured (P < .0001), suggesting construct validity of the simulator. Conclusion In this study, we could demonstrate face, content, and construct validity for a novel high-fidelity virtual reality otoscopy simulator. The results encourage the use of the otoscopy simulator as a complementary tool to traditional teaching methods in a curriculum for medical students.

scholarly journals The Impact of an Educational Program on Medical Students’ Knowledge and Awareness of Elder Abuse

2021 ◽  
Vol 8 ◽  
pp. 238212052110164
Author(s):  
Abbie West ◽  
Cara Cawley ◽  
Elizabeth Crow ◽  
Alexis M. Stoner ◽  
Natalie M. Fadel ◽  
...  
Keyword(s):  
Medical Students ◽  
Educational Program ◽  
Survey Methodology ◽  
Elder Abuse ◽  
P Value ◽  
Significant Difference ◽  
Survey Results ◽  
Second Year ◽  
College Of Osteopathic Medicine ◽  
The Impact

Objective: Approximately 1 in 6 adults 60 and older have experienced a form of abuse in the past year. Many cases remain under-reported due to lack of knowledge and awareness. This study created an educational program on elder abuse for medical students to determine if participation would increase knowledge and awareness of elder abuse. Methods: This study used a pre and post survey methodology to evaluate students’ knowledge and awareness of elder abuse before and after participating in this educational program. Sixty first and second year osteopathic medical students at the Edward Via College of Osteopathic Medicine, Carolinas Campus participated in this study. Students were emailed a pre-survey to evaluate their pre-existing knowledge and awareness. The survey was, previously created by the Student Training on Preventing Domestic Violence (STOP-DV) team using validated measures. Participants then attended educational events about various forms of elder abuse and recognizing its associated signs, and afterward completed the post-survey. The results were compared using t-tests to determine if there was a significant difference. Results: First and second year students differed significantly in pre-survey results of knowledge but not post-survey results. The results showed a significant difference in overall mean knowledge ( P-value < .001) and awareness scores ( P-value < .001) in all students. Conclusion: These results suggest education on elder abuse can enable future physicians to better recognize, understand, and support older adults regarding elder maltreatment.

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