scholarly journals P.180 What do patients expect of a competent neurosurgeon?

2021 ◽  
Vol 48 (s3) ◽  
pp. S71-S72
Author(s):  
J Rabski ◽  
A Baba ◽  
L Bannon ◽  
MD Cusimano
Keyword(s):  
First Language ◽  
Medical Knowledge ◽  
Public Perceptions ◽  
Structured Interviews ◽  
Residency Programs ◽  
Post Secondary ◽  
Societal Needs ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Patient Values

Background: To improve accountability and reflect patient and societal needs, the Royal College of Physicians and Surgeons of Canada proposed Competence by Design (CBD) for all residency programs. This study compares neurosurgical patient values and expectations of their neurosurgeon to resident competences proposed by CBD curriculum. Methods: Semi-structured interviews of 30 neurosurgical patients and family members were recorded, transcribed and analyzed for themes. Results: Of the first 13 interviews (8 males, 5 females; median age 54), 10 had English as a first language, all completed post-secondary education, and 8 had a brain tumor. In addition to expecting excellent surgical skills and comprehensive medical knowledge, participants expected “good” neurosurgeons to be human (compassionate, empathetic, no ego), transparent communicators, accountable, passionate, collaborative, emotionally composed and highly intuitive. However, there were marked differences in minimum set of competencies required and the expectations of the thresholds to determine competence for neurosurgeons. Conclusions: Patient perspectives show commonalities and marked differences of the expected competencies compared to CBD and significant variability of the thresholds of competence. Further investigations should explore these themes in other specialties. The existing CBD curriculum will need to expand its framework to include humanistic values to improve public perceptions of competence.

scholarly journals Public health risk factors at music festivals: “Be Safe Lab” initiative

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Beržanskytė
Keyword(s):  
Risk Factors ◽  
Harm Reduction ◽  
Drug Users ◽  
Medical Knowledge ◽  
Integrated Services ◽  
Unprotected Sex ◽  
Structured Interviews ◽  
Music Festivals ◽  
Governmental Organizations ◽  
Non Governmental Organizations

Abstract Background At large public events such as music festivals there is an increased exposure to the risk factors as alcohol, tobacco and narcotics, unprotected sex, trauma and violence. Non-governmental organizations engage in prevention and support activities at such events. An initiative “Be Safe Lab” has developed in Lithuania to reduce the likelihood of adverse events due to harmful behavior at public festivals. Study Aim To investigate the experience of operating the “Be Safe Lab” initiative at Lithuanian music festivals. Methods In this qualitative study the data were collected from five “Be Safe Lab” volunteer staff using semi-structured interviews lasting in average of 50 minutes. The main guidelines were prepared and informants were asked to tell in general about the initiative, motives and reasons to develop the initiative, its goals and tasks, the questions that visitors apply to them, challenges and obstacles, personal experience in the initiative. Data were analysed using inductive thematic analysis according to Braun and Clarke (2013). Results The analysis revealed 6 main themes: principles of the initiative, variety of services, substance use harm reduction, changes of volunteers' perspectives, the role of teamwork, and initiative challenges. Conclusions The initiative has a number of strengths and challenges. Integrated services are provided not just to drug users, but also to other festival visitors who seek help or advice. The volunteer staff must have special skills, competencies and medical knowledge. The harm reduction measures for drugs and psychoactive substances used in the initiative are believed to be effective and attract music festival visitors. Initiative volunteers benefit both personally and professionally from providing services. However, further success of the initiative requires additional financial support, training, and collaboration with institutions providing emergency medical services at music festivals. Key messages Integrated services are provided to any festival visitor who seek help from “Be Safe Lab” specialists. The initiative volunteers benefit both personally and professionally from providing services.

“I can come up with more things when I’m happy, or especially when I’m angry”

2021 ◽  
Author(s):  
Beatrice Venturin
Keyword(s):  
Second Language ◽  
First Language ◽  
Structured Interviews ◽  
English As Second Language ◽  
1.5 Generation ◽  
Language Dominance ◽  
Emotional Resonance ◽  
Expression Of Emotions

Abstract This study examines language preferences to express anger and happiness among 15 Russian Australians belonging to the 1.5 generation, who acquired Russian as first language (L1) and English as second language (L2), after migration during childhood. While most research into these topics has focused on L1-dominant bilinguals, this study offers a novel perspective, as 1.5-generation migrants are generally L2-dominant or multidominant (L1+L2-dominant), and possibly L1 attriters. Semi-structured interviews were conducted and underwent qualitative thematic analyses. From the results it emerges that these speakers mostly express emotions in the L2 or both languages, in line with their language dominance, but their choices do not seem to relate to language emotionality, as the L1 maintains the highest emotional resonance for them. While research on multilinguals’ expression of emotions has mainly focused on anger, this study calls attention to the expression of happiness, and points to the importance of L2-dominant and multidominant multilinguals.

scholarly journals Practical Negotiation for Medical Professionals

2018 ◽  
Vol 32 (04) ◽  
pp. 166-171 ◽  
Author(s):  
Bradley Eisemann ◽  
Ryan Wagner ◽  
Edward Reece
Keyword(s):  
Clinical Medicine ◽  
Clinical Care ◽  
Medical Knowledge ◽  
Medical Innovation ◽  
Medical Field ◽  
Residency Programs ◽  
Clinical Patient ◽  
Negotiation Strategies ◽  
Business Acumen ◽  
Time And Energy

AbstractDespite incredible advances in medical innovation and education, many students finish medical school, and physicians finish residency, without sound business acumen regarding the financial realities of the modern profession. The curriculum in medical schools and residency programs too often neglects teaching the business of medicine. This overview addresses how physicians can utilize effective negotiation strategies to help develop a medical practice or add value to an existing practice or institution. The authors applied the six foundations of effective negotiating, detailed by Richard Shell in his Bargaining for Advantage, to the medical field to demonstrate the processes involved in effective negotiating. They then outlined a strategy for physicians to adopt when negotiating and showed how this strategy can be used to add value. The six foundations include: developing a personal bargaining style, setting realistic goals, determining authoritative standards, establishing relationships, exploring the other party's interests, and gaining leverage. As physicians complete training, the ability to solely focus on medical knowledge and clinical patient care disappears. It is crucial that physicians invest the time and energy into preparing for the business aspects of this profession in much the same way they prepare for the clinical care of patients. This overview seeks to define the basics of negotiation, characterize the application of negotiation principles toward clinical medicine, and lay the foundation for further discussion and investigation.

scholarly journals Dissing learning disabilities

2021 ◽  
Author(s):  
Richa Sud
Keyword(s):  
Learning Disabilities ◽  
Academic Success ◽  
Secondary Students ◽  
Academic Experiences ◽  
Social Model ◽  
Students With Learning Disabilities ◽  
Structured Interviews ◽  
Social Model Of Disability ◽  
Post Secondary ◽  
Qualitative Research Study

This qualitative research study explores the experiences of post-secondary students with Learning Disabilities (LDs). Using phenomenology, semi-structured interviews were conducted with four university students from Southern Ontario. The study discusses the strengths, challenges, commonalities and differences between the students‘ academic experiences through which they have derived current academic success. Data analysis draws from Critical Theory of Education, Social Model of Disability and Goffman‘s analysis of Stigma. The findings in this study provide insight into the classroom experiences of the students with LDs in elementary, middle and high schools. Further, they help understand ways adapted by students to navigate the education system through each of their varied experiences. This paper will conclude with implications and suggestions for social work professionals working with students who have LDs.

Research and Reflective Practice in the Pre-Literate ESL Classroom

2020 ◽  
pp. 243-271
Author(s):  
Vineetha Hewagodage
Keyword(s):  
Second Language Acquisition ◽  
Language Learning ◽  
Adult Students ◽  
English Language ◽  
First Language ◽  
Literacy Skills ◽  
Structured Interviews ◽  
Language Program ◽  
English Only ◽  
Low Educated

This chapter reports on findings of a qualitative study conducted with diverse cultural and linguistic background adult students engaged in learning English through an adult migrant English language program offered in a refugee welcome zone in a rural region of Australia. Twenty students whose first language was not English were observed in the language learning environment and participated in semi-structured interviews. The research explored how English language learning can be best supported for humanitarian refugees with little or no literacy in their first language to become acculturated and socially integrated into Australian society. It was found that the typical ‘English only approach' that is commonly used in the Adult Migrant English Language Program (AMEP) to teach literacy and develop proficiency in the English language is called into question when applied to learners with limited or no print literacy skills in their first language. It was concluded that these learners, who are commonly referred to in the literature as LESLLA (Low Educated Second Language Acquisition and Literacy for Adults), are faced with a number of social exclusionary practices during their integration process. Recommendations are made on how these issues might be addressed.

Fever in the Neurosurgical Patient

2019 ◽  
pp. 123-155
Author(s):  
Rakhshanda Akram ◽  
Crystal Benjamin ◽  
Linda Mwamuka ◽  
Katherine A. Belden
Keyword(s):  
Patient Population ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Acalculous Cholecystitis ◽  
Postoperative Fever ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Postoperative Meningitis ◽  
Tract Infections ◽  
The Cost

Postoperative fever falls under the category of nosocomial fever, not incubating at the time of surgery. Early postoperative fever is more likely to be a part of the cytokine-mediated physiologic response to surgery and does not always need an infectious workup. Other important noninfectious causes of postoperative fever in neurosurgical patients include dysautonomia and central fever, which are often diagnoses of exclusion after infectious etiologies have been ruled out. Infections in neurosurgical patients can be secondary to the surgical procedure, such as postoperative meningitis, cerebrospinal fluid shunt and drain infections, cranial or spinal epidural abscess, and osteomyelitis and surgical site infections. Other hospital-associated infections, such as nosocomial pneumonia, sinusitis, diarrhea, urinary tract infections, bloodstream infections, and acalculous cholecystitis, are other important causes to be considered as part of the infectious workup. Hyperthermia-induced brain injury is a significant concern in neurosurgical patient population. Therefore, careful management of fever in this patient population is imperative to improve patient outcomes and decrease the cost of medical care.

Common Neurosurgical Procedures

2019 ◽  
pp. 1-15
Author(s):  
Kevin Hines ◽  
Stavropoula Tjoumakaris ◽  
Pascal M. Jabbour ◽  
Robert H. Rosenwasser ◽  
M. Reid Gooch
Keyword(s):  
Cervical Spine ◽  
Lumbar Spine ◽  
Adverse Events ◽  
Medical Management ◽  
Neurosurgical Procedures ◽  
Ventriculoperitoneal Shunting ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients

Medical management of the neurosurgical patient can be complicated. These patients may suffer from a difficult neurosurgical pathology while still living with challenging comorbidities. As a result, this population often requires cooperation between multiple teams including neurosurgeons, neurologists, neurointensivists, and hospitalists. In this chapter, the authors review common neurosurgical procedures that the neurohospitalist encounters, including ventriculoperitoneal shunting, craniotomy and craniectomy, cervical spine decompression with or without fusion, lumbar spine decompression and/or fusion, and cerebral angiograms. The authors aim to highlight the methodology, indications, and issues of perioperative medical management. Understanding these procedures is vital to minimizing adverse events and providing the best possible care for neurosurgical patients.

scholarly journals Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shayan Moosa ◽  
Lindsay Bowerman ◽  
Ellen Smith ◽  
Mindy Bryant ◽  
Natalie Krovetz ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Population ◽  
Medical Center ◽  
Academic Medical Center ◽  
Readmission Rates ◽  
Academic Medical ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

scholarly journals The “Zing Factor”—How Do Faculty Describe the Best Pediatrics Residents?

2014 ◽  
Vol 6 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Glenn Rosenbluth ◽  
Bridget O'Brien ◽  
Emily M. Asher ◽  
Christine S. Cho
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Knowledge Integration ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Residency Programs ◽  
Graduate Medical ◽  
Trained Interviewer ◽  
And Behaviors ◽  
Assessment Strategies

Abstract Background Faculty in graduate medical education programs may not have uniform approaches to differentiating the quality of residents, and reviews of evaluations suggest that faculty use different standards when assessing residents. Standards for assessing residents also do not consistently map to items on evaluation forms. One way to improve assessment is to reach consensus on the traits and behaviors that are (or should be) present in the best residents. Methods A trained interviewer conducted semistructured interviews with faculty affiliated with 2 pediatrics residency programs until content saturation was achieved. Interviewees were asked to describe specific traits present in residents they identify as the best. Interviews were recorded and transcribed. We used an iterative, inductive approach to generate a coding scheme and identify common themes. Results From 23 interviews, we identified 7 thematic categories of traits and behaviors: personality, energy, professionalism, team behaviors, self-improvement behaviors, patient-interaction behaviors, and medical knowledge and clinical skills (including a subcategory, knowledge integration). Most faculty interviewees focused on traits like passion, enthusiasm, maturity, and reliability. Examination score or intelligence was mentioned less frequently than traits and behaviors categorized under personality and professionalism. Conclusions Faculty identified many traits and behaviors in the residents they define as the best. The thematic categories had incomplete overlap with Accreditation Council for Graduate Medical Education (ACGME) and CanMEDS competencies. This research highlights the ongoing need to review our assessment strategies, and may have implications for the ACGME Milestone Project.

scholarly journals Residency Programs' Evaluations of the Competencies: Data Provided to the ACGME About Types of Assessments Used by Programs

2010 ◽  
Vol 2 (4) ◽  
pp. 649-655 ◽  
Author(s):  
Kathleen D. Holt ◽  
Rebecca S. Miller ◽  
Thomas J. Nasca
Keyword(s):  
Medical Education ◽  
Interpersonal Communication ◽  
Graduate Medical Education ◽  
Medical Knowledge ◽  
Residency Programs ◽  
The Public ◽  
Graduate Medical ◽  
Resident Assessment ◽  
Using Data ◽  
Almost All

Abstract Background In 1999, the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project began to focus on resident performance in the 6 competencies of patient care, medical knowledge, professionalism, practice-based learning and improvement, interpersonal communication skills, and professionalism. Beginning in 2007, the ACGME began collecting information on how programs assess these competencies. This report provides information on the nature and extent of those assessments. Methods Using data collected by the ACGME for site visits, we use descriptive statistics and percentages to describe the number and type of methods and assessors accredited programs (n  =  4417) report using to assess the competencies. Observed differences among specialties, methodologies, and assessors are tested with analysis of variance procedures. Results Almost all (>97%) of programs report assessing all of the competencies and using multiple methods and multiple assessors. Similar assessment methods and evaluator types were consistently used across the 6 competencies. However, there were some differences in the use of patient and family as assessors: Primary care and ambulatory specialties used these to a greater extent than other specialties. Conclusion Residency programs are emphasizing the competencies in their evaluation of residents. Understanding the scope of evaluation methodologies that programs use in resident assessment is important for both the profession and the public, so that together we may monitor continuing improvement in US graduate medical education.

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