scholarly journals Cohort study of hospitalists’ procedural skills: baseline competence and durability after simulation-based training

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045600
Author(s):  
Caleb Hale ◽  
Jonathan Crocker ◽  
Anita Vanka ◽  
Daniel N Ricotta ◽  
Jakob I McSparron ◽  
...  
Keyword(s):  
Cohort Study ◽  
Secondary Outcome ◽  
Academic Medical Centre ◽  
Skill Maintenance ◽  
Academic Medical ◽  
Short Period ◽  
Simulation Based ◽  
The Usa ◽  
Passing Scores ◽  
National Decline

ObjectivesHospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months.DesignProspective cohort study with pretraining and post-training measurements.SettingSingle, large, urban academic medical centre in the USA.ParticipantsTwenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures.InterventionsOne-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP).Primary and secondary outcome measuresOur primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence.ResultsAt baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time.ConclusionsHospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.

scholarly journals Effectiveness of a simulation-based mastery learning to train clinicians on a novel cricothyrotomy procedure at an academic medical centre during a pandemic: a quasi-experimental cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054746
Author(s):  
Nabil Issa ◽  
Whitney E Liddy ◽  
Sandeep Samant ◽  
David B Conley ◽  
Robert C Kern ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mastery Learning ◽  
Tertiary Care ◽  
Medical Centre ◽  
Pretest Score ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Simulation Based ◽  
Quasi Experimental ◽  
Nose And Throat

ObjectivesTo develop and evaluate a simulation-based mastery learning (SBML) curriculum for cricothyrotomy using wet towels to suppress aerosolisation during a pandemic.DesignQuasi-experimental, pre–post study.SettingTertiary care, academic medical centre in Chicago.ParticipantsEar, nose and throat and general surgery residents, fellows and attendings.InterventionCricothyroidotomy simulation-based mastery learning curriculum.Outcomes measurePretest to posttest simulated cricothyrotomy skills checklist performance.Results37 of 41 eligible surgeons participated in the curriculum. Median pretest score was 72.5 (IQR 55.0–80.0) and 100.0 (IQR 98.8–100.0) for the posttest p<0.001. All participants scored at or above a minimum passing standard (93% checklist items correct) at posttest.ConclusionsUsing SBML is effective to quickly train clinicians to competently perform simulated cricothyrotomy during a pandemic.

Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study

2010 ◽  
Vol 19 (6) ◽  
pp. 547-554 ◽  
Author(s):  
L. A. Paine ◽  
B. J. Rosenstein ◽  
J. B. Sexton ◽  
P. Kent ◽  
C. G. Holzmueller ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Safety Culture ◽  
Prospective Cohort ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Academic Medical

scholarly journals Determinants of an evidence-based practice environment: an interpretive description

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Jed Duff ◽  
Laura Cullen ◽  
Kirsten Hanrahan ◽  
Victoria Steelman
Keyword(s):  
Nurse Managers ◽  
Evidence Based Practice ◽  
Direct Care ◽  
Evidence Based ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Iowa Model ◽  
The Usa ◽  
History Of ◽  
Evidence Based Care

Abstract Background Despite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment. Method The study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019. Results Four determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP. Conclusion Introducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.

Utilisation of Acupuncture at An Academic Medical Centre

2010 ◽  
Vol 28 (4) ◽  
pp. 189-190 ◽  
Author(s):  
Ann Vincent ◽  
Kelly M Kruk ◽  
Stephen S Cha ◽  
Brent A Bauer ◽  
David P Martin
Keyword(s):  
Health Insurance ◽  
Spinal Pain ◽  
Primary Diagnosis ◽  
Medical Centre ◽  
Clinical Use ◽  
Academic Medical Centre ◽  
Insurance Carrier ◽  
Academic Medical ◽  
The Usa ◽  
The Cost

Objective To provide information about the clinical use of acupuncture at an academic medical centre in the USA. Methods A retrospective review of 904 patients (receiving 6070 treatments) who were referred for acupuncture treatment at the Mayo Clinic (Rochester, Minnesota, USA) between 1 January 2004 and 31 December 2008. Data gathered included age, sex, primary diagnosis, number of treatments per diagnosis and health insurance carrier. Results The mean (SD) age of the patients was 53.4 (16.2) years; 73.8% were female and 26.2% were male. The three most common diagnostic categories for which acupuncture was used were spinal pain (33.4%), pain (other) (25.1%) and joint pain (12.3%). About 42% of visits were not covered by health insurance carriers and hence patients had to pay themselves. For the remaining 58% of visits, health insurance carriers picked up all or part of the cost of the acupuncture treatments. Conclusion The results indicate that pain is the most common reason for use of acupuncture in an academic medical centre and that women use acupuncture more than men. This is one of the few reports of clinical use of acupuncture at academic medical centres in the USA.

scholarly journals Efficacy of an educational intervention on students' attitudes regarding spirituality in healthcare: a cohort study in the USA

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026358 ◽  
Author(s):  
Zachary Paul Wargo Smothers ◽  
Jennifer Young Tu ◽  
Colleen Grochowski ◽  
Harold G Koenig
Keyword(s):  
Cohort Study ◽  
Medical Students ◽  
Educational Intervention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Future Research ◽  
Group Setting ◽  
The Usa ◽  
Students Attitudes

ObjectiveTo determine if an educational intervention focused on the role of spirituality in healthcare positively affects medical students' attitudes and perceptions relating to this topic.DesignA pre-post cohort study.SettingAn undergraduate medical institution affiliated with an academic medical center in the USA.ParticipantsA total of 110 medical students currently on their clinical rotations received the educational intervention, of whom 71 (65%) completed both the presurvey and postsurvey. Demographic variables did not significantly differ from the national average of medical students, or from a comparison group. All students who attended the intervention were given the opportunity to participate in the survey.InterventionsThe educational intervention consisted of a 60-minute lecture focusing on religion/spirituality (R/S) in healthcare, followed by a 90-minute case discussion in a small group setting.Primary and secondary outcome measuresAssessment consisted of 18-item preintervention and postintervention survey quantifying student’s attitudes towards, comfort with, and perceptions of R/S in healthcare.ResultsAttitudes towards, comfort with, and perceptions of R/S in healthcare were generally positive preintervention. Following the intervention, students expressed an increased willingness to include R/S competency in their future practice (p=0.001), were more comfortable sharing their own R/S beliefs with a patient when appropriate (p=0.02), and were more willing to approach a patient with R/S concern (p=0.04). The other surveyed attitudes demonstrated positive, but non-significant improvement.ConclusionAn educational intervention focusing on approaching patients with R/S concerns has the ability to improve the attitudes and comfort of medical students. By incorporating a total of 150 minutes of education about R/S, medical schools can help develop this particular area of cultural competence, preparing a generation of physicians to professionally approach R/S concerns of patients. Future research should move beyond quantifying attitudes and strive to understand changes in knowledge and student behaviour.

scholarly journals Vitamin B12deficiency and hyperhomocysteinaemia in outpatients with stroke or transient ischaemic attack: a cohort study at an academic medical centre

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026564 ◽  
Author(s):  
Shamon Ahmed ◽  
Chrysi Bogiatzi ◽  
Daniel G Hackam ◽  
Angela C Rutledge ◽  
Luciano A Sposato ◽  
...  
Keyword(s):  
Cohort Study ◽  
Transient Ischaemic Attack ◽  
Small Vessel Disease ◽  
Medical Centre ◽  
Large Artery ◽  
Stroke Subtype ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Ischaemic Attack ◽  
Total Homocysteine

ObjectiveWe sought to assess the current magnitude of the opportunity for secondary stroke prevention with B vitamins.DesignA cohort study.SettingThe Urgent TIA (Transient Ischaemic Attack) Clinic at an academic medical centre.Main outcome measuresWe assessed the prevalence of biochemical vitamin B12deficiency (B12Def, serum B12<156 pmol/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] >14 µmol/L) and metabolic B12deficiency (MetB12Def, serum B12<258 pmol/L and HHcy) between 2002 and 2017, by age group and by stroke subtype.ResultsData were available in 4055 patients. B12Def was present in 8.2% of patients overall; it declined from 10.9% of patients referred before 2009 to 5.4% thereafter (p=0.0001). MetB12Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged ≥80 years, MetB12Def was present in 18.1% and HHcy in 35%. Among the 3410 patients whose stroke subtype was determined, HHcy was present in 18.4% of patients: 23.3% of large artery atherosclerosis, 18.1% of cardioembolic, 16.3% of small vessel disease, 10.8% of other unusual aetiologies and 13.6% of undetermined subtypes (p=0.0001).ConclusionsDespite a decline in our referral area since 2009, B12Def, MetB12Def and HHcy remain common in patients with stroke/TIA. Because these conditions are easily treated and have serious consequences, all patients with stroke/TIA should have their serum B12and tHcy measured.

Republished paper: Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study

2011 ◽  
Vol 87 (1028) ◽  
pp. 428-435 ◽  
Author(s):  
L. A. Paine ◽  
B. J. Rosenstein ◽  
J. B. Sexton ◽  
P. Kent ◽  
C. G. Holzmueller ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Safety Culture ◽  
Prospective Cohort ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Academic Medical

scholarly journals Differences in burnout prevalence between clinical professionals and biomedical scientists in an academic medical centre: a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023506 ◽  
Author(s):  
Erick Messias ◽  
Molly M Gathright ◽  
Emily S Freeman ◽  
Victoria Flynn ◽  
Timothy Atkinson ◽  
...  
Keyword(s):  
Health Centre ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Academic Medical Centre ◽  
Work Related ◽  
Academic Medical ◽  
Prevalence Estimates ◽  
Clinical Environments

ObjectiveTo determine the prevalence and associated factors for personal, work-related and patient/client-related burnout in clinical professionals and biomedical scientists in academic medicine.DesignPrevalence survey using the Copenhagen Burnout Inventory.SettingMid-size academic health centre.ParticipantsClinical providers (n=6489) and biomedical scientists (n=248) were invited to complete the survey. 1646 completed responses (response rate 24.4%) were analysed.Primary and Secondary outcome measuresPrevalence estimates and adjusted ORs (AOR) were stratified for gender, age and professional category.ResultsType of burnout varies across professional categories, with significant differences between clinicians and scientists. The prevalence of personal burnout was 52.7% (95%CI 50% to 55%), work-related burnout 47.5% (95%CI 45% to 49%) and patient/client-related burnout 20.3% (95%CI 18% to 22%). The prevalence of personal and work-related burnout was higher among women, while those aged 20–30 had a higher prevalence of all three burnout categories. Overall, clinical professionals had higher personal and work-related burnout, while biomedical scientists had higher client-related burnout. Accounting for the effects of gender and age, a significantly higher risk for personal burnout was found for physicians (AOR 1.64; 95%CI 1.3 to 2.1) and nurses (AOR 1.5; 95%CI 1.03 to 2.2). Significantly higher odds of work-related burnout were found for nurses (AOR 1.5; 95%CI 1.2 to 1.9) and residents (AOR 1.9; 95%CI 1.04 to 3.6). Basic scientists (AOR 10.0; 95%CI 5.7 to 17.6), physicians (AOR 2.8; 95%CI 1.9 to 4.1) and nurses (AOR 2.1; 95%CI 1.3 to 3.5) had higher odds of patient/client-related burnout.ConclusionsTypes of burnout are unevenly distributed in academic medical centres. Physicians have higher risk of personal and patient/client-related burnout, residents have higher risk of work-related burnout, basic scientists are at higher risk of client-related burnout and nurses have higher odds of all three types of burnout. Interventions addressing the problem of burnout in clinical environments may be inadequate to support biomedical scientists.

scholarly journals Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study

2019 ◽  
Vol 66 ◽  
pp. 72-78 ◽  
Author(s):  
Aidan L. Tan ◽  
Calvin J. Chiew ◽  
Sijia Wang ◽  
Hairil Rizal Abdullah ◽  
Sean SW. Lam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Elective Surgery ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Academic Medical
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