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 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.

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 Assessing residents’ knowledge of patient satisfaction: a cross-sectional study at a large academic medical centre

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017100 ◽  
Author(s):  
Diana E Stewart ◽  
Bich N Dang ◽  
Barbara Trautner ◽  
Cecilia Cai ◽  
Sergio Torres ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Tertiary Care ◽  
Learning Experiences ◽  
Knowledge Score ◽  
Health Science ◽  
Medical Centre ◽  
Cross Sectional ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Faculty Feedback

ObjectivesPatient satisfaction impacts healthcare quality and outcomes. Residents play an important role in patient satisfaction at academic institutions. This study aims to assess residents’ patient satisfaction knowledge and determine which learning experiences contributed to their knowledge acquisition.SettingsThis study was conducted at a health science university in a large, urban, tertiary-care academic medical centre in the USA.ParticipantsAll residents from internal medicine (n=185) and paediatrics (n=156) were asked to participate.DesignResidents completed a survey from April 2013 to December 2013 that assessed (1) knowledge of factors that impact patient satisfaction and (2) learning experiences that may have contributed to their understanding of the drivers of patient satisfaction (eg, experiential (personal or clinical) or didactics). Trainees identified the importance of factors in determining patient satisfaction on a five-point Likert scale; answers were compiled into a knowledge score. The score was correlated with prior personal/clinical experience and didactics.ResultsOf the 341 residents, 247 (72%) completed the survey. No difference was found in knowledge among training levels or residency programme. More than 50% incorrectly thought physician board certification, patient’s education, patient’s income and physician’s age impacted satisfaction. Personal experience, through hospitalisation of a relative or friend, was correlated with higher knowledge (67% vs 71%, p=0.03). Ninety-nine per cent (n=238) stated peer observation, and all stated faculty feedback impacted their patient satisfaction knowledge. Seventy-seven per cent (n=185) had attended didactics on satisfaction, but attendance did not correlate with higher scores.ConclusionsOur study showed trainees have a few gaps in their patient satisfaction knowledge, and attending past educational sessions on patient satisfaction did not correlate with higher knowledge scores. Our data suggest that academic centres should leverage residents’ personal experiences, their observations of peers and faculty feedback to enhance patient satisfaction knowledge.

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 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

scholarly journals Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components

2021 ◽  
Vol 3 (1) ◽  
pp. e000087
Author(s):  
Rachel C. Sisodia ◽  
Dan Ellis ◽  
Michael Hidrue ◽  
Pamela Linov ◽  
Elena Cavallo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Administration ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Process Measure ◽  
Academic Medical

ObjectiveThe goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.DesignA cohort study.SettingLarge tertiary academic medical centre.ParticipantsThe study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).InterventionThe addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.Main outcome measuresImpact of ERAS process measure adherence on length of stay.ResultsAfter initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%).ConclusionsWhile adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.

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