scholarly journals The Effectiveness of Bioskills Training for Simulated Open Lumbar Laminectomy

2017 ◽  
Vol 7 (8) ◽  
pp. 794-800 ◽  
Author(s):  
Barrett S. Boody ◽  
Brett D. Rosenthal ◽  
Tyler J. Jenkins ◽  
Alpesh A. Patel ◽  
Jason W. Savage ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Education ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Training Session ◽  
Senior Resident ◽  
Control Group ◽  
Junior Resident ◽  
Training Module

Study Design: Randomized, prospective study within an orthopedic surgery resident program at a large urban academic medical center. Objectives: To develop an inexpensive, user-friendly, and reproducible lumbar laminectomy bioskills training module and evaluation protocol that can be readily implemented into residency training programs to augment the clinical education of orthopedic and neurosurgical physicians-in-training. Methods: Twenty participants comprising senior medical students and orthopedic surgical residents. Participants were randomized to control (n = 9) or intervention (n = 11) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 40-minute bioskills training module, while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported by each participant (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Decompression Score metrics. Results: When compared with the control group, the intervention group yielded a significant mean improvement in OSATS ( P = .022) and PPDIS ( P = .0001) scores. The Objective Decompression Scores improved in the intervention group with a trend toward significance ( P = .058). Conclusions: We conclude that a concise lumbar laminectomy bioskills training session can be a useful educational tool for to augment clinical education. Although no direct clinical correlation can be concluded from this study, the improvement in trainee’s technical and procedural skills suggests that Sawbones training modules can be an efficient and effective tool for teaching fundamental spine surgical skills outside of the operating room.

scholarly journals The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement

2017 ◽  
Vol 8 (6) ◽  
pp. 557-562 ◽  
Author(s):  
Barrett S. Boody ◽  
Sohaib Z. Hashmi ◽  
Brett D. Rosenthal ◽  
Joseph P. Maslak ◽  
Michael H. McCarthy ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Randomized Study ◽  
Intervention Group ◽  
Training Session ◽  
Control Group ◽  
Junior Resident ◽  
Training Module ◽  
Pedicle Screw Instrumentation ◽  
The Impact ◽  
Lumbar Pedicle

Study Design: Prospective randomized study. Objectives: To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol. Methods: Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models. Results: The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group ( P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches ( P = .001) compared with 28% decrease in the control group ( P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047). Conclusions: We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.

scholarly journals Efficacy of implementing intermittent STOP THE BLEED® reviews on long term retention of hemorrhage control skills of first year medical students

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Enkhtsogt Sainbayar ◽  
Nathan Holt ◽  
Amber Jacobson ◽  
Shalini Bhatia ◽  
Christina Weaver
Keyword(s):  
Medical Students ◽  
Intervention Group ◽  
Training Session ◽  
Likert Scale ◽  
Control Group ◽  
First Year ◽  
Hemorrhage Control ◽  
Term Retention ◽  
Long Term Retention

Abstract Context Some medical schools integrate STOP THE BLEED® training into their curricula to teach students how to identify and stop life threatening bleeds; these classes that are taught as single day didactic and hands-on training sessions without posttraining reviews. To improve retention and confidence in hemorrhage control, additional review opportunities are necessary. Objectives To investigate whether intermittent STOP THE BLEED® reviews were effective for long term retention of hemorrhage control skills and improving perceived confidence. Methods First year osteopathic medical students were asked to complete an eight item survey (five Likert scale and three quiz format questions) before (pretraining) and after (posttraining) completing a STOP THE BLEED® training session. After the surveys were collected, students were randomly assigned to one of two study groups. Over a 12 week intervention period, each group watched a 4 min STOP THE BLEED® review video (intervention group) or a “distractor” video (control group) at 4 week intervals. After the 12 weeks, the students were asked to complete an 11 item survey. Results Scores on the posttraining survey were higher than the pretraining survey. The median score on the five Likert scale items was 23 points for the posttraining survey and 14 points for the pretraining survey. Two of the three knowledge based quiz format questions significantly improved from pretraining to posttraining (both p<0.001). On the 11 item postintervention survey, both groups performed similarly on the three quiz questions (all p>0.18), but the intervention group had much higher scores on the Likert scale items than the control group regarding their confidence in their ability to identify and control bleeding (intervention group median = 21.4 points vs. control group median = 16.8 points). Conclusions Intermittent review videos for STOP THE BLEED® training improved medical students’ confidence in their hemorrhage control skills, but the videos did not improve their ability to correctly answer quiz-format questions compared with the control group.

scholarly journals The Effectiveness of Training on Auscultation of Heart with a Simulator of Cardiology in Medical Students

2021 ◽  
Vol 9 (E) ◽  
pp. 1055-1060
Author(s):  
Gulbakit Koshmaganbetova ◽  
Saulesh Kurmangalieva ◽  
Yerlan Bazargaliyev ◽  
Azhar Zhexenova ◽  
Baktybergen Urekeshov ◽  
...  
Keyword(s):  
Medical Students ◽  
Diagnostic Accuracy ◽  
Intervention Group ◽  
Control Group ◽  
Mitral Insufficiency ◽  
Training Module ◽  
Real Patient ◽  
Fourth Year Medical Students ◽  
Effectiveness Of Training ◽  
Clinical Conditions

Abstract The purpose of this study was to determine whether the training module with a simulator of cardiology improves auscultation skills in medical students. Methods. Medical students of the third year after completing the module of the cardiovascular system of the discipline “Propaedeutics of internal diseases, passed a two-hour or four-hour training module in clinical auscultation with retesting immediately after the intervention and in the fourth year. The control group consisted of fourth-year medical students who had no intervention. Results. The diagnostic accuracy in two-hour training was 45.9% vs 35.3% in four-hour training p <.001. The use of a cardio simulator significantly increased the accurate detection of mitral regurgitation immediately after training on a simulator (more than 73%) p <.001. The next academic year, regression was observed in the diagnostic accuracy of mitral insufficiency in the intervention group after six months of observation by 4%. The auscultation skills of students at the bedside of real patients did not increase after training on a simulator: the accuracy of diagnosis of the auscultatory picture of the defect was equally low in the intervention group and the control group (35.0% vs 30.8%, p = 0.651). Conclusions. Two-hour training was more effective than four-hour training. After training on cardiac auscultation using a patient’s cardiological simulator, the accuracy rate was low in a situation close to the clinical conditions and a clinic on a real patient.

Evaluation of An Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients

2021 ◽  
pp. 089719002110302
Author(s):  
Amanda M. Van Prooyen ◽  
Jessica L. Hicks ◽  
Ed Lin ◽  
Scott S. Davis ◽  
Arvinpal Singh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Pharmacist Intervention ◽  
Control Group ◽  
Medication History ◽  
Discharge Medication ◽  
Medication Plan ◽  
The Impact

Purpose: To evaluate the impact of an inpatient pharmacy consult on discharge medications following bariatric surgery. Methods: A pharmacy consult for discharge medication review for bariatric surgery patients was instituted at an academic medical center. The intervention included conducting a medication history, reviewing home medications for updates post-bariatric surgery, creating and documenting a discharge medication plan, and providing patient education. The impact of the intervention was evaluated by comparing medication classes, doses, and formulations prescribed during the intervention relative to a historical control group. Results: The study included 85 patients who received pharmacist intervention and 167 patients who did not receive pharmacist intervention following bariatric surgery. The prescription of an extended-release medication at discharge in the intervention group was reduced by 19.3% (28.7% vs. 9.4%, p = 0.0005). For patients on hypertension medications, 94.0% had their regimen reduced in the intervention group compared with 37.5% of patients in the control group (p < 0.001). Of patients on insulin at baseline, 87.5% of patients in the intervention group had dose reductions at discharge vs. 66.7% of patients in the control group (p = 0.37). No patients in the intervention group were discharged with oral antihyperglycemic medications or non-insulin injectable medications vs. 33.3% (p = 0.12) and 20.0% (p = 0.47), respectively, in the control group. Readmission rates at 30 days were insignificantly lower in the intervention group (3.5% vs. 4.2%, p = 1). Conclusions: Clinical pharmacist involvement in the discharge medication reconciliation process for bariatric surgery patients reduced prescribing of unadjusted medication classes, doses, and drug formulations.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

scholarly journals Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

scholarly journals A Multimodal Curriculum With Patient Feedback to Improve Medical Student Communication: Pilot Study

2019 ◽  
Vol 21 (1) ◽  
pp. 115-121
Author(s):  
Nicole Dubosh ◽  
Matthew Hall ◽  
Victor Novack ◽  
Tali Shafat ◽  
Nathan Shapiro ◽  
...  
Keyword(s):  
Communication Skills ◽  
Assessment Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Effective Means ◽  
Intervention Group ◽  
Control Group ◽  
Communication Assessment ◽  
Patient Feedback ◽  
Fourth Year Medical Students

Introduction: Despite the extraordinary amount of time physicians spend communicating with patients, dedicated education strategies on this topic are lacking. The objective of this study was to develop a multimodal curriculum including direct patient feedback and assess whether it improves communication skills as measured by the Communication Assessment Tool (CAT) in fourth-year medical students during an emergency medicine (EM) clerkship. Methods: This was a prospective, randomized trial of fourth-year students in an EM clerkship at an academic medical center from 2016-2017. We developed a multimodal curriculum to teach communication skills consisting of 1) an asynchronous video on communication skills, and 2) direct patient feedback from the CAT, a 15-question tool with validity evidence in the emergency department setting. The intervention group received the curriculum at the clerkship midpoint. The control group received the curriculum at the clerkship’s end. We calculated proportions and odds ratios (OR) of students achieving maximum CAT score in the first and second half of the clerkship. Results: A total of 64 students were enrolled: 37 in the control group and 27 in the intervention group. The percentage of students achieving the maximum CAT score was similar between groups during the first half (OR 0.70, p = 0.15). Following the intervention, students in the intervention group achieved a maximum score more often than the control group (OR 1.65, p = 0.008). Conclusion: Students exposed to the curriculum early had higher patient ratings on communication compared to the control group. A multimodal curriculum involving direct patient feedback may be an effective means of teaching communication skills.

Real-world virtual patient simulation to improve diagnostic performance through deliberate practice: a prospective quasi-experimental study

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Susrutha Kotwal ◽  
Mehdi Fanai ◽  
Wei Fu ◽  
Zheyu Wang ◽  
Anand K. Bery ◽  
...  
Keyword(s):  
Real World ◽  
Medical Center ◽  
Academic Medical Center ◽  
Deliberate Practice ◽  
Intervention Group ◽  
Patient Simulation ◽  
Diagnostic Errors ◽  
Control Group ◽  
Diagnostic Skills ◽  
Quasi Experimental

Abstract Objectives Diagnostic errors are pervasive in medicine and most often caused by clinical reasoning failures. Clinical presentations characterized by nonspecific symptoms with broad differential diagnoses (e.g., dizziness) are especially prone to such errors. Methods We hypothesized that novice clinicians could achieve proficiency diagnosing dizziness by training with virtual patients (VPs). This was a prospective, quasi-experimental, pretest-posttest study (2019) at a single academic medical center. Internal medicine interns (intervention group) were compared to second/third year residents (control group). A case library of VPs with dizziness was developed from a clinical trial (AVERT-NCT02483429). The approach (VIPER – Virtual Interactive Practice to build Expertise using Real cases) consisted of brief lectures combined with 9 h of supervised deliberate practice. Residents were provided dizziness-related reading and teaching modules. Both groups completed pretests and posttests. Results For interns (n=22) vs. residents (n=18), pretest median diagnostic accuracy did not differ (33% [IQR 18–46] vs. 31% [IQR 13–50], p=0.61) between groups, while posttest accuracy did (50% [IQR 42–67] vs. 20% [IQR 17–33], p=0.001). Pretest median appropriate imaging did not differ (33% [IQR 17–38] vs. 31% [IQR 13–38], p=0.89) between groups, while posttest appropriateness did (65% [IQR 52–74] vs. 25% [IQR 17–36], p<0.001). Conclusions Just 9 h of deliberate practice increased diagnostic skills (both accuracy and testing appropriateness) of medicine interns evaluating real-world dizziness ‘in silico’ more than ∼1.7 years of residency training. Applying condensed educational experiences such as VIPER across a broad range of common presentations could significantly enhance diagnostic education and translate to improved patient care.

scholarly journals Teaching the Technical Essentials of Direct Ophthalmoscopy Using a Portable Fundus Camera

2021 ◽  
Author(s):  
Weibo Feng ◽  
Yuxian Zou ◽  
Yonghao Li ◽  
Tao Shen ◽  
Ya Gao ◽  
...  
Keyword(s):  
Medical Students ◽  
Intervention Group ◽  
Training Session ◽  
Group Versus ◽  
Control Group ◽  
Accuracy Score ◽  
Fundus Camera ◽  
End Point ◽  
Accuracy Test ◽  
Direct Ophthalmoscopy

Abstract Aim: A portable fundus camera could allow the third person to observe the technique essentials of direct ophthalmoscopy from a real time screen. This study was designed to compare the proficiency of teaching direct ophthalmoscopy using a portable camera with conventional way in medical students. Methods: Medical students of fourth year were invited to participate the study. At baseline, the participants were taught fundoscopy with a conventional direct ophthalmoscope shortly. Then they were randomized to be taught the skill of fundoscopy either with a portable fundus camera or with a conventional direct ophthalmoscope as control for two days. Accuracy tests to match a subject’s fundus with one of the four photographs after examining an undilated eye using a direct ophthalmoscope were performed at baseline and end point. Accuracy test scores and self-reported confidence were compared between the two groups. Results: A total of 160 students participated the study, with 79 assigned to the intervention group, and 81 to the control group. All the students finished the study. At baseline, there was no difference in accuracy test score between the two groups. After two-day training session, the accuracy score improved in 26/79 (32.9%) students of intervention group versus 15/81 (18.5%) of the control group (p=0.037). At end point, a total of 39/79 (49.4%) students in the intervention groups versus 25/81 (30.9%) in the control group identified the correct fundus photograph (p=0.017). The confidence levels were significantly higher in the intervention group than the control group. Conclusions: Teaching direct ophthalmoscope using a portable fundus camera is associated with improved accuracy score and elevated confidence level in medical students when compared with conventional method.

Antibiotic utilization variability among training services at an academic medical center: An observational study

2020 ◽  
pp. 1-5
Author(s):  
Katherine A. Cinnamon ◽  
Lucas T Schulz ◽  
Ann M. Sheehy ◽  
Sean M. O’Neill ◽  
Edward Lalik ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Analysis ◽  
Senior Resident ◽  
Junior Resident ◽  
Antibiotic Prescribing ◽  
Resident Physicians ◽  
Antibiotic Utilization ◽  
Academic Medical

Abstract Objective: Evaluate the difference in antibiotic prescribing between various levels of resident training or attending types. Design: Observational, retrospective study. Setting: Tertiary-care, academic medical center in Madison, Wisconsin. Methods: We measured antibiotic utilization from January 1, 2016, through December 31, 2018, in our general medicine (GM) and hospitalist services. The GM1 service is staffed by outpatient internal medicine physicians, the GM2 service is staffed by geriatricians and hospitalists, and the GM3 service is staffed by only hospitalists. The GMA service is led by junior resident physicians, and the GMB service is led by senior resident physicians. We measured utilization using days of therapy (DOT) per 1,000 patient days (PD). In a secondary analysis based on antibiotic spectrum, we used average DOT per 1,000 PD. Results: Teaching services prescribed more antibiotics than nonteaching services (671.6 vs 575.2 DOT per 1,000 PD; P < .0001). Junior resident–led services used more antibiotics than senior resident–led services (740.9 vs 510.0 DOT per 1,000 PD; P < .0001). Overall, antibiotic prescribing was numerically similar between various attending physician backgrounds. A secondary analysis showed that GM services prescribed more broad-spectrum, anti-MRSA, and anti-pseudomonal antibiotics than the hospitalist services. GM junior resident–led services prescribed more broad-spectrum, anti-MRSA, and antipseudomonal therapy compared to their senior counterparts. Conclusions: Antibiotics were prescribed at a significantly higher rate in services associated with trainees than those without. Services led by a junior resident physician prescribed antibiotics at a significantly higher rate than services led by a senior resident. Interventions to reduce unnecessary antibiotic exposure should be targeted toward resident physicians, especially junior trainees.

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